Colorectal cancer - the disease and its management
Colorectal cancer is the third most common cancer in the UK, after cancer of the lung and breast. In 2000, there were 33,173 new cases of colorectal cancer diagnosed, with slightly more cases in men (17,249) than women (15,924) (worldwide data presented in Table 1, p176).1 The prevalence rate per 100,000 (all ages) is 57.1 for men and 37.5 for women.2 The incidence increases with age, the average age at diagnosis being 60–65 years.
In 2002, colorectal cancer was responsible for 16,220 deaths (66 per cent colon cancer, 34 per cent rectal cancer).2 It is the second most common cause of cancer death after lung, and accounts for over 10 per cent of cancer deaths.
Survival rates for colorectal cancer have improved in recent years with current five-year survival at around 40 per cent. Between the early 1970s and the early 1990s, five-year survival rates for colon cancer in men improved from 22 to 42 per cent, while for rectal cancer equivalent rates improved from 25 to 39 per cent. For colon cancer in women over the same period, five-year survival increased from 23 to 40 per cent and for cancer of the rectum, 27 to 43 per cent.2
The development of colorectal cancer is still poorly understood, although there is evidence for the influence of a range of environmental and genetic factors. These include:
- Age — incidence increases over the age of 50 years
- Low physical activity
- Inflammatory bowel disease
- Family history of bowel cancer (particularly with relatives diagnosed under the age of 45 years)
It is thought that less than 10 per cent of all cases can be explained genetically — the rest are caused by diet and lifestyle. It is estimated that up to 80 per cent of cases of colorectal cancer are caused by diet alone.3 The disease is more common in westernised countries than in Asia or Africa — the higher intake of plant-based foods in Asia and Africa has been proposed as accounting for these differences. There is epidemiological evidence for a protective effect of vegetable intake4 and there is also evidence that a diet rich in red meat may increase risk.5
Patients with long-standing ulcerative colitis or Crohn’s colitis are at higher risk of developing colorectal cancer than the rest of the population. In ulcerative colitis, the cumulative risk of developing colorectal cancer appears to be 2 per cent at 10 years, 8 per cent by 20 years and 18 per cent by 30 years.6
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Citation: Hospital Pharmacist URI: 10977320
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