Colorectal Cancer Risk Factors In Older Adults

Colorectal cancer risk factors in older adults

Summary

Colorectal cancer is one of the most frequent diseases in our environment;In recent years there has been a theoretical, practical and technological advance in the knowledge of the mechanisms that participate in their evolution and prevention. Most elderly patients suffering from colon cancer suffer from cardiovascular and pulmonary diseases, which increases surgical risk, post -surgical morbidity and mortality. The effectiveness of surgery in older adults depends on security with the realization, patients will return to their normal life, or at least, they will not decrease with the surgical procedure. Despite the advances in surgical techniques, the anesthetic procedure and post -surgical care, which have returned to safer surgery, less elderly patients undergo colorectal cancer surgery, compared to younger ones, since they are offeredOn a smaller scale an ‘optimal treatment’ that includes the fact that they have less possibilities of being referred to a specialist with knowledge knowledge to make this decision;properly, due to its mental and physical fragility and presents an organic disorder of age. Finally, the aspects that seem important to me in the diagnosis and prevention of this disease are described, in order to increase the life expectancy of patients suffering from colorectal cancer. In this trial we will deal with colorectal cancer, symptoms, causes, types, risk factors in older adults and prevention, etc.

Keywords: colorectal cancer, polyps, diagnosis, risk factors, colonoscopy. 

Introduction

Colorectal cancer is the second most frequent tumor in humans. Scientific and technological advances offer patients, increasingly effective treatments and although survival rates are increasing. Receiving a cancer diagnosis implies a great emotional impact and is a break with the usual way of life. Overnight and in many cases without prior notice, we are forced to change habits and customs, give up many things and above all to face situations of threat and unknown. The hospital, the tests, the waiting for the results, the treatments, are difficult situations for sick, family and friends. Sometimes treatments are brief and experienced and life quickly returns to normal. Other times, it is more and longer complicated, with relapses and the process becomes longer and more complicated. Each case is unique, and it will be unique to live it. In this trial we try to inform about the risk factors of colorectal cancer in older adults, since it is a topic of great interest for the elderly, family, friends, etc. And its objective is to provide a useful resource to the community in general, to face this disease. 

Developing

 The word cancer is a very broad term that covers more than 200 types of malignant tumors. Each of them has particular characteristics that in some cases are completely different from the rest of the other cancers, being able to identify independent diseases, with their causes, their evolution and their specific treatment. That is why it is not appropriate to compare with each other the process through which two people who have a diagnosis of cancer may be happening. Despite suffering a disease that has the same name, its symptoms, treatments and evolution can be totally different and what is used for one cannot have any value for another. (Sáenz, 2015) 

 Colorectal cancer (CCR) is also known as colon or rectum cancer and the third most frequent cause of morbidity and cancer mortality for both men and women. The rates of incidence and mortality by age are very high, so it is a serious public health problem worldwide, especially in very rich countries. Most colorectal cancers appear on an existing polyp years before in the mucosa of the colon or rectum, which over time and due to the action of different agents on it, evolving to a malignant tumor. (Yépez, 2012) Polyps are small benign tumors that appear in the mucosa of the colon and rectum. They are usually quite frequent in the population of more than 50 years. When a microscope polyp is observed, it can be seen that there are several different types: hyperplastic: they are the most frequent and are not evil. 

• Inflammatory: Like the previous ones, they do not have the ability to malignant. 
• Adenomatous: they have a potential for malignancy, which depends on their size and number;Not all adenomatous policies are malignant, only 10% of them do it. 

A healthy lifestyle can reduce the risk of colorectal cancer and people who perform physical activity during their free time. The prevalence of excess weight presents an ascending tendency and is more prevalent in 50 -year -old women, so it can be argued that important changes in lifestyle, along with a greater probability of a late diagnosis, can explain theCCR behavior. The low mortality rates in countries such as Brazil, Colombia and Mexico had a favorable effect of dietary habits in these countries;However, colonortal cancer patterns for the future are unfavorable as consequences of changes in dietary habits, including an increase in prevalence of overweight and obesity. (NORAT, 2013).

