Colorectal Cancer: Prevention, Diagnosis and Treatment

Colorectal Cancer: Prevention, Diagnosis and Treatment



Colorectal cancer is in the third place for its popularity within the range of cancer diseases after lung and breast cancers, while in the 90s it was in the 6th place. This was informed to the Medicine reporter by Prof. Alexander Aghavelyan, the head of the Coloproctology Service in “Astghik” MC.

As to the doctor, this change in statistics took place for two reasons:  the increased number of patients with this disease, also the detection of the disease which is conditioned with the diagnosis improvement of modern technologies. Moreover, the mortality degree of this disease is not high but the early detection of the disease is very important.  Colorectal cancer in early stage is curable but, unfortunately, patients in Armenia visit a doctor in the third or fourth stage. “In Armenia, 2-3 colorectal cancer cases in first and second stagesare diagnosed in a year which witnesses that the prevention and diagnosis are not complete yet,” noted the doctor.

What Is Needed to Improve the Diagnosis of Colorectal Cancer?

As to the doctor, special screening programs are needed for the improvement of the situation. It is also necessary to raise the level of awareness of the population.  People should know the first clinical symptoms in case of which they should immediately apply a specialist. The alertness of the primary care physicians towards oncology should also be raised. “If a patient visits a doctor complaining of abdominal pains, unstable feces (constipation, then diarrhea), excrement, blood; they are the main symptoms when special attention should be paid on colon,” noted Alexander Aghavelyan. But, he continues, the patient with these symptoms applies to the primary care specialists where he is not examined thoroughly because the polyclinics do not have certain diagnostic conditions. “As the physician of polyclinic is not cautious towards oncology, the patient loses time. Often he is prescribed treatment for intestinal dysbacteriosis, hemorrhoid and so on,” noted the specialist. Meanwhile, the primary care doctor should send the patient to colonoscopy, rectoscopyor anoscopy. “But the primary care service here is still weak and consequently, the patient loses his precious time. This is the main problem that needs solutions.

Methods of Diagnosis

The main methods of colorectal diagnosis are colonoscopy and irigoscopy (X-ray contrast agent). But a cancer is possible to detect by the first examination of touching the rectum with fingers with the help of anuscopy and rectoscopy.  If a cancer has already formed in the rectum, it should be examined by CT scan to find out whether there are multiple metastases in the neighboring organsand the lympho system, and to evaluate the cellulose state surrounding the rectum.

Instructions for the Prevention of Colorectal Cancer

As to Alexander Aghavelyan, after the age of 40 people should undergo a colonoscopy at least once in five years at a proctologist. The specialist noted that a very simple method is used in the world for the analyses of the presence of fecal occult blood.  Those are test layers like the test layers for pregnancy which change the color if there is blood in feces. This method is partly imported to Armenia but it is not widely used.

Colon Cancer Treatment

“The colon cancer is treated in 100 percent,” confirmed the proctologist. But the problem is in the life quality of patients. The sooner it is discovered, the higher will be the life quality of the patient after treatment. For example, the cancer of rectum distal segment also may not be operated depending on how the cancer is influenced by radiotherapy or chemotherapy. But in late stages a standard operation is done – a rectum extirpation; it is removed with the anus. The intestine is brought out and a colostome is installed on it. The only thought that patients should take care of their natural needs with the help of a colostomy bag all their life, makes most of themrefuse the surgery.

Alexander Aghavelyan reminded that in 1999 he offered a new surgical approach for the first time in Armenia to treat the rectum distal segment cancer which allows the patient to avoid the colostomy bag: this method assumes the rectum extirpation by lowering the sigmoid colon into the perineum and a creation of artificial sphincter from the delicate thigh tissue. In Armenia 30 similar surgeries have been done till today, and though the artificial sphincters do not replace the natural ones for 100 percent they do that for about 60-70%, as the professor confirms. In 2009 Alexander Aghavelyan suggested another method of rectum extirpation, not with the use of thigh tissues but by using the rest of levators which hold the rectum anus. Around 20 such surgeries have been done.

Risk Factors for Colorectal Cancer

  • Age, though recently colorectal cancer has become common in young people
  • Diet (fatty, fried food)
  • Colon Polyps
  • Intestine Chronic Inflammatory Diseases
  • Chronic Constipation

What concerns smoking, as to Alexander Aghavelyan, the connection between a colon cancer and smoking is not proved yet, though “most people say that smoking leads to both lung cancer and colon cancer.”

About “Astghik” MC

“This is an extra modern clinic with unlimited possibilities and I am very happy to be invited here,” said Alexander Aghavelyan. As to his estimation, the clinic is already getting staffed with skillful and professional specialists; it is best equipped with diagnostic, as well as surgical devices. “The operation rooms are typical to European and American styles. I have rarely seen such conditions even in Europe, – he said. –Working here is only pleasure.”