Articles On Ayurved · Kaya Chikitsa

Colo-Rectal Cancer

Colo-Rectal Cancer
Cancer of the large bowel is second only to lung cancer as a cause of cancer death in the United States: 153,760 new cases occurred in 2007, and 52,180 deaths were due to colorectal cancer. Colorectal cancer generally occurs in person’s ≥50 years. Most polyps produce no symptoms and remain clinically undetected. Occult blood in the stool is found in <5% of patients with polyps.

Aetiological Factors:

Animal Fats One hypothesis is that the ingestion of animal fats found in red meats and processed meat leads to an increased proportion of anaerobes in the gut microflora, resulting in the conversion of normal bile acids into carcinogens. This provocative hypothesis is supported by several reports of increased amounts of fecal anaerobes in the stools of patients with colorectal cancer. Diets high in animal (but not vegetable) fats are also associated with high serum cholesterol, which is also associated with enhanced risk for the development of colorectal adenomas and carcinomas.

Insulin Resistance The large number of calories in “western” diets coupled with physical inactivity has been associated with a higher prevalence of obesity. Obese persons develop insulin resistance with increased circulating levels of insulin, leading to higher circulating concentrations of insulin-like growth factor type I (IGF-I). This growth factor appears to stimulate proliferation of the intestinal mucosa.

Hereditary Factors: Up to 25% of patients with colorectal cancer have a family history of the disease, suggesting a hereditary predisposition.

Inflammatory Bowel Disease: Large-bowel cancer is increased in incidence in patients with long-standing inflammatory bowel disease (IBD). Cancers develop more commonly in patients with ulcerative colitis than in those with granulomatous colitis, but this impression may result in part from the occasional difficulty of differentiating these two conditions.

OTHER HIGH-RISK CONDITIONS

Streptococcus bovis Bacteremia: For unknown reasons, individuals who develop endocarditis or septicemia from this fecal bacterium have a high incidence of occult colorectal tumors and, possibly, upper gastrointestinal cancers as well. Endoscopic or radiographic screening appears advisable.

Tobacco Use: Cigarette smoking is linked to the development of colorectal adenomas, particularly after >35 years of tobacco use. No biologic explanation for this association has yet been proposed.

CLINICAL FEATURES
Presenting Symptoms may vary with the anatomic location of the tumor.
Since stool is relatively liquid as it passes through the ileocecal valve into the right colon, cancers arising in the cecum and ascending colon may become quite large without resulting in any obstructive symptoms or noticeable alterations in bowel habits.
Lesions of the right colon commonly ulcerate, leading to chronic, insidious blood loss without a change in the appearance of the stool.
Consequently, patients with tumors of the ascending colon often present with symptoms such as fatigue, palpitations, and even angina pectoris and are found to have a hypochromic, microcytic anemia indicative of iron deficiency.
Since the cancer may bleed intermittently, a random fecal occult blood test may be negative. As a result, the unexplained presence of iron-deficiency anemia in any adult (with the possible exception of a premenopausal, multiparous woman) mandates a thorough endoscopic and/or radiographic visualization of the entire large bowel.
Since stool becomes more formed as it passes into the transverse and descending colon, tumors arising there tend to impede the passage of stool, resulting in the development of abdominal cramping, occasional obstruction, and even perforation.
Cancers arising in the rectosigmoid are often associated with hematochezia, tenesmus, and narrowing of the caliber of stool; anemia is an infrequent finding.

Investigation:

Digital rectal examination
Proctosigmoidoscopy as a screening tool was based on the observation that 60% of early lesions are located in the rectosigmoid.
Flexible sigmoidoscopy.
Colonoscopy
Double-contrast barium enema. Radiographs of the abdomen often reveal characteristic annular, constricting lesions (“apple-core” or“napkin-ring”).
Occult fecal blood testing
Regardless of the clinicopathologic stage, a preoperative elevation of the plasma carcinoembryonic antigen (CEA) level predicts eventual tumor recurrence.

Screening:
Some authorities favor measuring plasma CEA levels at 3-month intervals because of the sensitivity of this test as a marker for otherwise undetectable tumor recurrence. Subsequent endoscopic or radiographic surveillance of the large bowel, probably at triennial intervals, is indicated, since patients who have been cured of one colorectal cancer have a 3–5% probability of developing an additional bowel cancer during their lifetime and a >15% risk for the development of adenomatous polyps.

In Ayurved Panchkarma (Purificative Procedure) like Virechan (Medicine induced Diarrhea) and Basti (Medicated oil enema or Medicated decoction enema) is very useful. The Purificative procedures help to reduce the overgrowth of gut microbiome.

Following herbs may be used for internal use:
Bilwa, (Aegle marmelos), Bengal Quince
Lodhra, (Symplocos racemosa), Symplocos bark
Snuhi, (Euphorbia neriifolia), Milk Hedge
Arka, (Calotropis gigantea) Madar, Gigantic Swallow wort
Patha, (Cissampelos pareira), Velvet leaf
Manjistha, (Rubia cordifolia), Indian madder
Bakuchi, (Psoralea corylifolia), Malaya tea
Bhallataka, (Semecarpus anacardium) Marking nut
Nishoth, (Operculina turpethum), Turpeth root

Especially for Rectum Cancer following drugs and procedure may be prescribed
Chavya, (Piper officinarum)
Mochrasa (gum of Salmalia malabarica)
Piccha basti

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
drsnojha@rediffmail. com
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