 Advances in chemotherapy and early detection of the CCR have improved survival even in patients with liver disease and has led to a decrease in CCR mortality in a large number of countries. In Latin American countries, this scenario is distant for the majority of the population due to the high proportion of cases detected in advanced stages. (NORAT, 2013). CCR survival has increased and reflects progress in the control of the disease, however, it continues to be low compared to developed countries, which highlights the deficiencies of health services for early diagnosis, timely treatment andAttention to the monitoring of patients with CRC. Taking into account the upward trend of the incidence and mortality of the disease and premature mortality by CCR can be avoided;It is a priority that it implements an early detection program and that guarantees timely and quality access to the diagnosis and treatment of patients with this disease, since one of the greatest limitations of this study is the care of information on the subject at the time of diagnosisIn patients with CCR. (Pardo, 2016) 

Symptoms

 Like all malignant tumors, colorectal cancer produces a series of symptoms, which can vary depending on their location within the large intestine:

•  Blood in the stool: it is one of the most frequent symptoms of colorectal cancer. It can be red blood, more frequent in straight, sigma and descending colon tumors, or black blood, which is mixed with the stool giving rise to black deposits also called hair that appears frequently when the tumor is located in theascending colon.
•   Change in the rhythm of deposits: diarrhea or constipation appears in people with normal intestinal rhythm. It is necessary to keep in mind that this symptom can be intermittent and it is advisable.
•   Narrower stools: this is practically produced because the tumor is narrowing the intestine and does not allow the normal step of the feces. 
•  Tenesmus or incomplete evacuation sensation: it usually appears in tumors located in the rectum or in the left colon. 
•  Abdominal pain: It is usually a frequent symptom, although normally, it is an nonspecific pain. When the tumor partially closes the caliber of the intestinal tube, an abdominal colic pain is produced. When the closure is complete, it is accompanied by constipation and vomiting. 
• Extreme fatigue or weight loss without apparent cause: general and nonspecific symptoms that occur frequently in cases of diseases, among which are tumors. (Blanco, 2010) 

Causes

Colorectal cancer is one of the main causes of death due to cancer. Early diagnosis can often carry out a complete cure;almost all CCL. He continued in the colon coating and the rectum. When doctors talk about colorectal cancer, it is usually what they are referring to. There is no unique cause for colon cancer. Almost all colon cancers begin as non -cancerous (benign) polyps, which slowly become cancer and there is a greater risk of colorectal cancer if: 

•  Is an age more than 60 years.
•  It is of African -American or Eastern Europe 
•  Consumes many red or processed meats. 
•  It has correct policies. 
•  It has inflammatory intestinal disease.
•   It has a family history of colon cancer. 

Some hereditary diseases also increase the risk of colon cancer. One of the most common is called family adenomatous polyposis (PAF). This type of cancer is also presented by the diet that people follow, since it can be associated with a fat diet, fiber low and high consumption of red meat. Some studies have found that the risk is not reduced if it is passed to a diet rich in fiber;smoking cigarette and drinking alcohol, are other risk factors for colorectal cancer. (Blanco, 2010). 

Types of colorectal cancer

 The vast majority of colorectal malignant tumors occur on injuries affected in their mucosa, such as inflammatory polyps or diseases. If we observe malignant cells at microscope colorectal cancers can be several types. They stand out among them: 

•  Adenocarcinoma that occurs in the glands that cover the inside of the colon and rectum. It is the most frequent type of cancer that appears in 90-95% of cases. SARCOMAS: Digestive tract connection tissue tumors. 
•  Lymphomas: Stomach and intestine defense cell cancer. 
•  Carcinoid tumors: from the hormone producing cells of the digestive system. 
•  Melanomas.- It is the most serious type of skin cancer. Melanoma;It is formed in the cells (melanocytes) that produces melanin, the pigment that gives color to the skin. Melanoma can also manifest in the eyes and, rarely, in the internal organs, such as the intestines. The fact that the tumor is less frequent does not mean that its prognosis is worse, but different from the type of tumor of greater incidence in colon and straight. 

Colorectal cancer classification

Depending on how far he has grown, colorectal tumors are classified into different stages or stages. It is a standardized way to describe the degree of cancer propagation. There are two classification systems for colorectal cancer. Both are used equally, and are called: TNM classification and classification of Astler and Coller. TNM classification: This system describes the degree of tumor extension (it is identified by T), the affectation or not of the nodes (identified by N) and the absence or presence of metastasis (m). These categories can be grouped to determine the different stages of the disease:  Stage 0: It is the most early phase of the disease, in which malignant cells do not transfer the most internal capacity of the colon or rectum (mucosa).  Stage I: The tumor has grown up transferring several layers, but without crossing, in any case, the muscle layer. There is no involvement of ganglia.  Stadium II: The tumor has crossed all layers that have the structure of the colon or rectum and in some cases can affect other organs. Ganglionic affectation is not appreciated.  Stage III: There are affected nodes, affected as far as tumor cells on the wall have penetrated.  Stage IV: The tumor spread and affected other remote organs. Astler and Coller classification.- In this classification, the letters ranging from A to D are used. A: Mucosa limited injury without ganglionic affectation. B: The tumor affects a part of the colon wall or rectum, without crossing it or affecting the ganglia. B2: It affects the entire wall without ganglione invasion. C: The disease can affect a part or the whole wall, with ganglionic affectation. D: There is an affectation of other remote organs. (Sánchez, 2013) 

