Rectal cancer display same symptoms as haemorrhoids:

The silent killer

by Sajitha PREMATUNGE

Initially painless but fatal if diagnosed late, rectal cancers are a silent killer. Rectal cancers are a hidden disease often overlooked due to painlessness. Of patients with rectal cancer in over 90% are diagnosed after the age of 50.

Consultant General Surgeon Dr. C.K. Pathirana

The condition is not common among the young and the middle aged. Last week we talked about anal fissures in Healthwise. The condition discussed this week depicts several of the symptoms depicted by anal fissures and piles. According to Consultant General Surgeon Dr. C.K. Pathirana, a major reason for cases of delayed diagnosis is that symptoms of this potentially fatal condition are often confused with that of haemorrhoids or piles.

Symptoms

Symptoms of this condition include bleeding, recent alteration in bowel habits such as having too many or less motions a day, stools getting narrower, passing of flatus more often, weakness, loss of weight and bloating or abdominal distension. Bloating and abdominal distension are also symptoms of gastritis and therefore there is a rare chance of misdiagnosis.

According to Dr. Pathirana bleeding in these patients may occur at the beginning or at the end of a motion, as fresh blood or altered or dark blood mixed with stools or clots mixed mucous. “Even if they have a motion patients suffering from rectal cancer feel as if they have defecate again...” explained Dr. Pathirana “in which case they may pass blood or mucous.”

In the worst case scenario bleeding can go completely unnoticed. If a patient suffering from continuous bleeding does not seek medical attention, loss of blood can leave the patient looking pale, “which is one of the first signs doctors look for.”

Patients become emaciated and, according to Dr. Pathirana, often have to be admitted to the ER with long duration constipation, vomiting and loss of appetite - which is a result of the disease spreading to other organs and the stomach - all symptom of advanced rectal cancer. “Most patients are old people neglected by themselves and often rest of the family.” As Dr. Pathirana explained the entire combination of symptoms mentioned may not be seen in one patient.

Because pain does not set in until the advance stage of the disease patients put off seeking medical attention. A delay in diagnosis in the case of rectal cancer can be fatal. “Another major reasons for the disease going unnoticed is that most patients come to their own diagnosis that they are suffering from piles, since many of the symptoms are similar for both conditions”, explained Dr. Pathirana. “If you have the symptoms mentioned the best thing is not come to a diagnosis on your own,” warned Consultant General Surgeon, Dr. C.K. Pathirana.

Causes

Dr. Pathirana explained about people with polyps - a protrusion on the inner lining of the rectum or any other part of the gastro intestinal tract. “Some polyps are benign, but some can become cancers” explained the doctor. “Even patients with benign polyps are more vulnerable to rectal cancers than the average person.” Moreover, inherent conditions when patients develop multiple polyps are most vulnerable.

* Lifestyle - people taking a low fibre - less fruits and vegetable - high fat - rich in animal fat - diet are most susceptible while less physical activity and smoking can also make a person vulnerable to this form of cancer.

* Family history - there may be a high probability of a patient developing rectal cancer, whose first degree relatives - father, mother or siblings - have been previously diagnosed with the disease. Genetic mutations can also render people vulnerable to this disease.

* Other diseases - inflammatory bowel disease, which involves the ulceration of the whole colon - which occur in younger people - is another cause of rectal cancer.

Diagnosis

“If any of the rectal cancer symptoms are depicted by a patient doctors conduct a simple day procedure called the DRE (Digital Rectal Examination) where the doctor puts his finger inside the rectum to feel any palpable growth” explained Dr. Pathirana. If there is such a palpable growth a biopsy is conducted - where tissue from the growth is extracted to confirm diagnosis. “Such growths could involve part of the rectum or the entire circumference.”

If there is no palpable growth, it is mandatory to conduct an endoscopic evaluation or colonoscopy and a biopsy after testing the patient’s haemoglobin level count and taking a ‘stools for occult blood test’. “If a certain patient is not fit for a colonoscopy we will conduct what is referred to as a ‘Double contrast barium enema’” explained the doctor. This is a screening process which involves the introduction of a gas and a liquid through the rectum - to distend the colon - and subjecting the patient to something like a video X ray. Depending on the degree of the disease ultrasound or CT scans of the abdomen may be required to determine whether it has spread to other organs.

