Chulalongkorn University's expertise in medicine and pharmacy encompasses the field of colon and rectal cancer. This type of cancer, also known as colorectal cancer, is prevalent both nationally and globally. In 2020, statistics revealed that approximately 20,000 Thai individuals were affected by this cancer, ranking it as the 4th-5th most common cancer in Thailand. Additionally, around 10,000 people lost their lives to this disease during the same year. These figures highlight the significant public health issue posed by colon and rectal cancer at the national level. Consequently, public education is crucial to promote self-care practices and minimize the incidence and mortality rates associated with this cancer.

    Risk factors for colorectal cancer can be classified into two main categories: modifiable and non-modifiable factors. Let's first explore the non-modifiable risk factors to determine the current level of risk and the necessary monitoring for potential symptoms. These non-modifiable risk factors include:

      1. Advanced age: Increasing age, especially beyond 50 years, inevitably raises the risk of colon and rectal cancer.

      2. Polyps in the colon and rectum or a personal history of colorectal cancer.

      3. Chronic inflammatory bowel disease.

      4. Presence of specific hereditary conditions such as Lynch Syndrome (hereditary non-polyposis colorectal cancer or HNPCC) and familial adenomatous polyposis (FAP).

      5. Family history of colon cancer.

      6. Diabetes.

    Modifiable risk factors for colorectal cancer should be taken into consideration to encourage behavioral changes that reduce the chances of developing the disease, particularly in individuals with unmodifiable risk factors. These modifiable risk factors include:

      1. Being overweight or obese.

      2. Leading a sedentary lifestyle with little to no physical activity.

      3. Excessive consumption of certain foods, such as red meat and animal fat, as well as processed meats like sausages and bacon.

      4. Smoking.

      5. Alcohol consumption.

    It is worth noting that items 4 and 5 are recognized risk factors associated with the incidence and mortality rates of other cancers, such as lung and liver cancer, as well as various chronic diseases.

    Early detection plays a crucial role in successful cancer treatment and prolonging patients' lives. Detecting the disease in its earliest stages, ideally before it advances, significantly enhances the effectiveness of treatment. Consequently, professional associations in public health are dedicated to issuing recommendations that facilitate timely screening before the onset of symptoms.

    The Association of Gastroenterologists of Thailand has provided the following recommendations for colon and rectal cancer screening:

      1. Individuals aged 50 and above, classified as medium-risk, should undergo colon cancer screening. However, given the increased incidence of colorectal cancer in younger populations in recent years, some guidelines suggest initiating screening at the age of 45.

      2. Individuals at higher risk than the general population should undergo earlier screening based on their specific risks. This includes patients with genetic conditions predisposing them to colon cancer, individuals with first-degree relatives (parents, siblings, blood relatives) diagnosed with colon cancer or colon polyps, patients with chronic inflammatory bowel disease, and those with a history of colon polyps or prior colon cancer.

    There are three primary screening methods for colon and rectal cancer:

      1. Periodic examination for hidden blood in the stool, typically performed every 1-2 years.

      2. Colonoscopy, usually conducted every 10 years if no abnormalities are detected.

      3. Computed tomography of the colon.

    Recognizing the significance of screening, the public sector, through the National Health Security Office (NHSO), provides convenient access to cancer screening services for various types of cancer, including cervical, colon, and oral cancer. Eligible individuals covered by the National Health Security system can avail these benefits

Assoc. Prof. Dr. Nattada Areepiam and Asst. Prof. Dr. Bodin Tiwasuwan

Faculty of Pharmacy Chulalongkorn University