Goodbye to Totò Schillaci, unforgettable top scorer of the ‘magical nights’ of Italia ’90, died today at just 59 years old due to colon cancer that struck him a couple of years ago. The former footballer had been hospitalized in the Pneumology department of the Civic Hospital of Palermo since September 7, when his health conditions had worsened. Colon cancer, explained to Adnkronos Salute a few days ago Maurizio Vecchi, professor of gastroenterology at the University of Milan and director of Gastroenterology and Endoscopy at the Policlinico of the Lombardy capital, is the “second most frequent tumor and is in the top positions in both males and females. A neoplasm that we must take into consideration”.
Colon Cancer ‘Numbers’, Prevention Key Point
The data speaks for itself: according to the estimates that are released each year in the report ‘Cancer Numbers’, in 2023 there were approximately 50,000 new diagnoses of colorectal cancer, a number second only to new cases of breast cancer (around 55,900). “A high frequency”, observes the expert. But this tumor also has another characteristic: “If caught in the very early stages, it can be completely eradicated and have an excellent prognosis for life, with a 5-year survival rate of over 90%”.
For this reason, Vecchi continues, “it is really important to adhere to the screening” planned for this disease. “Unfortunately, this concept is not yet very widespread among the general population, because only 30-40% of people adhere to this type of program. It is certainly an unsatisfactory rate, very low”. And there is another alert that is opening new evaluations: “Unfortunately lately we are reporting a higher frequency of cases of colon cancer even at an age not previously expected”, among younger people. “So much so that we are considering lowering the age of starting screening to 45”.
Tests, diagnosis: what to do
If this tumor is diagnosed late, “when it is already very extensive and when distant metastases are present, at that point the 5-year survival is low”. This is why this neoplasm is “the ideal target for a screening program, which in this case includes once every two years, starting from the age of 50, the invitation to pick up a test tube for the search for occult blood in the stool at the pharmacy, and perform the test, returning the sample to the pharmacy, all this free of charge”.
If the occult blood test is positive, “the patient is always invited to undergo the second level test, which is a colonoscopy, free of charge. Obviously, in this phase, participation is much higher. Colon cancer is a tumor that we must deal with, also because prevention programs in this case are truly aimed not only at making an early diagnosis of a tumor that is already in progress, but also at finding even the adenomatous polyps of the colon, which are the typical ‘precursor’ of carcinoma, and can be removed during colonoscopy, starting from scratch a path that had already begun towards colon cancer. This is the only field in which we carry out real prevention, because we are going to remove a lesion that is not yet a tumor, but that will become one”.
In general, “the percentage of tumors diagnosed in the early stages has increased, because screening has significantly reduced the stage of the disease. And – continues Vecchi – there are studies that demonstrate in the US, but also in Italy, how the implementation of screening ultimately reduces mortality”. And here, reflects the expert, “also because it is always surprising that the disease can recur after a long time, at the moment in which it is completely eradicated with surgery and possibly with adequate therapy. In some cases obviously this happens, especially when the diagnosis, surgery and therapy are performed when the tumor has already gone a little beyond the initial organ, perhaps it has affected the lymph nodes and is present in the liver where the typical site of the first metastases is. And we cannot be certain that, even if we go to remove those lymph nodes or those lesions of the liver, there are not already cells around that perhaps will reveal themselves at a later time”.
“Today we say that the forms diagnosed in the most advanced phase can be around 10-15%, the stage that already involves the lymph nodes probably concerns 30-40% of cases. While around 50%, fortunately, it is discovered in the initial phase”, explains the specialist. After the liver, the second ‘filter’ of the organism that can be affected “is the lung – explains Vecchi – It is therefore clear how important it is that the media also dedicate time and space to colon cancer. 95% of these neoplasms are represented by the so-called sporadic tumor, which however has its own familiarity, so people who have had cases in their family are more exposed to this risk, especially if the colon tumors of the relative occurred at an early age or around the age of 50. In these circumstances, first-degree relatives must begin screening even before the age expected for the general population”.
The therapies
As for therapies, “they have improved dramatically over the years, both in terms of surgical techniques, which are increasingly precise and focused, and chemotherapies, which have become much more effective. In lower rectal tumors, there are selected cases with specific genetic characteristics in which immunotherapy has been shown to completely reverse the disease. And we are also working towards mRNA vaccines and systems that can increase diagnostic capacity without using invasive means. For example, in the space of a few years, the so-called ‘liquid biopsy’ should become a reality: from a blood sample, we will be able to identify the presence of tumor DNA. The first message today is: join the screenings” that offer the search for occult blood, concludes Vecchi. “And it wouldn’t be a bad choice if a 50-year-old whose mother was struck by cancer at 70 wanted to undergo a colonoscopy. But another fixed point to keep in mind is that, even when the diagnosis arrives in an advanced stage, it is possible to intervene, with targeted approaches even on secondary lesions. So never give up”.
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