Colorectal cancer is the second most common malignancy in morbidity and mortality in Serbia. Statistic explains that 4000 people suffer from it annually. Discovery in early phase significantly increases rate of healing. How routine preventive exam look like, how often they should be performed and what are the symptoms that should pay attention to, dr Miljan Ćeranić, general surgeon in Atlas General Hospital will speak about.
Signs and symtoms of colorectal cancer
Symptoms of colon cancer are: bloody stools, weight loss (when it comes to an advanced tumor), anemia of unkown etiology and at the end, if it is not diagnosed on time, we have tumor that can be palpated through abdominal wall which is not a good sign.
How colon cancer is discovered, how health checks look like?
I would divide that in two groups. The first group of the patients do not have any symptoms. Depending on age and genetic predisposition, we perform the screening. Screening diagnostic is performed in people that do not have any symptoms. The most simple screening is test on occult bleeding that is done in patients that are older than 50 years or even earlier if the colorectal cancer that runs in family.
Golden standard is that if there are positive results on occult bleeding twice, then colonoscopy should be done. Colonoscopy is irreplaceable and today in gastroenterology filed it is obligatory to perform in all patients.
How often persons that are asymptomatic should perform check ups and are there genetic risk factors or certain food intake?
In my opinion the greatest risk factor is stress. Food is more and more full of pesticides and it is every day more present on the market. People need to listen to their body and if there are any changes in the way they are discharged (this is the second group of patients who already have some problems), a colonoscopy should be done immediately.
It is very dangerous that blood in the stool is attributed to hemorrhoids – this is very common. Then GP gives some creams or ointments, and in the background liescolorectal cancer. It is very dangerous to waste time dealing with hemorrhoids. The obligation is to have a colonoscopy done, not to skip it.
Colonoscopy where nothing is detected is the least damage that we could do, the biggest damage is to skip it. One in 100 colonoscopies if colorectal cancer is detected on time, is considered a success.
What does a colonoscopy exam look like, is it painful, how long does it take?
Colonoscopy is an examination that depends on the patient’s structure, anatomy of the colon, and depends on the skill of the gastroenterologist. It is mostly done under anesthesia because it is not a very pleasant examination.
If during colonoscopy results are not the best one, what does the further treatment look like?
A tumor biopsy should be taken, then the combination of CT and a pelvic MRI should be done to determine the stage of the disease. The treatment modality is different and a consilium needs to be made as these patients are most commonly treated multidisciplinary.
Can you tell us more about laparoscopic colon surgery?
Laparoscopic, or minimally invasive, treatment for colon cancer has been the gold standard in the world for almost 10 years. It involves surgery like open surgery (where there is a large incision), however, all of this is done laparoscopically inside and then a small incision of 5-6 cm is made through which the tumor is pulled out and the bowel is connected inside. So, at the end we have a tumor extracted with an adequate oncological result with a 5-6 cm incision. Recovery of these patients is significantly faster, blood loss is smaller.
The laparoscopic approach is certainly more demanding for the surgeon, but it is easier for the patient in every respect
The next phase, the world has already moved on, and we’re trying to keep up with it, is robotics surgery, which is very similar to laparoscopic surgery, with robotic hands being used instead of assistants’ hands. In this way, we have even more precise surgery and more importantly minimal bleeding and minimal use of antibiotics so that it is both the present and future of surgery.