[이데일리 이순용 기자] Mr Choi, a 31-year-old male office worker, cannot forget the memory of undergoing emergency surgery two years ago. Mr. Kim usually suffered from severe abdominal pain, but he was still young and thought it was just a simple stomach ulcer caused by work stress, so he was not too worried. Then, the day after the dinner, I visited the emergency medical center of Eunpyeong St. Hospital. Mary with abdominal troubles and unbearable abdominal pain.
Choi, who was examined by medical staff, had frequent small bowel, and it was an emergency situation where an intestinal obstruction was seen due to a tumor at the junction of the small and large intestine. Immediately transferred to the operating room, Choi underwent emergency surgery to resect the right colon, and was diagnosed with stage 3 colorectal cancer in a post-operative biopsy. Kim, who completed 6 months of adjuvant chemotherapy, has follow-up examinations with no recurrence or metastasis two years later, and is living a healthy life after being re-employed at the company she used to work for.
The colon cancer clock is ticking. Colon and rectal cancer is known to occur most often in people over 50 years of age. However, according to a study recently published in an international medical journal, the incidence of colorectal cancer per 100,000 people aged 20 to 49 in Korea was 12.9, ranking first in the world.
Colon and rectal cancer is one of the most common cancers in general cancer incidence statistics. According to the 2020 National Cancer Registration Statistics, colorectal cancer patients accounted for 11.2% of all cancer patients in Korea, the third most common. This is a step up from 4th place in 2019. Of the total of 27,877 patients with colorectal cancer, 16,485 were males and 11,392 were females. In the case of females, they came third after cancer breast and thyroid cancer, which are representative female cancers. In men, it is also the most common after lung cancer, stomach cancer, and prostate cancer. Even when restricted to the relatively young age group, 15 to 34 years, the incidence of colorectal cancer was 3.6 per 100,000 of the population, ranking third. This means that there are more young colorectal cancer patients than well-known leukemia doctors (3.3).
◇ Eating habits that focus on meat are risk factors
The large intestine is the last organ of the digestive tract located between the small intestine and the anus. The large intestine is largely divided into the colon and rectum. The colon includes the cecum, ascending colon, transverse colon, descending colon, and S colon (colon folded in the shape of the letter S). About 70% of all colorectal cancers occur in the rectum and colon S, which is in contact with the rectum.
The causes of colorectal cancer are mainly divided into environmental and genetic factors. As is well known, the environmental factors are western lifestyles such as high protein and high fat food intake, lack of exercise, and obesity. In particular, there is a report that the likelihood of cancer increases according to the amount of meat that is eaten, so a balanced diet is important to prevent colon and rectal cancer. Chronic diseases such as diabetes, obesity, and an overweight population under the age of 50 also accelerate the rate of increase in young colorectal cancer.
Genetic factors also influence the risk of colorectal cancer. In particular, if there is a family member who has been diagnosed with colorectal cancer at a young age, or if there are several patients with stomach cancer, skin cancer, endometrial cancer, or ovarian cancer, Lynch syndrome can , a genetic disease, is suspected. Lynch syndrome refers to a genetic disease that has a higher chance of developing certain types of cancer before the age of 50 than the general population, and approximately 70 to 80% of Lynch syndrome patients develop colorectal cancer.
Professor Kim Hyung-jin from the Department of Colon and Rectal Surgery at Eunpyeong St. Hospital said. Mary, The Catholic University of Korea, “Colto-rectal cancer caused by a genetic disease is quite young, in the early 40s, and especially in women, the probability of having uterine cancer is as high as 40 to 50 %.” “Lynch syndrome is Since the probability of passing it on to children reaches 50%, if there is a young colorectal cancer patient in the family, it is necessary to check the genetic factor,” he explained.
◇ Do not neglect symptoms in daily life such as constipation and diarrhea
The main symptoms of colorectal cancer are abdominal pain, bloody stools, and changes in bowel habits. These symptoms can appear at any time during life even if they are not related to colon cancer, so it is easy to ignore them, but if sudden changes or symptoms persist, you need to pay attention.
