2023-09-09 00:17:02
[이데일리 이순용 기자] September is ‘Colon Cancer Month’ designated by the Korean Society of Colon and Proctology. Since 2007, we have been running the Colon Awareness Gold Ribbon Campaign to emphasize the importance of colon cancer prevention and early screening.
Colon cancer is a scary disease that ranks third in both incidence and mortality in Korea. If you are suffering from inflammatory bowel disease, have colonic polyps, or have a family history of colon cancer, the risk of developing it is very high and caution is required. Let’s learn about the causes and treatments of colon cancer with the help of Park Yun-young, a professor of surgery at Kangdong Kyung Hee University Hospital.
◇ If you have inflammatory bowel disease or colon polyps, be especially careful about colon cancer.
There are various risk factors for developing colon cancer, but there are some that require special caution. The first is if you suffer from inflammatory bowel disease. It is known that if you have Crohn’s disease or ulcerative colitis, the incidence rate of colon cancer increases and the age of onset is also earlier. The second is when there is a colonic polyp. Among the polyps often discovered during colonoscopy, adenomatous colonic polyps can later develop into colon cancer. In addition, age over 50, consumption of large amounts of red meat and meat products, obesity, drinking, smoking, and family history increase the risk of developing colon cancer.
◇ Even those under 50 years of age should undergo an endoscopy if bloody stool recurs for more than 1 month.
In Korea, a fecal occult blood test is performed on people over 50 years of age through national cancer screening, and if the result is positive, a colonoscopy is recommended. Accordingly, Professor Park Yoon-young said, “The age of onset of colon cancer is gradually getting younger. “Even if you are under the age of 50, it is recommended to undergo a colonoscopy if you have any symptoms suspected of colon cancer, such as bloody stool, repeated diarrhea or constipation, weight loss, and fatigue, or if you have a family history of inflammatory bowel disease or colon cancer,” he advised. 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 colon cancer in Korea aged 20 to 49 was 12.9 per 100,000 population, the highest among the 42 countries surveyed.
◇ Treatment continues to develop, survival rate is also on the rise
Even if you have been diagnosed with colon cancer through a test, it is too early to be discouraged. Colon cancer is one of the cancers with a very high mortality rate, but the survival rate continues to increase. According to data from the Central Cancer Registry announced in 2022, the 5-year relative survival rate for colon cancer, including colon cancer, from 2016 to 2020 was 74.3% for both men and women, up about 15% from 58.9% from 1996 to 2000. In particular, Professor Park said, “In a study published in the International Medical Journal in 2018, Korea reported the world’s highest survival rate in the field of colorectal cancer (colon and rectum). “If you undergo regular checkups and receive treatment with confidence in our country’s medical standards, you don’t have to worry too much,” he explained.
◇ Depending on the degree of tumor invasion, treatment and resection site are determined.
What is important in determining the treatment method for colon cancer is the extent to which the tumor has invaded the tissue rather than the size of the tumor. Usually, surgery, chemotherapy, and radiation therapy are appropriately combined. Early-stage colon cancer has no risk factors such as lymphatic vascular invasion or poor differentiation, and if it is limited to the mucosa or the depth of invasion into the submucosal layer is very shallow, it can be treated with endoscopic resection alone.
The most fundamental treatment for stage 2 and 3 colon cancer is surgery. Centering on the tumor, the large intestine is resected in both distal (below the tumor) and proximal (above the tumor) areas far enough away from the tumor, and lymph nodes are also extensively resected.
For stage 4 colon cancer, multidisciplinary treatment is essential in which specialists from various departments, the patient, and their guardians gather together to discuss treatment policy by collecting not only the opinions of the medical staff but also the patient’s preferences and values. This is because there are numerous cases depending on the degree of cancer progression, location and number of metastatic lesions, etc. Even for stage 4 colon cancer patients, the 5-year survival rate can be raised to 40% if combined treatment, including surgery, is actively administered.
◇ Laparoscopic and robotic surgeries are widely performed with fast recovery and low complications
Laparoscopic surgery and robotic surgery are commonly used surgical methods.
△Laparoscopic surgery is the most widely used method in Korea, and so-called ‘single-hole laparoscopic surgery’, which uses only one incision, is currently being attempted. The minimal incision not only minimizes scarring after surgery, but also causes very little pain, so the patient’s recovery is quick and there is a low risk of complications such as intestinal obstruction.
△Robotic surgery allows for precise surgery using a robot arm and 3D screen. In particular, when performing rectal cancer surgery located in the narrow and deep pelvic cavity, its practice is gradually increasing as it has advantages in preventing decline in urinary and sexual functions through more detailed preservation of the autonomic nerves and precise tissue dissection, as well as faster recovery.
◇ Total calories, meat, drinking, smoking ↓, fiber, calcium intake, physical activity ↑
Colon cancer, like other cancers, is caused by the interaction of various factors. The best way to prevent it is to reduce the factors that influence it in daily life. For this purpose, it is recommended to reduce the total calories consumed regardless of the type of food, as it has been reported that the risk of colon cancer increases. △Red meat, such as beef, pork, and lamb, is known to increase the likelihood of colon cancer, so it is recommended to reduce intake of processed meat or red meat. △Eating a lot of fiber and calcium is also helpful. Additionally, the lower the amount of physical activity, the higher the risk of colon cancer, so office workers who sit all day should increase their physical activity through exercise. Drinking alcohol increases the risk of rectal cancer, especially in men, and smoking increases the risk of both colon adenoma and colon cancer. To prevent colon cancer, people should abstain from drinking and smoking.
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