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Doctors urge colorectal screening to reduce 3rd leading cancer in PHL

By RIE TAKUMI, GMA News

When he was diagnosed with stage 1 colorectal cancer (CRC) in 2013, Christian Guerrero could not believe it.

"There's no one in the family, both on my mother's side and my father's side who has CA. It's the first. Knowing you are the first member of the family to have CA, parang may doubt," Guerrero said.

He only had himself tested when he began bleeding from his rectum, not realizing that the stomach cramps and bloatedness he had been experiencing in previous months were already signs of his condition.

"Knowing that you have CA, it's like the whole world [fell] upon you," he said.

Guerrero's case is an example of what The Medical City Cancer Center (TMCCC) is trying to minimize by educating the public of the latest advancements in detecting and treating CRC.

 

 

"This starts with educating the public and our physicians," TMCCC director Dr. Daniel Alonzo said at a symposium at TMC on Tuesday. "Education includes the following: prevention, screening, and early diagnosis."

 

 

Preventative medicine and early screening

CRC is the third leading type of cancer in the Philippines, behind breast and lung cancer, with at least 1.4 million cases and 693,900 deaths in 2012.

 

 

People aged 50 and above regardless of gender are at most risk, and their lifestyle habits—including their consumption of red or processed meat, smoking and drinking, and weight—play a heavy factor in their chances of recovery.

But with early detection, said TMC Department of Surgery chairman Dr. Manuel Francisco Roxas, CRC is one of the most preventable and curable cancers.

"Screening works. If you pick it up early, it's also very curable," Roxas said. "The [main] cure is surgery. If you remove it early, you don't need chemotherapy, you don't need radiotherapy, as long as it's early."

One of the most routine tests is a fecal occult blood test (FOBT). Costing an average of P400, it uses the patient's feces to determine rectal bleeding and must be undertaken every year.

The American Cancer Society recommends a combination of FOBT and flexible sigmoidoscopy, a process where the nearest part of the colon and the rectum are checked with a flexible, lighted tube called a sigmoidoscope, every five years.

Colonoscopies are carried out after initial signs have been detected. The procedure costs at least P10,000 and involves using a long, flexible tube to check the entire colon for polyps, tumors, or any form of lesions or bleeding.

Robots and chemo wash

Due to his weight at the time and limitations in technology, Guerrero developed complications which required the use of a colostomy bag to prepare his body for a third and final procedure.

"I would say that is the most painful three months of my entire life. Very painful because I was not able to adapt to the system. I had allergies all over my body," he said.

Roxas said they could not do much then, but robot-assisted surgery procedures, such as the da Vinci surgical system, now allows for less invasive, more precise operations which help reduce complications.

 

 

"Sometimes operations are not easy because it's like operating with a chopstick. The innovation now is instead of like holding a chopstick, we have the robot that moves like a human hand in a very tight space," Roxas said.

Heated intraperitoneal chemoperfusion (HIPEC), or "chemo bath", also helps improve recovery.

In HIPEC, a heated chemotherapy solution is circulated throughout the patient's abdomen after surgery to kill remaining cancer cells.

ERAS and the PhilHealth Z Package

But perhaps the most important advancement now implemented by TMC is enhanced recovery after surgery (ERAS), protocols aiming to minimize complications and costs for patients and health institutions.

"[Guerrero] was a little obese when we operated on him; he was not in the best of health. Complications go up for that," Roxas explained.

“With [ERAS], we’re able to build our patients up better. We’re able to build up their immune system, we’re able to feed them early, so the complication rates have gone down."

 

 

ERAS, an evidence-based approach to peri-operative care, aims to help patients recover faster by allowing them to be mobile and consume food and water as soon as possible after a major operation.

It also has patients eat well, exercise, avoid stress, and stop both smoking and consuming alcohol to prepare their body for surgery.

Health Secretary Eric Tayag said the Department of Health (DOH) will study ways to integrate these advances into PhilHealth's Z Benefit Package for colon and rectal cancers.

"We want to make sure we cover all bases," Tayag explained. “We're pushing more for prevention… We're focusing on diseases that matter."

Roxas, one of the main consultants on the health package, said PhilHealth will have funds "even for the most indigent" who require CRC treatment.

“The most indigent patients are given—if it’s colon, almost P300,000, or lampas P300,000 for the whole treatment. For rectum, P450,000. That will cover surgery, chemotherapy, radiotherapy," Roxas said.

Even those with means can opt for the Z Package's negotiated fixed co-pay.

“They benefit from it, PhilHealth, and then they just have to match similar amount kasi they want to be in the private hospital. Even the private patients will get support from colorectal treatment under the PhilHealth Z Benefit,” Roxas said.

Health literacy

However, for these advancements to truly benefit Filipinos, Tayag said, public health literacy must improve.

 

 

"If the recipient of that message has no health literacy, they will be made clueless," he said.

"Even before we can think about the information we can best share with our patients, sharing them at the right time, in plain language as much as possible, we should join hands in making sure health literacy improves in this country," Tayag added. — BM, GMA News

Tags: colorectalcancer, coloncancer, philhealth, departmentofhealth
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