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Understanding Colorectal Cancer: Risks, Symptoms, and Screening: Q&A Session with an Expert

  • decodeMR Team
  • 7 hours ago
  • 3 min read

Welcome to another episode of Inline, brought to you by decodeMR.


In this episode, we focus on colorectal cancer. According to the World Health Organization, colorectal cancer is the third most common cancer worldwide, accounting for nearly 10% of all cancer cases, and is the second leading cause of cancer-related deaths globally.


To discuss this further, we spoke with Professor Art Hiranyakas, a colorectal surgeon at Bangkok Hospital, Thailand. Dr. Art Hiranyakas explained how colorectal cancer typically develops over time—from a healthy colon to benign polyps and eventually cancer—highlighting the role of environmental and lifestyle factors, alongside genetic influences. He also noted that many colorectal cancers develop silently over several years, often without noticeable symptoms, making early screening crucial for prevention and timely intervention.


Key Discussion Points


1. How Colorectal Cancer Develops (0:51)

  • Colorectal cancer typically develops from benign polyps in the colon or rectum

  • Transformation from a polyp to cancer usually takes 5–10 years

  • Polyps are often asymptomatic, making early detection challenging without screening


2. Risk Factors (1:33)

  • Environmental factors account for ~80–85% of cases:

    • Diet low in fiber

    • High intake of red and processed meat

    • Sedentary lifestyle

    • Obesity, stress, and lifestyle-related hormonal changes

  • Genetic factors contribute to ~10–15% of cases:

    • Family history and inherited cancer syndromes


3. Symptoms Often Ignored (4:41)

  • Symptoms vary by tumor location:

    • Left-sided colon cancer (more common):

      • Painless rectal bleeding

      • Change in bowel habits

      • Chronic diarrhea or new-onset constipation

    • Right-sided colon cancer:

      • Fatigue

      • Unexplained anemia

      • Weight loss or abdominal mass

  • Right-sided symptoms are often vague and easily dismissed


4. Prevention Through Lifestyle Changes (7:23)

  • High-fiber diet

  • Limiting red and processed meat

  • Regular physical activity (30 minutes, at least 4 times a week)

  • Maintaining a healthy BMI (~25)


5. Screening Options (8:46)

  • Stool-based tests:

    • FIT (fecal immunochemical test)

    • Stool DNA tests

  • Colonoscopy (gold standard)

  • ctDNA blood tests (newer, emerging option)

  • Screening recommended from age 45 onwards, even without symptoms


6. Addressing Fear Around Screening (11:20)

  • Non-invasive stool tests can be a good starting point

  • Annual FIT testing can significantly reduce late-stage diagnosis

  • Early screening prevents cancer rather than just detecting it


7. Diagnosis and Treatment Planning (13:07)

  • Confirmation through colonoscopy and biopsy

  • Clinical staging using CT scans to assess spread

  • Treatment decisions (surgery vs chemotherapy) depend on staging and tumor behavior


8. Emotional and Family Support (15:03)

  • Interaction with successfully treated patients builds confidence

  • Improved treatments have significantly increased survival rates

  • Informed families play a crucial role in patient support



Key Take-Home Messages

  • Colorectal cancer often develops silently—screening is essential even in the absence of symptoms

  • Most cases are preventable through lifestyle changes and early detection

  • Not all symptoms are obvious—fatigue or anemia should not be ignored

  • Screening saves lives, and multiple non-invasive options are available

  • Early diagnosis leads to better outcomes, with significant improvements in survival over the last decade

  • Emotional support and realistic expectations help patients and families navigate the treatment journey with confidence and hope


About Dr. Art Hiranyakas:


Dr. Art Hiranyakas is a renowned colorectal surgeon at Bangkok Hospital, Thailand, and serves as Director of the Multidisciplinary Cancer Care Team (Group 6). He specializes in advanced colorectal cancer care, minimally invasive and robotic colorectal surgery, and the management of complex colorectal disorders. He has possesses a unique and comprehensive surgical fellowship training portfolio from leading international institutions in Singapore, Australia, the United States, Japan, and South Korea, including the Cleveland Clinic Florida and the University of California, San Diego.


Dr. Hiranyakas is a fellow of several prestigious international surgical societies and is widely recognized for his contributions to multidisciplinary cancer care, medical education, and clinical excellence in colorectal disease management.




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