About 80 per cent of Nigerians who are diagnosed with colon cancer die from it, even though the disease is preventable. Experts said rectal bleeding, fresh blood in the stool, unexplained constipation, diarrhoea alternating with constipation are among the indicators of colon cancer. APPOLONI A ADEYEMI reports
News about the death of the Zimbabwean opposition leader Morgan Tsvangirai who died from colon cancer at the age of 65, is another indication of how late stage cancers could increase mortality.
Reports showed that Tsvangirai who was the president of the Movement for Democratic Change in Zimbabwe, had been suffering from colon cancer for at least two years, but his condition deteriorated rapidly shortly before his death, despite treatment in neighbouring South Africa.
The death of Tsvangirai on February 14 may have brought colon cancer death to the consciousness of Nigerians; sensitisation about this condition has been in the front burner. As far back as 2016, the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), had raised the alarm that Nigeria was contending with heavy burden of colon cancer. According to SOGHIN, “More Nigerians above 40 were coming down with colon cancer, which is also known as colorectal cancer and bowel cancer.”
In spite of this background, most Nigerians may not be aware of colon cancer; yet it is one of the most common cancers, globally. Colon cancer is the third most common cancer in Nigerian men, after prostate and liver cancer and the fourth most common cancer in Nigerian women, after breast, cervical and liver cancer. Colon cancer is the development of cancer from the colon or rectum (parts of the large intestine).
The human colon, or large intestine, is a muscular, tube-shaped organ measuring about four feet long. It extends from the end of the small bowel to the rectum.
Its functions include to digest and absorb nutrients from food, to concentrate fecal material by absorbing fluid (and dissolved salts, also called electrolytes) from it, and to store and control evacuation of fecal material. Most colon cancers develop slowly, over ten (10) to fifteen (15) years. It usually begins as a small non-cancerous growth, called polyp on the inner lining of the colon or rectum.
The World Health Organisation (WHO) estimates that every two hours a Nigerian is diagnosed of colon cancer.
The Chairman, National Consultative Committee on Cancer Control in Nigeria, Prof. Francis Abayomi Durosinmi-Etti told the New Telegraph that more Nigerians were coming down with colon cancer. “We are noticing an unusual increase in the incidence of colon cancer. “This last week alone, I saw three colon cancer patients at the clinic at the Lagos University Teaching Hospital (LUTH).”
“On what his clinical experience has been like Durosinmi-Etti said from the rate at which affected persons turn up in the clinics, we can conveniently say colon cancer ranks among the first five common cancers in both men and women in the country presently.”
Nigeria records an estimated 102,000 new cancer cases including colon cancer annually, according to data from the Federal Ministry of Health (FMOH). Similarly, cancer is responsible for 72,000 deaths in Nigeria every year.
Sadly about 80 per cent of all Nigerians who are diagnosed of colon cancer die from it, said Dr. Abia Nzelu, a fellow and consultant of the West African College of Surgeons and the National Postgraduate Medical College of Nigeria.
Nzelu who is also the Executive Secretary, Committee Encouraging Corporate Philanthropy (CECP-Nigeria), said, “This is very unfortunate given the fact that colon cancer is one of the cancers that is virtually 100 per cent preventable.” Examples of personalities that survived colon cancers are Justice Ruth Joan Ginsburg, the oldest and only female Justice of US Supreme Court who marked her 82nd birthday on March 15, 2015.
She developed colon cancer in 1999. During the treatment, she did not miss a day on the bench. In 2009, she again had successful treatment for pancreatic cancer and did not miss any oral arguments in court. Similarly, Queen Elizabeth the Queen mother, survived colon cancer and breast cancer at ages of 66 and 83 years respectively.
She died cancer-free at the age of 101. Furthermore, Pope John Paul II, the second longest serving pope in history, survived colon cancer and later became a patron of the Global Campaign for Prevention of Digestive Cancers.
These success stories are a result of availability of infrastructure for screening and treatment of cancer in the respective countries of the survivors. Symptoms On factors that indicate the existence of colon cancer in a person, Durosinmi-Etti said people who experience rectal bleeding must see the medical doctor urgently.