Treatment

Depending on the stage of the disease different methods of treatment is taken by doctors. If it is diagnosed in the early stage, when it is just confined to the inner lining of the rectum, the tumour can be removed endoscopically. “If it is in the intermediate stage, where it has spread to the muscle layer, the part of the rectum must be removed along with the tumour” explained the doctor. “One of the principles of cancer surgery is not to leave any cancer cells to avoid a patient from going into remission.” Consequently a considerable amount of tissue from either side has to be removed along with the tumour.

“But because the rectum is the last part of the elementary cannel doctors have to take into consideration whether the tumour can be removed with a safe margin of clearance.” If the rectum cannot be securely reconnected after surgery stools may leak into the abdomen, which can be fatal. “Because of the dangerous nature of this surgery the rectum needs sufficient time to recuperate” said Dr. Pathirana. A temporary colostomy - where the colon is repositioned so that the stools can be defecated from the side of the abdomen with the help of a catheter - allows the healing period necessary for the rectum.

If the tumour is too close to the edge of the rectum, and too close to the anus, it may not be possible to remove enough tissue from either side of the anus to avoid remission without losing the anus. “In such cases the patient has to undergo a permanent colostomy.”

The patient can be subjected to radio and chemo therapy before or after surgery, depending on the stage of the disease.

Reducing risks

It is important to maintain a healthy lifestyle to avoid any kind of disease. The same goes for rectal cancers.

“Add more fruits (preferably fresh fruit) and vegetables to your diet, exercise regularly and cut down on animal fat”, suggested Dr. Pathirana.

If you see any of the symptoms mentioned please seek medical attention. “If you have polyps in the rectum get them removed.”

And if any of your immediate relatives have been diagnosed with rectal cancer it is always safe to get a genetic screening.

Toxic paints, a health hazard

by Jayampathy JAYASINGHE

Has anyone thought for a moment about the safety of paints used widely in our bedroom walls and toys that our children play with all the time? A global study conducted by Dr. Abhay Kumar of India in 2009 has shed light on the hazardous use of toxic paints that people use in developing countries. People are ignorant of such hazardous paints being used in their households. Dr. Kumar’s study on lead was conducted in ten countries including Sri Lanka, Philippines, Thailand, Tanzania, South Africa, Nigeria, Senegal, Belarus, Mexico, Brazil and India.

Many Studies have revealed that lead, a toxic substance was being widely used by paint manufacturers all over the world. His findings were published in a report by the International Pops Elimination Network (IPEN). It states that lead paint was used by millions of people all over the world to paint their walls, toys etc. According to the World Health Organisation (WHO) lead, has had an impact on 40 million children worldwide. Paint companies add lead to improve the sheen, durability and colour of their products.

The report further states that the paint industry knew for more than a half a century the use of lead, was a health hazard. As early as 1935, the European countries banned the use of lead in household paints. The United States banned it in 1971. It was proven that lead lowers the IQ and causes other complications as well. The report states that all paint manufacturers in India use lead except for one major manufacturer. A huge outcry in the US and in Europe erupted when it became apparent that lead was used in the manufacture of toys, lead-based paint in older houses was known to be associated with elevated levels of blood in children.

Dr. Abhay Kumar conducted his study on 317 paint samples.They were analysed during November 2008 to February 2009 and found that majority of enamel paint had lead concentration higher than 90 Parts Per Million (PPM) or 600 PPM. The study also found that there was a general lack of awareness on the issue of lead by majority countries. The report states that in the absence of any mandatory standards big and small, companies continue to make use of lead without caring for environmental and health hazards.

The Acting Director of the Central Environmental Authority (CEA) Sarojini Jayasekera said that some common sources of lead that we come across in our day to day life are enamel, bases paints in houses batteries used in vehicles, toys, etc.

There is a high risk of exposing children to lead from toys and ingesting and degraded paints.

The exposure to lead can be diverse and multiple with respect to human health and environment. She said lead has no biological utility and is hard to eliminate from the body. It could have an adverse effect on the human body. Children are particularly more vulnerable to the lead exposure. The toxicity of lead often depends on the blood levels. The lowest toxic range influences intelligence, hearing, growth and pregnancy.

