This tumor, very frequent, occurs in the large intestine, or colon and rectum, and is caused by the uncontrolled proliferation of mucosal cells, ie the inner lining of the intestinal wall. The cancer develops most often in the colon (around 70% of cases) and less frequently in the rectum (30%). It is a type of cancer that can be prevented or cured if caught early. In fact, in most cases the cancer is determined by the initial formation of so-called adenomatous polyps, which are abnormal tissue growths that are initially benign but over time, can develop into cancer.
In Humanitas, operations are undergone by physicians experienced in the diagnosis and treatment of colorectal cancer and those who have expertise on inherited forms of this disease, such as familial adenomatous polyposis, Lynch syndrome (hereditary non-polyposis or cancer) and Peutz-Jeghers syndrome.
Like all of Humanitas cancer programs, including the “colorectal cancer” program, they are typically multidisciplinary and based on the integration of clinical and professional gastroenterologists, surgeons and medical oncologists, the quality of diagnostic services of Pathology and Radiology, as well as on the availability of geneticists, radiological interventionists, radiotherapists and nutritionists in cases requiring these skills.
The overall aim of this approach is to provide patients with the best opportunities for prevention, diagnosis and treatment. In Humanitas, doctors are well aware of the anxiety that can be generate from the fear of having cancer and even more so, the impact of living with an established diagnosis of cancer. At this facility, patients are guaranteed precise and transparent communication, as well as diagnostic and therapeutic, and if needed, psychotherapeutic support.
The main risk factors for this disease are:
- Age: occurs in about 90% of patients over the ages of 50
- Family history of colorectal cancer: the risk increases if colorectal cancer or adenomatous polyps are found in relatives (especially parents and siblings)
- Personal medical history: the risk increases if the individual is suffering from chronic inflammatory bowel disease (ulcerative colitis or Crohn's disease) or they have previously removed a cancerous tumor or a polyp
- Being overweight and lacking in physical exercise
- Diet : if the diet consists of high fat content, especially of animal origin, the risk of developing the disease increases; while a diet rich in fruits and vegetables reduces its risk.
- Smoking and alcohol consumption
Prevention and Screening
The ideal form of prevention, so called primary prevention, is based on eliminating risk factors (diet, lack of physical activity, smoking, alcohol consumption, etc). The prevention that has had the greatest impact however, is the removal of precancerous lesions (polyps) that may precede years before the development of the tumor. The identification of these injuries, or at least early diagnosis of a curable cancer, can occur in asymptomatic patients who undergo screening through different modes.
In Italy, there are regional programs of population screening that are based on research of fecal occult blood tests and done every two years in individuals over the ages of 50. If the test is positive, it becomes mandatory to undergo a colonoscopy in order to confirm or rule out cancer as the cause of the positive test results. Humanitas is a reference center for the Lombardy Region for execution of colonoscopy as part of the screening program.
Based on individual preferences, persons over the ages of 50 may decide to directly undergo a colonoscopy screening, which has a higher sensitivity in detecting precancerous lesions. In Humanitas, this procedure, though often perceived as painful, can be performed on an outpatient basis under sedation, without any discomfort. Particular attention to screening for colorectal cancer should be done in individuals who are familiar (relatives of first degree) for this type of cancer.
The current international guidelines recommend that these individuals, if over the ages of 40, should undergo their first colonoscopy. Unfortunately, this recommendation is often neglected. In Humanitas, since 2009, a study funded by the National Center for Prevention and Disease Control (CCM) pertaining to the Ministry of Health has become active on this issue. The study is open to all citizens over the ages of 40 who have a relative who has been recently diagnosed with colorectal cancer. The study aims to compare the reliability of colonoscopy with “virtual colonoscopy” and to assess how many of these individuals belong to families with real hereditary predisposition to cancer.
In addition, Humanitas is active in the outpatient consultation genetics program and appropriate follow up clinical trials for endoscopy specifically dedicated to patients diagnosed with hereditary cancer (familial polyposis, Lynch syndrome, and Peutz-Jeghers syndrome) and their families.