September is designated as ‘Colon and Rectal Cancer Month’ by the Korean Society of Colon and Rectal Cancer. The society has been promoting the importance of preventing and screening for colorectal cancer through the Colorectal Awareness Gold Ribbon Campaign since 2007.
Colorectal cancer is a daunting disease that ranks third in terms of incidence and mortality in Korea. Individuals with inflammatory bowel disease, colon polyps, or a family history of colorectal cancer are at a particularly high risk. It is crucial for them to exercise caution. To understand the causes and treatment options for colorectal cancer, we turn to Park Yoon-young, a professor of surgery at Gangdong Kyunghee University Hospital.
If you have inflammatory bowel disease or colon polyps, it is essential to pay special attention to colorectal cancer. Although there are many risk factors associated with developing this type of cancer, there are certain ones that require extra vigilance. Firstly, individuals suffering from inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, are known to have a higher incidence and later onset of colorectal cancer. Secondly, the presence of colon polyps, particularly adenomatous colon polyps found during colonoscopy, can potentially develop into colon cancer. Other risk factors include age over 50, a high intake of red meat and meat products, obesity, alcohol consumption, smoking, and a family history of colorectal cancer.
In Korea, individuals aged 50 and above are recommended to undergo a fecal occult blood test as part of the national cancer screening program. If the test result is positive, a colonoscopy is advised. However, Professor Park Yoon-young emphasizes the need for individuals under 50 with suspected symptoms of colorectal cancer, such as bloody stools, frequent diarrhea or constipation, unexplained weight loss, fatigue, or a family history of inflammatory bowel disease or colon and rectal cancer, to also undergo a colonoscopy. Recent research conducted at the University of Colorado Medical Center in the United States revealed that Korea had the highest incidence of colorectal cancer among individuals aged 20-49 among the 42 countries surveyed, highlighting the importance of early detection.
While a diagnosis of colon cancer may be disheartening, it is not a reason to lose hope. The survival rate for colorectal cancer has been steadily increasing. According to data from the Central Cancer Registry, the 5-year relative survival rate for colorectal cancer, including colon cancer, in Korea has risen to 74.3% between 2016 and 2020, a remarkable improvement from 58.9% between 1996 and 2000. In fact, a study published in an international medical journal in 2018 reported that Korea had the world’s highest survival rate for colorectal cancer. Professor Park reassures patients that with the level of medical expertise in Korea and regular checkups, there is less cause for concern.
Treatment options for colorectal cancer depend on the degree of tumor penetration rather than the tumor’s size. Typically, surgery, chemotherapy, and radiation therapy are combined accordingly. Early-stage colorectal cancer limited to the mucous membrane or with minimal invasion to the submucosal layer can be treated through endoscopic resection. Surgical intervention is the primary treatment for stage 2 and 3 colorectal cancer, involving resection of the large bowel around the tumor and extensive lymph node removal. Stage 4 colorectal cancer requires multidisciplinary care, considering factors such as cancer progression, location and number of metastatic lesions. Combined treatment, including surgery, can significantly improve the 5-year survival rate.
Laparoscopic and robotic surgeries are commonly performed for colorectal cancer treatment, offering advantages such as faster recovery and fewer complications. Laparoscopic surgery, using minimal incisions, is the most widely employed method in Korea. Single-incision laparoscopic surgery, which involves using a single incision, is also being explored. Robotic surgery, on the other hand, provides precise surgical procedures through a robot arm and a 3D stereoscopic screen. It is particularly advantageous in rectal cancer surgery, as it enables meticulous autonomic nerve preservation, precise tissue dissection, and aids in the preservation of urinary and sexual functions.
Prevention is key when it comes to colorectal cancer. By taking certain measures, individuals can reduce their risk. Studies have shown that a higher total calorie intake is associated with an increased risk of colon and rectal cancer. Therefore, reducing calorie consumption across various types of food is recommended. Consumption of red meat, such as beef, pork, and lamb, is also known to elevate the likelihood of developing colorectal cancer. Hence, limiting the intake of processed meat and red meat is advisable. Including fiber and calcium-rich foods in the diet can be beneficial. Additionally, individuals with sedentary lifestyles, such as office workers, should boost their physical activity levels through exercise. Drinking alcohol has been linked to an increased risk of rectal cancer, particularly in men, while smoking raises the risk of colorectal adenoma and colorectal cancer.
In conclusion, raising awareness about colorectal cancer is crucial. By understanding the risk factors, seeking regular screening, and adopting a healthy lifestyle, individuals can reduce the incidence and mortality rates associated with this disease.
[이데일리 이순용 기자] September is ‘Colon and Rectal Cancer Month’ designated by the Korean Society of Colon and Rectal Cancer. Since 2007, he has been emphasizing the importance of colorectal cancer prevention and early screening by running the Colorectal Awareness Gold Ribbon Campaign.
Colorectal cancer is a frightening disease that ranks third in terms of incidence and mortality in Korea. People with inflammatory bowel disease, colon polyps, or a family history of colorectal cancer are at a very high risk of it occurring, so caution is needed. Learn about the cause and treatment of colorectal cancer with the help of Park Yoon-young, professor of surgery at Gangdong Kyunghee University Hospital.
