The sudden death of American actor Chadwick Boseman late last month has thrown colon cancer back into the spotlight, and local surgeon Dr. Ernest Jehangir is hopeful the tragedy will help highlight the importance of screening and early detection.
“We’re beginning to see these cancers in younger people and that is one of the lessons that this unfortunate death brings to light, is that we find that people are getting this cancer earlier than before,” Jehangir told the Cayman Compass.
Boseman, 43, who was widely known for his portrayal of the popular Marvel character Black Panther, succumbed to stage four colon cancer after a four-year battle on 28 Aug.
Jehangir, a colorectal surgeon at the Cayman Islands Health Services Authority, said there is a high rate of colon cancer among the African-Caribbean population, and he wants Boseman’s death to spur people to take cancer checks more seriously.
“I sincerely hope it will make an impact, and I hope that people will come forward for the screening for cancer,” he said.
Screening a must
Here in Cayman, colon cancer is the second-leading cause of cancer-related deaths for women, and among the top cancers detected in men.
Local cancer statistics, Jehangir said, are difficult to collate, as registering on Cayman’s Cancer Registry is voluntary, and often people with colon cancer seek treatment aboard, making it tough to keep track of numbers.
According to the Cancer Registry, colon cancer is the second-most commonly reported cancer.
Approximately 8% of registered cases involve colon cancer – 37% of which are male patients, and 63% are female.
The average age at the time of diagnosis for reported cases of colon cancer is 52 years old.
Globally, Jehangir said, it is the second-leading cause of cancer-related deaths and, based on US figures, one out of 21 men and one out of 23 women will develop colon cancer in their lifetime.
“We talk about prostate cancer [and] breast cancer separately for men and women, but if you put men and women together, colon cancer is probably the biggest killer, or maybe the second,” he said.
Jehangir said the most effective way to detect colon cancer is through a colonoscopy, which entails inserting a long flexible tube, with a camera at the tip, into the rectum to scan for abnormalities throughout the entire colon.
He said while the procedure may make patients apprehensive, it is key for the detection of cancerous polyps.
“In the colonoscopy, probably the worst thing is taking the bowel prep than doing the procedure itself. Most patients just sail [through]. In fact, yesterday [Tuesday], one of the patients asked me when I finished the procedure, ‘Doc, when are we going to start? I said, ‘It’s over, done with,’ so it’s not as daunting as one would think,” he said.
The colonoscopy takes about 30 to 40 minutes and, he said, in Cayman, patients are sedated when it is performed.
This makes it more “comfortable” as patients do not feel any pain nor do they remember the procedure, he said.
“I would advise everybody to stick to the guidelines which have been put out. … You do a colonoscopy at 45 if you are [of] African Caribbean heritage. If you are [of other heritage], it would start at 50. That is the guidelines that [are] put out by the American College [of Physicians],” he said.
Early detection saves lives
Jehangir emphasised that, as a physician, he is seeing younger patients and “when they are younger, the disease is more aggressive”.
“So, we need to pick it up early. My take-home message is very simple – look in the pot. When you go to the toilet, look in the pot. If you see red, it’s an absolute dangerous signal, and you need to see a doctor straight away,” he said. While he cautioned that the sight of blood in the stool does not mean the patient has cancer, he said it is an indication that something is wrong, and it needs to be checked.
He said while diet is a predisposition to bowel cancer, smoking, alcohol and family history also play a big part.
“Now, if you have other predisposing conditions, like ulcerative colitis or inflammatory bowel disease, you’re also at a higher risk group and they become special cases,” he said.
Jehangir explained that once a polyp is found, it is removed and sent to the lab.
“We look at it and we see whether it’s a type that will develop into a cancer or not. If it is the type that develops into a cancer, you will be put on to a surveillance programme where we will be doing a colonoscopy regularly to pick up new polyps or any changes in the area where we removed the polyp,” he said.
Treatment for colorectal cancer, Jehangir said, is almost entirely surgical, although they may be additional treatments, such as chemotherapy and radiotherapy.
“So, once we find the tumour, we will then offer a patient surgery and we usually do the keyhole method… that is laparoscope,” he said.
The cure rates for cancers in stage one is nearly 95%, he said, whereas if it is caught at stage four, there is a less than 5% cure rate.
“So, that is the headline figure. If we catch it early, we can treat it well. If you catch it late, then I’m afraid not,” he said.