In particular, if you have been constipated but suddenly have diarrhoea, or if the opposite happens, you need a test. It is also important to look at the thickness and color of the stool whenever you visit the toilet. A tumor in the large intestine narrows the passage of the stool, making the stool as thin as a pencil or bloody stool due to bleeding.
Professor Kim emphasized, “It is common to misunderstand bloody stool as a symptom of hemorrhoids, but a colonoscopy should be performed to confirm that there are no other causes.”
Colonoscopy is the most important test method for diagnosing colon cancer. Colon and rectal cancer usually starts as small wart-like lumps called colon polyps. Cancer can be prevented by removing these polyps which may develop into cancer in the future through endoscopy in the absence of symptoms. In addition, even if polyps are found to be cancerous, early detection at a time when there are no symptoms can lead to a better prognosis by establishing a tailored treatment plan.
Professor Kim Hyung-jin said, “Currently, colorectal cancer screening is only performed for those over 50 in the national health examination, and only when abnormalities are detected in this test requires a colonoscopy, so awareness of the need for the test is low.” , If you experience bloody stool or changes in your bowel habits, we recommend that you have an early colonoscopy, regardless of your age.”
◇ Treatment that considers quality of life, such as preserving the anus and normalizing bowel function, is the key
The level of colorectal cancer treatment in Korea is world class. The surgical method and the multidisciplinary cooperation system have developed to such an extent that the prognosis of colon and rectal cancer patients in Korea is reported to be the best in global statistics. When colorectal cancer is diagnosed, additional CT or MRI examinations are carried out to check for metastases to other organs such as the liver, lungs, and lymph nodes, as well as local progress in the colon, and a consultation is carried out multidisciplinary. Recently, collaboration to proceed with effective treatment in the most appropriate order according to the patient’s condition is the most important strategy for treating colorectal cancer.
In particular, in the case of rectal cancer, it is very difficult to treat because it is located inside the pelvis, above the anus, and is adjacent to important structures such as the prostate, the uterus, the bladder, and pelvic nerves. Therefore, in order to preserve the anus and the major structures when performing surgery, radiation therapy, and chemotherapy, it is essential for experts in various fields to put their heads together to make a treatment plan.
In recent years, minimally invasive surgical methods such as laparoscopic surgery and robotic surgery have been rapidly developed, as well as pre- and post-operative chemotherapy and radiation therapy.
Eunpyeong St. Mary’s Hospital also operates a multidisciplinary cooperation system that focuses on the Colon and Rectal Cancer Center to obtain the best treatment results by effectively combining cutting-edge treatments. The Colorectal Cancer Collaborative Team, which includes gastroenterology, oncology, colorectal surgery, radiation oncology, radiology, and pathology, meets once a week to discuss customized treatment plans on for all colorectal cancer patients. In addition, it has state-of-the-art equipment such as the 3D laparoscopic surgery machine, the latest robotic surgery machine, Da Vinci Xi, and the dream cancer treatment machine, True Beam, and strives to get the best treatment results .
Professor Kim Hyung-jin said, “Even if colorectal cancer is detected early, additional chemotherapy or surgery may be required, so a systematic and varied approach is necessary.” We will discuss it in the collaborative meeting,” he said.
Due to the nature of the procedure where part of the colon is removed, it is inevitable that colorectal cancer will change the function of the bowel after treatment. In the case of rectal cancer that develops in the area surrounding the anus, not all patients can maintain normal bowel function even if the anus is preserved. This is because a number of factors, including the rectal and pelvic nerves, as well as the rectal sphincter, are required for normal bowel function.
These changes in bowel function significantly limit the patient’s quality of life, especially travel, outdoor activities, and work life. Accordingly, recently, in addition to research on the recovery of bowel function after colorectal cancer treatment, research on non-surgical treatment for rectal cancer patients who have good results from pre-operative radiotherapy and chemotherapy has been carried out in active.
Professor Kim Hyung-jin said, “There are many patients who are unaware of the symptoms of colorectal cancer or neglect them and visit the hospital late,” said Professor Kim Hyung-jin jin If you maintain and feel symptoms constantly, regardless of your age, we recommend that you visit a hospital and consult a specialist.”
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