The CEO of Akzo Nobel Paints Lanka (Pvt) Ltd, Gerald de Saram said at a media briefing recently that an international report on paints covering several countries were published in India. The report deals exclusively with lead in decorative paints used in households.

He said people who come in contact with decorative paints should be careful when they use such products. However, the paints manufactured by them contained less lead, according to the IPEN.

The CEO said strict regulations governing the paint industry was a pre-requisite. “I propose a partnership be set up with NGO’s, businesses and the regulatory authority on the management of toxic materials.

“It was scary using paints with a high percentage of lead. The issue is whether we are able to manage lead to conform to safety standards. Lead is a toxic substance that affects the children who are vulnerable. Studies have found that it also affects the reproductive process of the adults. Persons who come into contact with lead from paints and from automobile fuel emissions etc. Pharmaceutical, paints and even the food industry contain such chemicals. “We have to use them carefully and sensibly,” he said.

The CEO Saram said they have done away with the wood preservative business despite being the market leader in Sri Lanka. “It is because it was harmful to our stakeholders and to customers as well. Profit should not come to us at the cost of hurting our customers as well.”

He said some of the chemicals used in the paint industry were extremely dangerous. The Western companies were more sensitive to this problem than their Asian counterparts when it comes to quality standards.

Meanwhile, the IPEN report said that the paint industry in Sri Lanka comprises 30 large and small players.

Some were well known companies for strong brands. According to the Census and Statistics Department around 100 paint companies operated in 2003, declined to 60 in 2004.

The IPEN report states that the highest concentration of lead was found in enamel paint samples. However, one paint company viz. ICI had lead levels less than 90 ppm in both enamel and emulsion samples.

Weight gain contributes to breast cancer risks

by Madeline ELLIS

If you were to do a little time travelling, flashing back to when you were 18, how would your weight differ from what it is today? According to research by the American Cancer Society, the amount of weight a woman gains after the age of 18 is a strong indicator as to whether she will get breast cancer later in life.

Weight gain and body mass were identified long ago as risk factors for breast cancer. The Cancer Society estimates between one-third and one-half of all breast cancer deaths among older women have been contributed to weight.

Fat tissue makes estrogen, and estrogen can help breast cancer grow.

Heather Spencer Feigelson, senior epidemiologist with the American Cancer Society said, “Breast cancer is strongly dependent on body weight. Even modest amounts of weight gain lead to a significantly increased risk of breast cancer.”

One of the largest studies of breast cancer and weight included 1,934 breast cancer cases among 62,756 women involved in a separate long-term study. Women ages 50 to 74, who were post-menopausal, were asked their weight in 1992 when the study began and their weight when they were 18 years old. They were also sent questionnaires at yearly intervals.

The researchers said older women who gained 20 to 30 pounds after high school graduation were 40 percent more likely to get breast cancer than women who kept the weight off. If the weight gain was more than 70 pounds, the risk was doubled. Lean post-menopausal women not taking hormone replacement therapy produce very little estrogen and had the lowest cancer risk in the study.

Associate professor of surgery at Columbia University, Dr. Paul Tartter said, “The more fat you have-fat cells are capable of synthesising estrogen-the heavier you are, the higher your estrogen levels. There’s no question that estrogen is the common denominator of most of our risk factors for breast cancer.”

A study published in the Archives of Internal Medicine suggests that weight gain throughout adulthood is linked to an increased risk of developing breast cancer after menopause for women who do not undergo menopausal hormone therapy. Scientists already knew that being overweight or obese increased breast cancer risks after menopause, but the correlation between the timing and the amount of weight gain in adulthood had not been investigated before.

The study showed the importance of the timing of when the weight gain occurred. Women who put on more than 66 pounds between the ages of 18 and 35 had a 65 percent higher risk, but those whose weight increased by the same amount between 35 to 50 had a 223 percent higher risk of developing breast cancer after menopause.

The results of these studies appear to confirm that putting more estrogen into the body increases the risk of breast cancer for older women, whether the estrogen comes from hormone therapy or from being overweight. The postmenopausal women at the lowest risk seem to be the ones with the lowest levels of estrogen, who do not use menopausal hormone therapy, and who stay lean.

- Healthnews