Colorectal cancer diagnosis 

 When there are symptoms that suspect the possible existence of a colon or rectum injury, the doctor will ask for a series of tests to determine the diagnosis;First, a medical history is prepared in which patient data is collected, subsequently performing a physical examination in which the general state of the sick person is valued. This exploration, which includes rectal touch, is usually performed when the patient refers to some of the previously mentioned symptoms. The rectal touch consists of the manual exploration of the year and part of the rectum. The doctor plays a glove and uses lubricant to gently slide the finger through the anus and explore the area. Although it is an awkward proof, it is important to know that it is not painful. The more relaxed you get the muscles, the test will be easier. However, rectal touch is insufficient to reach a correct diagnosis, so it is necessaryto be presented by the anus. For the realization of the diagnosis, it is necessary that the person follow a special diet, at least for 2-3 days and the day before the laxative employer test, so that both the colon and the rectum are clean of feces and canObserve the mucosa without impediments. (Sáez, 2015) 

Emotional reactions

Facing a diagnosis of cancer is a complex, difficult and very stressful experience. Without a doubt, during this process a large number of events that generate tension, uncertainty and anguish will be combined. On a personal level, it constitutes a vital crisis, it is an unexpected and threatening situation that is a resounding change in the life of a patient, because, it goes from being a more or less healthy person, being a person with a serious illness, even more whenThey are older adults. Most of the patients diagnosed with an emotional shock affected;Upon receiving the news, some get very nervous, agitated, others feel tremendously sad, or locate themselves;There are many reactions. We could say that all those emotions, sensations and alterations mean that your alarm shot, you perceive that there is a threat and react. During this initial period of confusion, dejection, anger or anxiety they can accept what you feel and identify it. If you repress it, in the end, it explodes. It also is no use trying not to feel. Although it does not express it, it is still there, and sooner or later, in some way, it is. From the transformation of a first normal cell to the appearance of a detectable cancer, it is necessary that a high number of years take place, since, it is a process that entails multiple alterations in the genes. Although colorectal cancer is usually talked about, the term encompasses two very different behavior tumors: colon cancer and rectum cancer. Most colorectal cancers appear on an existing polyp years before in the mucosa of the colon or rectum, which over time and due to the action of different agents, evolving to a malignant tumor. 

CCR risk factors in older adults 

A risk factor is all that increases the probability that a person develops cancer, so it is very important to know the risk factors of colorectal cancer to help the patient make decisions and improve their lifestyle. These risk factors are: age.- The risk of developing colorectal cancer increases with age and can appear in young and adolescent adults, but most cases are presented in people over 50 years. For colon cancer, the average age at the time of diagnosis is 68 years in men and 72 years in women. Elderly patients who received a diagnosis of colorectal cancer unique challenges, especially in relation to cancer treatment. It is important to note that although colorectal cancer is still more frequently diagnosed in older adults, the incidence rate for colorectal cancer decreased around 5% per year in adults from 65 years or older and decreased 1.4% per year inadults from 50 to 64 years, according to the latest statistics. Meanwhile, the reduced incidence rate around 2% per year in adults under 50 years. The increase is due in large part to the growing amount of rectum cancer cases. About 11% of all colorectal cancer diagnoses are in people under 50 years. (Roque, 2011) 

