Colon cancer begins in the inner lining of the large bowel and usually develops over years from benign growths called polyps. The main warning signs are a lasting change in bowel habit, blood in the stool, abdominal pain and unexplained anaemia. In Turkey screening starts at age 50, and earlier for those with a family history of colon cancer. When caught at an early stage it can be treated successfully with surgery in a high proportion of cases.
Colon cancer is among the most common cancers both worldwide and in Turkey. Yet it has one feature that sets it apart from many others: it can be caught before it ever becomes cancer. This article looks at the path from polyps to cancer, the warning signs, why screening matters so much, and how surgical treatment is planned.
How Does Colon Cancer Develop?
Small growths called polyps can form over time on the inner lining of the large bowel. Most polyps are benign and never turn into cancer. A proportion of them, however, progress towards malignancy over an average of seven to ten years.
That long interval is the most important feature of colon cancer. When a polyp found during colonoscopy is removed in the same session, any cancer that might have developed from it is prevented before it starts. Colonoscopy is therefore both a diagnostic and a preventive procedure.
Symptoms and Warning Signs
In the early stage there are usually no symptoms at all. By the time symptoms appear the disease has generally been progressing for some time. The main warning signs are:
- A change in bowel habit lasting more than a few weeks: constipation, diarrhoea or the two alternating
- Blood in the stool, or stools that are dark and tarry
- Stools becoming narrower
- A feeling that the bowel has not emptied completely
- Abdominal pain, bloating and trapped wind
- Unexplained anaemia, fatigue and weight loss
Note: Blood in the stool is most often due to haemorrhoids. But a diagnosis of haemorrhoids does not mean the same person cannot also have a polyp or a cancer. The cause of bleeding should therefore be assessed according to age and risk.
Screening: Who, and When?
Under the Turkish Ministry of Health national screening programme, screening in people without symptoms begins at age 50 and continues to age 70. The programme is built on a faecal occult blood test every two years and a colonoscopy every ten years.
Earlier screening is recommended in the following situations:
- A first-degree relative with colon cancer or advanced polyps
- Hereditary syndromes such as familial polyposis and Lynch syndrome
- Long-standing ulcerative colitis or Crohn's disease
- Previous removal of polyps
In people who do have symptoms, age is not a threshold: the complaint is itself a reason for investigation.
Diagnosis and Staging
Diagnosis is made by colonoscopy and biopsy taken at the same time. Once cancer is confirmed, computed tomography and, where needed, magnetic resonance imaging and PET/CT are used to determine the extent of disease. The blood marker CEA is used both at the outset and in follow-up after treatment.
Staging is based on how deeply the tumour has invaded the bowel wall, whether nearby lymph nodes are involved and whether there is spread to distant organs. The treatment plan follows from that staging.
Surgical Treatment and the Laparoscopic Approach
Surgery is the primary treatment in colon cancer. The segment of bowel containing the tumour is removed with a safe margin on either side, together with the vascular pedicle supplying that segment. Removing an adequate number of lymph nodes along that pedicle is decisive both for accurate staging and for the success of treatment. The two ends of the bowel are then joined.
In suitable cases the operation is performed laparoscopically, through a few millimetre-sized openings in the abdominal wall. With the keyhole approach there is less post-operative pain, bowel movement returns sooner, hospital stay is shorter and wound problems are fewer. Oncological outcomes are accepted as equivalent to open surgery.
Not every patient is suitable for the keyhole approach. The site and size of the tumour, previous abdominal operations and emergencies such as obstruction may make open surgery necessary. Some patients may need a temporary protective stoma, which in most cases is not permanent.
After Surgery and Follow-Up
After the operation, the pathology result determines whether chemotherapy is needed. That decision is taken at an oncology board, where surgical, medical oncology, radiology and pathology doctors assess the case together.
Once treatment is complete, regular follow-up begins: examination at set intervals, CEA measurement, computed tomography and colonoscopy. Follow-up aims both to catch any recurrence early and to prevent new polyps from developing. Colon cancer has a high long-term recovery rate when caught early, which is why not putting off symptoms and not missing the screening age matter so much.
Oncological Surgery and a Background in Colorectal Cancer
Op. Dr. Ersan Semerci completed his general surgery residency at Ankara Oncology Hospital. Working closely with cancer surgery from the earliest years of his career forms the foundation of his present practice in colorectal cancer. He has oncological surgery experience in stomach, colon and rectal cancers as well as in thyroid and breast cancer.
He has kept his training in this field up to date:
- Laparoscopic Colorectal Surgery Course, Mersin University Department of General Surgery (2013)
- Nutrition in Colorectal Disease Course, Mersin (2018)
- Colorectal Cancer Screening and Post-Screening Diagnosis Training, Turkish Ministry of Health, Antalya (2019)
He is a member of the Turkish Society of Colon and Rectal Surgery and the Turkish Surgical Society, and has presented papers at the National Congress of Colon and Rectal Surgery.
Op. Dr. Ersan Semerci has practised in Mersin since 2010 and currently works at Medicalpark Mersin Hospital. Colonoscopy, colon cancer surgery and post-operative follow-up are carried out at this hospital.
Op. Dr. Ersan Semerci has practised in Mersin since 2010 and currently works at Medicalpark Mersin Hospital. Consultations and operations in Colon Cancer are carried out at this hospital. Patients travelling from Mersin and neighbouring provinces can book via WhatsApp.
Book on WhatsAppIs colonoscopy painful?
Colonoscopy is now usually performed under sedation and no pain is felt during the procedure. Most patients are not aware it has taken place. The bowel preparation beforehand can be the more demanding part.
I have seen blood in my stool. Should I assume it is cancer?
No. The most common causes of blood in the stool are haemorrhoids and anal fissure. However, it is not right to put bleeding down to haemorrhoids and leave it there; the cause should be established by examination and, where indicated, colonoscopy.
There is colon cancer in my family. When should I be screened?
Screening generally begins earlier in people with a first-degree relative who has had colon cancer. The age at which it starts depends on how old that relative was at diagnosis and how extensive the family history is, so an individual assessment is needed.
Will I need a stoma bag after colon cancer surgery?
Most colon cancer operations do not require a stoma. Where one is needed it is usually a temporary stoma to protect the join, and it is generally closed a few months later. A permanent stoma arises mainly with rectal tumours very close to the anus.
Does diet affect the risk of colon cancer?
Processed meat, high red meat intake, low fibre intake, inactivity, obesity, smoking and alcohol are among the factors reported to raise risk. A fibre-rich diet and regular physical activity are regarded as protective. These are general factors affecting risk; individual risk assessment is a matter for your doctor.
How the decision is made, what pre-operative preparation involves, and how nutrition and the weight-loss timeline work after surgery.
Answers to the most common questions about appointments, the hospital, treatment scope and surgical experience are in the FAQ section on the home page.
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For Colon Cancer and related symptoms you can book an appointment at Medicalpark Mersin Hospital. Mezitli / Mersin, Turkey, weekdays 09:00-17:00.
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