The other day, a 28 year old guy stepped into my OPD with history of bleeding while he was defecating for the last 3 months. He has been showing this to a medical practitioner and is being treated for piles. But the symptoms persisted. He then decided to show it to me after hear say that I’m a good Surgical Gastroenterologist (Thanks to that patient who suggested my name and elevated me professionally). After thorough investigation, time has come to declare the test results. He has rectal cancer. Though I see many patients with rectal cancer as a professional, this one particularly bothered me as this young gentleman was married a little more than a year ago and has a months old baby. After gaining my senses, I decided to break the long silence and declared, ‘I’m sorry to say, but you have cancer in your intestine’. After a minutes pause, both husband and wife broke the silence with tears and asked me ‘why me doctor? Don’t you think I’m too young for cancer? Do you think I should undergo evaluation again? I think reports might have some errors?’. With a heavy heart I sighed and thought to myself, ‘I wish it was not true?’.
Though India is competing with developed countries with rocket pace in many fields, the very basic sense health care of the general public has not changed much in the past 20 years. People are readily adapting to the new life style in tandem with technology, but not with healthy life style. Diseases of the colon, rectum and anus are quite common among the general public even in the past, but the problems have increased substantially with western life style adaptation. Soon diseases of the colon and rectum are going to reach epidemic levels with rapid urbanization and westernization of food and life style. Stanford university research has clearly showed that Indian style lavatories are healthy and decrease the incidence rate of piles in people, compared to the western style lavatories. But it has not got wide acceptance by the general public, as most of the general public consider an Indian styled commode is Unstylish!!!?
Some of the diseases of the colon, rectum and anus are piles, fistula, fissure, prolapse, cancer, Inflammatory Bowel disease etc. Most of the times symptoms overlap, making it difficult to differentiate one from the other. Common among symptoms are bleeding while defecating, incomplete defecation, constipation, swelling around the anus, pain in the anal region, black tar like stools, anemia, abdominal bloating, pus from peri-anal region etc. Among all these, change in the bowel habits, weight loss, loss of appetite, painless swelling in peri-anal region, anemia and incomplete defecation highly suggest a carcinoma, either in the Gastrointestinal tract or elsewhere. It is recommended by many Gastroenterology associations globally, that any patient with these symptoms should undergo a thorough evaluation regardless of age. Evaluation might include a colonoscopy/ sigmoidoscopy/ proctoscopy/ ulrasonogram of abdomen and pelvis or a trans-rectal/ axial CECT along with blood investigations. Most of these bodies recommend a surveillance colonoscopy after 40 years of age for the general public. This awareness is still lacking in India.
With newer technologies and rapidly evolving private health care sector, care in coloproctology has improved significantly. But the affordability of patients has hardly changed. Though government is providing insurance to a limited population below the poverty line, it needs to rapidly change its plan and act towards preventive care by educating people about life style and food related diseases. Though an oncologist also deals with colon cancers, Colorectal surgery is a specialist training to Surgical Gastroenterologists dealing with both the benign and cancers related to the large intestine and anus from the time a cancer is diagnosed till the cure of the disease. A Surgical Gastroenetrologist plays a team leader role in dealing with cancers related to the large intestine and other parts of Gastrointestinal system.
“The Colorectal Clinics” by Sanjeevani PEBLS, Advanced Gastro Center is the first of its kind focusing on diseases of colon, rectum and anus in the capital city ‘Amaravathi’, of the newly formed state of Andhra Pradesh. Team of Surgical Gastroenterologists provide Surgical care of international standards with newer technologies and provide diagnosis with high end ‘Narrow Band Imaging Colonoscopy’.
Dr Pavan Addala
M.B.B.S, M.S (Manipal)
D.N.B Surgical Gastroenterology (Apollo Hospital, Chennai)
Consultant Surgical Gastroeneterologist, Sanjeevani PEBLS Advanced Gastro Center