“If you see any sign of fresh blood in your stool you need to see a doctor,” he said, adding that it was important to have such fresh blood checked by the medical team to ensure that was not colon cancer.
He advised people that experience unexplained constipation, stooling that is excreted in very small, narrow form, rather than being excreted in bulk, unexplained weight loss or weight gain, to see the doctor urgently, adding “These are all indicators of colon cancer.”
Durosinmi-Etti asserted that experiencing all these does not necessarily mean that the one has colon cancer, but advised affected persons to see the doctor that would recommend necessary tests to determine the health status of the patient visà- vis colon cancer.
Other symptoms of colon cancer include change in bowel habit such as diarrhoea, constipation, or diarrhoea alternating with constipation that lasts for more than a few days, a feeling that one needs to pass stool that is not relieved by doing so (tenesmus).
Tenesmus is a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness. Other symptoms are blood in the stool, cramping or belly pain, weakness and fatigue.
“It is noteworthy that colon cancer may not have obvious signs and symptoms in the early stages. So, people should not wait for symptoms,” Nzelu advised. Risk factors Factors that can affect a person’s risk for developing colon cancer include several modifiable lifestyle habits such as diet, weight, exercise, smoking and heavy alcohol intake as well as non-modifiable factors like age, family history of colon cancer or polyp; type 2 diabetes.
Race and ethnicity also play a role. For example, in the United States (US), of all racial groups, African Americans have the highest incidence and mortality rates of colon cancer.
Of these risk factors, the link between diet, weight and exercise and colon cancer risk are some of the strongest for any other type of cancer. Prevention According to Nzelu, with lifestyle modification (including regular medical screening) most cases of colon cancer can be prevented.
The recommended measures include the intake of diet high in fibre such as fruits, vegetables and whole grains, diet low in red meat (such as beef, pork, lamb or liver) and processed meat (such as hot dogs and sausage) as well as liberal intake of water. She said, “It is important to note that fibre supplements have not been shown to be helpful in reducing risk of colon cancers. “Rather, the emphasis should be on dietary sources of fibre, such as oat bran, wheat bran, legumes (beans), green leafy vegetables, carrots, oranges, bananas and other fruits and vegetables.
“Avoidance of excessive weight, smoking and excessive alcohol intake while increasing the intensity and amount of physical activity, also helps to reduce colon cancer risk.”
Above all, eligible individuals, people who are 40 years and above, should undergo screening as recommended. Nzelu said regular colon screening is one of the most powerful weapons for preventing the cancer.
“This can in many cases, prevent colon cancer, altogether. This is because, with regular screening, most polyps can be found and removed before they become cancers.
Screening can also result in finding colon cancer early, when it is highly curable.” Available tests Screening tests for colon cancer include stool test, endoscopy (sigmoidoscopy, colonoscopy), as well as x-ray (double contrast barium enema and CT colonography).
According to Nzelu, an important advantage of colonoscopy is that polyps that are found during the procedure could be clipped off on the spot.
In addition, it only needs to be repeated every ten (10) years if the result was normal. “The recommended age for commencement of screening in the western world is 50 years.
However, anecdotal evidence shows that the peak age of diagnosis of colon cancer in Nigerians is about 44 years.
“This is highlighted by the relative youthfulness of some prominent Nigerians that have fallen victim to colon cancer, according to recent media reports.
For this reason, Nigerians should commence screening from the age of 40.” Those with a family history should commence screening ten (10) years before that age at which the affected family member was diagnosed.
On his part, Durosinmi- Etti said most of the patients diagnosed with this condition in the country presently were persons living sedentary lifestyles, for example people in jobs requiring them to sit down all day long.
“What is also significant, according to Durosinmi- Etti is that now there’s more non-governmental organisations involved in raising awareness about colon cancer as well as providing free screening for Nigerians. “This development paves way for more persons afflicted with the disease to be picked up early for medical attention,” he added.
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