What is a colorectal cancer?

Colorectal cancer (CRC) is a collective term for cancer (tumor) of various areas of the colon and rectum. Among the multitude of other oncological diseases, this pathology is the least publicly known, the most obscure and most feared by patients, nevertheless, modern early-stage diagnosis possibilities give reasons to believe that CRC may be prevented in ~95% of cases.

Colorectal cancer is one of the most prevalent oncological disorders. Among males affected by malignant neoplasms, CRC occupies the third position following only lung and stomach cancer; in women it follows breast and skin cancer. The high mortality rate during the first year after the establishment of the diagnosis is an alarming reality. This is due to fact that 70% of patients affected by middle intestine cancer and over 60% affected by rectum cancer initially referred to a physician for diagnosis already had an advanced stage of cancer (stage III or IV), and at these stages about 40% of patients must undergo operative therapy.

Colorectal cancer predominantly develops as a degeneration of adenomatous (glandular) polyps.

Some of the other best studied predisposing factors are inflammatory diseases of the intestines (ulcerative colitis and Grohn's disease).

Age is a significant risk factor: colorectal cancer is rarely revealed before the age of 40, however, the frequency of its discovery increases with each subsequent decade and reaches its maximum at 60 to 75 years.

Screening is recommended to persons whose first-degree relatives (children, parents, brothers and sisters) were diagnosed with colon or rectum cancer, adenoma and intestinal inflammations. Such diagnoses in a close relative indicate an increase of risk level by a factor of two as compared to general population.

What is colorectal cancer screening?

This is a suit of procedures aimed at revealing persons exposed to CRC risk factors or affected by symptomless CRC. The procedures are based on specialized diagnostics techniques. Screening assays of colorectal cancer make it possible to drastically reduce the chance of carcinoma development since they allow detection of pre-malignant condition of the intestines or an early-stage cancer, and timely provision of medical assistance.

Colorectal cancer has many disguises, so it is a good idea to consult a physician if:

• you experience previously nonexistant increased tiredness, labored breathing, uncharacteristic paleness;
• you experience prolonged constipation or diarrhea;
• you often feel pain in the stomach;
• you see blood in stool after bowel movement;
• occult blood is revealed by a stool test.

Screening

Colonoscopy is the most informative and widely used early-stage diagnostic technique. This is an endoscopic (intraluminal) examination of the mucosal lining of the rectum, colon and a section of the small intestine (approximate probe length is 2 meters). Any abnormal tissues and polyps found during colonoscopy will be removed, or their samples will be taken for a histological analysis. If some abnormal growth has a broad base and cannot be safely removed during the colonoscopic procedure, the physician will consider a surgical intervention.

If polyps or some other pathologies are found in the colon and rectum, the frequency of examination may be increased to once annually or once every three to ten years. When assessing the risk of colorectal cancer development in patients with bowel disorders, the medical specialist will make a decision on examination frequency individually for every patient.

Immediately after cancer has been diagnosed, patients must undergo computer tomography of the thoracic cage and the abdomen to reveal any metastatic lesions, as well as laboratory studies to estimate the degree of manifestation of anemia.

In 70% of patients affected by colorectal cancer, increased levels of carcinoembryonal antigen (CEA) and the cancer-specific marker CA19.9 have been noted. Subsequent monitoring of CEA and CA19.9 may be useful for early diagnosis of tumor recurrence. Depending on indications, other colorectal cancer-specific markers may be studied.

This proactive stance of medical specialists toward early polyp diagnostic and colon/rectum tumor prophylaxis may result in a slowdown in the rate of growth of colorectal cancer incidents.

Uterine neck cancer screening

Uterine neck cancer (UNC) is the second most prevalent type of cancer in women around the globe, and the primary cause of cancer-related mortality among women.

Uterine neck cancer screening is a mandatory diagnostic procedure which all the patients of the risk group of this dangerous disease should undergo. The uterine neck cancer screening program was developed to reveal abnormal cervical cells at an early stage of development when they could be removed before a carcinoma develops.

Expected response to treatment and even the patient's life may depend on timely diagnosis of uterine neck tumor. The screening makes it possible to detect a pre-malignant abnormal tissue change which, in the absence of treatment, may transform into cancer.

What is the uterine neck cancer risk group? It should be said that the term is somewhat vague. The fact of the matter is that such a pathology may develop in any woman who have had sexual relationships.

One of the triggers of a pathology is human papilloma virus. However, papilloma virus may also affect virgins and very young girls. Research results confirm that the disease is transmitted not only sexually, and thus the screening assay should be performed on all the representatives of the fair sex.

The screening assay involves a number of tests:

• a Papanicolaou swab of uterine neck is taken (a cytological study is performed). A cytological examination offers sufficiently accurate information on the cellular composition of the studied organ and thus is a gold standard in uterine neck cancer screening;
• Liquid-based cytology is one of the most widely used and most accurate types of uterine neck cancer screening. After a Papanicolaou swab is taken, gynecological tools are submerged in a special liquid which washes off cells of the studied tissue. Following that, the specimen is placed into a centrifuge to separate blood, mucus and other impurities. Individual cells are studied under the microscope.
• Visual examination of the surface layer of uterine neck: there are several types of supplementary screening assays: visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI).
• Detection of human papilloma virus (HPV) DNA. These tests enable the detection of high-risk types of HPV DNA in vaginal or cervical swabs.

Every woman should take care of her reproductive system’s health, visit a gynecologist regularly and undergo preventive diagnostic examinations. This will make it possible to reveal dangerous gynecologic pathologies at an early stage, and to cure the disease promptly and safely.

Preventive activities involve vaccination and regular colposcopic examinations.

Breast cancer screening

It is a fact of life that mammal gland cancer is the leading oncological disorder of women in Belarus.

Mammal gland cancer screening is an important component of State Program “Public Health and Demographic Safety of the Republic of Belarus” for the period of 2016 to 2020. Early-stage detection of malignant tumors is the only way to reduce morbidity due to oncological diseases. In this regard, mammal gland cancer screening is one of the four methods of preventive examination that offer scientifically proven effectiveness.

The essence of the technique is that all women aged 50 to 70 are recommended to undergo regular (once every two years) mammography examination. Women of these ages are the main breast cancer risk group.

Mammal gland cancer screening involves:

• a mammologist'sexamination,
• an ultrasonic examination of mammal glands. One advantage of this technique is that there is no X-ray exposure. It is recommended that women over 35 years old have breast ultrasonography once every year. This is especially important for patients affected by benign breast neoplasms like mastopathy or fibrous adenoma, since their occurrence is a risk factor of a malignant tumor development in itself.
• Digital X-ray mammography examination is X-ray imaging of the mammal gland without the use of a contrast medium performed at a special machine called mammography station. This examination makes it possible to reveal even very small tumors at early stages of development, even before they become palpable. The study enables early-stage diagnosis of mammal gland cancer and offers the possibility to completely cure a malignant tumor, to reduce the duration of therapy or to perform only excision of the tumor itself and not the whole breast.