◇ If you have inflammatory bowel disease or colon polyps, pay special attention to colorectal cancer
There are many risk factors for developing colorectal cancer, but there are some that you need to be particularly careful about. The first is if you suffer from inflammatory bowel disease. Crohn’s disease or ulcerative colitis is known to increase the incidence of colorectal cancer and increase the age of onset. The second is when there is a colon polyp. Among the polyps often found at colonoscopy, adenomatous colon polyps can later develop into colon cancer. In addition, age over 50, high intake of red meat and meat products, obesity, drinking, smoking, and family history increase the risk of colorectal cancer.
◇ People under the age of 50 should have an endoscopy if bloody stools occur repeatedly for more than 1 month.
In Korea, a fecal occult blood test is performed in people over the age of 50 through national cancer screening, and a colonoscopy is recommended if it is positive. In response, Professor Park Yoon-young said, “The age of onset of colorectal cancer is gradually getting younger. Even if you are under 50, if you have suspected symptoms of colorectal cancer, such as bloody stools, frequent diarrhea or constipation, weight loss and fatigue, or if you have a family history of inflammatory disease the bowel or colon and rectal cancer, it’s good to have a colonoscopy.” In fact, according to a paper published by a research team at the University of Colorado Medical Center in the United States, the incidence of colorectal cancer in Korea between the ages of 20 and 49 was 12.9 per 100,000 of the population, the highest among 42 countries surveyed. .
◇ Continue to develop treatment, survival rate on the rise
Even if you have been diagnosed with colon cancer through a test, it is too early not to be encouraged. Colon and rectal cancer is a cancer with a very high mortality rate, but it is one of the cancers whose survival rate continues to rise. According to data from the Central Cancer Registry published in 2022, the 5-year relative survival rate for colorectal cancer, including colon cancer, between 2016 and 2020 was 74.3% for men and women, up about 15% from 58.9% between 1996 and 2000. In particular, Professor Park said, “In a study published in an international medical journal in 2018, Korea reported the world’s No. 1 survival rate in colorectal cancer (colon and rectum). If you believe in the level of Korean medicine and receive treatment along with regular checkups, you don’t have to worry too much,” he explained.
◇ Depending on the degree of tumor penetration, the treatment and excision site is determined
What is important in determining the treatment method for colorectal cancer is the extent to which the tumor has penetrated the tissue rather than the size of the tumor. Surgery, chemotherapy and radiation therapy are usually combined appropriately. Early colorectal cancer has no risk factors such as lymphatic invasion and poor differentiation, and can be treated with endoscopic resection only if it is limited to the mucous membrane or if the depth of invasion is to the submucosal layer is very shallow.
The most basic treatment for stage 2 and 3 colorectal cancer is surgery. Centered on the tumour, the large bowel is resected in both directions from the distal (lower part of the tumour) and proximal (above the tumour) to a place far enough from the tumor, as well as extensive lymph node resection.
For stage 4 colorectal cancer, multidisciplinary care is essential where experts from different departments, patients and guardians gather to discuss the treatment plan by converging not only the views of medical staff but also the preferences and values of the patient. This is because a number of cases depend on the degree of cancer progression, the location and number of metastatic lesions, and so on. For colorectal cancer, even in the same stage 4 patients, the 5-year survival rate can be raised to 40% if combined treatment including surgery is performed actively.
◇ Widely performed laparoscopic and robotic surgery with fast recovery and low complications
The most common surgical methods are laparoscopic surgery and robotic surgery.
△ Laparoscopic surgery is the most widely used method in Korea, and so-called ‘single-incision laparoscopic surgery’, which uses only one incision, is also being attempted. Post-operative scarring is minimized through a minimal incision, and pain is minimal, allowing patients to recover quickly and reduce concerns about complications such as intestinal obstruction.
△ Robotic surgery enables precise surgery through a robot arm and a 3D stereoscopic screen. In particular, in the case of rectal cancer surgery located in the narrow and deep pelvic cavity, more detailed autonomic nerve preservation and accurate tissue dissection are advantageous to prevent deterioration of urination and sexual function, as well as rapid recovery, and have perform them gradually. .
◇ Total calories, meat, drinking, smoking ↓, fiber, calcium intake, physical activity ↑
Colon cancer, like other cancers, is caused by the interaction of different factors. In everyday life, it is best to prevent it by reducing the factors that affect it. To this end, △ regardless of the type of food, there is a report that the higher the total calorie intake, the higher the risk of colon and rectal cancer, so it is good to reduce it. △ Regarding meat, it is known that red meat such as beef, pork and lamb increases the possibility of colon and rectal cancer, so it is good to reduce the intake of processed meat or red meat. Eating lots of fiber and calcium also helps. In addition, the lower the physical activity, the higher the risk of colon cancer, so office workers who sit all day should increase their physical activity through exercise. Drinking is known to increase the risk of rectal cancer, particularly in men, and smoking increases the risk of colorectal adenoma and colorectal cancer.
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