• Sex.- Men have a slightly greater risk of developing colorectal cancer than women. 
• Race.- Black people have the highest sporadic or non -hereditary colorecrectal cancer rates, becoming one of the main causes of death related to cancer in race people. Black women are more likely to die from colorectal cancer than women of any other racial group and black men are even more likely to die of colorectal cancer than black women. The reasons for these differences are unclear. Because black people are more likely to receive a diagnosis of colorectal cancer at an earlier age. 
• Family history of colorectal cancer.- Colorectal cancer can be transmitted in the family if first -degree parents (parents, brothers, children) or many other family members (grandparents, uncles, nephews, grandchildren, cousins) have suffered colorectal cancer this occurs especially when thefamily members are diagnosed colorectal cancer before 60 years of age. If a person has a family history of colorectal cancer, their risk of developing the disease is almost double. The increased risk more if other nearby relatives have also developed colorectal cancer or if a first -degree relative received the diagnosis at an early age. It is important to talk to their family members about the family history of colorectal cancer. If you think you can have a family history of colorectal cancer, you must have a genetic test, since you can only determine if you have a genetic mutation. 
• Rare hereditary conditions. – Family members with rare hereditary conditions also have a higher risk of colorectal cancer, such as other types of cancer. 
• Inflammatory Intestinal Disease (EII) .- People with intestinal inflammatory disease such as ulcerative colitis or Crohn’s disease can suffer a chronic inflammation of the large intestine. This increases the risk of colorectal cancer. 
• Adenomatous polyps (adenomas) .- Polyps are not types of cancer, but some types of polyps, called adenomas, can be transformed over time into colorectal cancer. Polypes, often, can completely remove with an instrument during a colonoscopy, the removal of polyps can prevent colorectal cancer. People who have had adenomas are more likely to have polyps again and suffer from colorectal cancer, so they must have periodically monitoring detection exams (see below). 
• Personal history of certain types of cancer.- People with personal history of colorectal cancer and women who have suffered from ovary cancer or uterus cancer are more likely to develop colorectal cancer.
•  Physical inactivity and obesity.- It is possible that people with a sedentary lifestyle, who do not perform physical exercise and permanence for a long time, and those who are overweight or are obese, run a greater risk of contracting the CCL
•  Nutrition. – Current research systematically links the greatest consumption of red meat and meat processed with a greater risk of developing the disease. Other dietary factors have also been observed to know if the risk of colorectal cancer is affected. 
• Smoking.- Recent studies have detected that smokers are more likely to die of colorectal cancer than non -smokers. (Roque, 2011). 

Follow -ups and medical reviews

 Once the treatments have been completed, it is necessary. Patients should consider the changes produced by the disease as an opportunity to mark new goals in their life;The loss of some possibilities can lead to discover others that are always ignored;When the patient feels frustrated by the limitations of the CCR, he must regain control over the different areas of his life, adapt to the changes he has to do. After the most complete treatment, there is always a risk of reappearance of the disease. In case this occurs, its previous diagnosis allows you to install a rapid treatment again and therefore can increase the survival of the patient. This limited risk over time. Therefore, during the first 2-3 years after the diagnosis it is advisable to perform evaluations every 3-4 months. During the 4th and 5th year the reviews can be spaced by something more and are done every 6 months. From the 5th year, the reviews can be done annually. The tests that are usually requested in periodic reviews after the realization of a thorough exploration are the following: 

• Colonoscopy: It allows to determine if the tumor has been reappeared in the place of origin or if a new polyp is observed, which is exactly to remove to prevent evil evolution.
•  Complete analytics: parameters are determined that indicate the functioning of the liver (organ where metastases appear more frequently) and the rest of organs. Also request tumor markers that serve as guidance in the evolution of the disease. 
• Abdominal and pelvic TAC: Value the pulmonary state and the area where the tumor was located. Abdominal ultrasound: It allows visualizing the existence or not of liver injuries that make us suspect a metastasis. 
• Thorax radiography: an radiography can be performed after the diagnosis of colorectal cancer to know if cancer has spread to the lungs.

 In the days or even weeks prior to revisions, patients can be noticed more irritable, nervous, with difficulty sleeping, impatient;This behavior makes more tension experience, being the most appropriate to start the useful strategies during treatments to control these reactions. In case there are no methods to handle these emotions, you can resort to a professional doctor who provides their help and advice. (Cortinas, 2014) 

conclusion

Colorectal cancer has become a common and lethal disease over the years, since it is the cause of mortality throughout the world and affects both men and women, developing more in adults 50 years and olderThe risk of colon cancer increases with age and if you are over 50 years old, you must detect early colon cancer detection tests. Most polyps and colon cancer in their early stages not producers of symptoms;You can have a polyp or even cancer without knowing it. Previous detection tests can diagnose polyps before they become cancer, or even cancer in their early stages. The possibilities of healing colon cancer depend on the phase in which the patient is at the time of his diagnosis. In the early stages of its development they exceed 90%. One in three deaths from colon cancer can avoid whether all people over 50 years of age are carried out regularly. Colonoscopy is the most precise and versatile test for the diagnosis of colorectal cancer.