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Journalism of Courage
“Keep a positive mindset and this too shall pass,” says 40-year-old Radhika Moona, assuring patients of colorectal cancer undergoing treatment at a Delhi hospital. Eight years ago, she was in their shoes and, therefore, can counsel them better. With age on her side, she thought her bloody stool and pain were symptoms of something benign like piles. But on a September morning in 2016, she received the devastating diagnosis of rectal cancer.
Usually thought to affect Western populations and the elderly, this form of cancer, which starts as growth in the rectum and colon, is affecting younger Indians between 31 and 40. It is slow-growing and symptoms overlap with so many other stomach conditions that many miss early diagnosis, which is crucial to containing the spread when it is in the bowel.
The rate of colorectal cancer in India increased by 20 per cent between 2004 and 2014, increasing from 5.8 per lakh to 6.9 per lakh, according to a 2020 study in the Journal of Clinical Oncology. Another 2018 study by researchers from the Chittaranjan National Cancer Institute showed that this increase was largely driven by cancers in the young. The study also found that an increasing proportion of total colorectal cancers treated at the centre were in younger age groups, while the proportion of cases in older age groups was on the decline.
That’s why Moona has taken it upon herself to educate unsuspecting youngsters, who are into poor lifestyles and poor diets, all of which are triggers. “My symptoms started with some pain and blood in my stool, which I mistook as piles. There is this myth about piles that it keeps coming back even after surgery — that’s why many people advised me not to go to a surgeon. I tried some home remedies and even homeopathy. But when my pain became unbearable after one-and-half months, the homeopathy doctor himself suggested that I go to a surgeon,” she says.
The first surgeon she went to diagnosed it as a fissure — a tear in the lining of anus or large intestine. But before she was scheduled to undergo fissure repair surgery, she sought a second opinion from Dr Deepak Govil, gastrointestinal surgeon at Indraprastha Apollo Hospital, New Delhi. “Many people are embarrassed to undergo a rectal exam and many physicians are reluctant to perform it. This results in people being presumptively treated for piles, which is much more likely in the young. Colorectal cancer usually affects those above the age of 58 years but now the risk is going up among the younger population,” he says.
Testing the young
Dr Govil sees several young colorectal cancer patients whose diagnosis is delayed because they are treated for piles or fissures. That’s why he suggests a colonoscopy to anyone who seeks treatment for these conditions at his clinic, regardless of age. “Whenever we operate a person for piles, we insist on a colonoscopy first, even if the patient is a 30-year-old. We sometimes see cancers along with piles. Colorectal cancers, in general, affect Indians a decade earlier than their counterparts in Western countries,” says Dr Govil.
The age for routine screening of colorectal cancer — in people who do not have any symptoms — was reduced by five years to 45 in the US a few years once the incidence went up in the young. This makes sense as routine screening in the older age groups over the years has resulted in lower incidence in these age groups.
“Early screening, diagnosis and treatment can help patients remain cancer-free for years unlike other cancers,” says Dr Vivek Tandon, gastrointestinal surgeon at Apollo, who also treated Moona.
Are diet and lifestyle the new risk factors?
What made Moona’s cancer diagnosis more surprising is the fact that she was lean, did not smoke or drink and was a vegetarian — all of which are risk factors for colorectal cancers. But she travelled a lot and had to depend on outside food.
“Children today are far unhealthier — living a sedentary life and eating junk, processed and inflammatory food,” says Dr Shailesh Shrikhande, deputy director of Mumbai’s Tata Memorial Hospital.
Explaining why over-consumption of meat is a risk factor for colorectal cancers, he says, “Diets high in protein cause constipation. And when there is delayed transit of food waste through the intestine, more carcinogens are produced. This is why consumption of meat is linked with an increased risk of colorectal cancers and why the incidence is higher in the West. That’s why one must consume meat in moderation,” Dr Shrikhande says.
Life after cancer
If detected and treated early, patients can live for years without any complications. “This is unlike pancreatic cancer, where no matter what you do, you cannot increase the five-year survival by much. If detected early, we can almost cure the patient. We have patients who have been living well for 10, 15, and even 20 years after their surgeries,” says Dr Govil. Although Moona’s cancer was detected in the third stage — it had already spread to her lymph nodes — with chemotherapy, radiotherapy, and surgery, she has been cancer-free for eight years.
She has had to make adjustments though — the radiation therapy meant her uterus has stopped functioning and she lives with menopause. “I have lived with symptoms of menopause such as loss in bone density and hot flashes since 2016, but now they have become a part of my life,” she says.
By sharing her journey, she has become a beacon of hope for other patients. “I tell them that I can do everything. I even eat pizza but everything is in moderation — I would only have one slice every once in a while,” she says.
Now, she makes sure that she includes enough fibre in her diet, has juices and exercises a little every morning. “I eat more fibrous and probiotic foods and control my diet even when I am travelling. I also try to keep myself occupied — spending time with my family and working full time as a chartered accountant,” she says.
