Introduction
Colorectal cancer is the third most common cancer in India and is increasingly affecting adults under 50. Early detection dramatically improves outcomes - Stage I disease has a 5-year survival above 90%, while Stage IV survival is far lower.
The trouble is that early symptoms are easy to dismiss. A bit of bleeding blamed on piles, a change in bowel habit blamed on stress, mild anaemia blamed on diet. By the time these symptoms become impossible to ignore, the disease is often more advanced.
This article walks through the five warning signs that should always be evaluated, who should consider screening even without symptoms, and what a colonoscopy actually involves.
What is colorectal cancer?
Colorectal cancer starts in the large intestine or rectum, almost always from a small benign growth called a polyp. Over 5 to 10 years, some polyps turn cancerous. This long lead time is what makes screening so effective: a colonoscopy can find polyps before they turn cancerous and remove them in the same sitting.
Caught at Stage I (confined to the bowel wall), surgical cure rates are above 90%. The disease is one of the most curable solid cancers when caught early - and one of the most challenging when caught late.
Modern colorectal cancer surgery is largely laparoscopic, with equivalent long-term outcomes to open surgery and significantly faster recovery.
Symptoms & when to seek help
- Blood in stool, even if intermittent
- Persistent change in bowel habit lasting more than 4 weeks
- Unexplained weight loss with abdominal symptoms
- Iron-deficiency anaemia in adults, especially men
- Family history of colorectal cancer in a first-degree relative
- Persistent feeling of incomplete bowel emptying
- Narrow or pencil-thin stools
Causes & risk factors
- Age over 45 to 50
- Family history of colorectal cancer or polyps
- Personal history of inflammatory bowel disease
- Diet high in processed and red meat, low in fibre
- Obesity, smoking, heavy alcohol use
- Type 2 diabetes
- Genetic syndromes (FAP, Lynch)
How it is diagnosed
- Outpatient consultation and digital rectal examination
- Colonoscopy with biopsy of any suspicious area
- CT scan of abdomen and chest for staging
- MRI of pelvis for rectal cancers
- CEA blood test as a baseline tumour marker
- Multidisciplinary tumour board review
Treatment options
- Polyps and very early cancers removed at colonoscopy
- Localised colon cancer: laparoscopic colectomy
- Rectal cancer: chemoradiation followed by surgery
- Adjuvant chemotherapy for higher-stage disease
- Stage IV: combination chemotherapy, sometimes surgery for liver or lung metastases
Recovery & aftercare
- Day 0 to 1: surgery and early walking
- Day 2 to 4: gradual diet advancement
- Day 5 to 7: discharge home
- Week 4 to 6: adjuvant chemotherapy if indicated
- Long term: structured surveillance colonoscopy and CEA monitoring
Risks of delaying care
- Stage progression with sharply lower survival
- Bowel obstruction requiring emergency surgery
- Local invasion into bladder or pelvic structures
- Spread to liver, lungs or peritoneum
- Severe anaemia requiring transfusion
Frequently asked questions
Reviewed by
Dr. Sanjay Yadagiri
Consultant - Minimal Access Surgery & Surgical Oncology
Over three decades of surgical experience. UK-trained, France-certified in laparoscopic and colorectal surgery, with a long association with the Indo-American Cancer Institute and Omega Hospitals, Hyderabad.
Continue reading
Related patient guides
Have questions about your case?
Book a private consultation with Dr. Sanjay Yadagiri in Jubilee Hills, Hyderabad.