Those of the colon is one of the types cancer most common in the world and also one of the deadliest, although there is an effective way to diagnose it early and save your life. Not only that: the number of cases is increasing, also in Italy and unfortunately also among young people (even before the age of 40). In 2022 they were estimated 48,100 new colon cancer diagnoses
, while in 2020 there were just over 43,700. And it gets worse: if this neoplasm in the pre-Covid era had been the example of the effectiveness of screening prevention programs for which both the number of cases and the death rate had decreased, due to the pandemic and the delays incurred during the emergency in terms of health, we have taken a step backwards. “Seven out of ten citizens do not take the occult blood search test, which the health system offers free of charge to all 50-69 year olds every two years – he points out. Saverio Cinieri, President of the Italian Society of Medical Oncology (Aiom) —. Aiom has promoted this a major awareness project to improve adherence to therapy. There will be commercials, leaflets, a strong social campaign and active involvement from pharmacies is expected.”

Nine out of ten cases could have been prevented

The aim is essentially twofold: to ensure that the Italians who receive the letter of invitation to be screened with the test to look for occult blood in the stool do not throw it away and to raise the awareness of everyone, young and old, to do not ignore possible alarm bells. On both fronts, time is a precious ally against cancer. The faster a neoplasm is discovered, the greater the chance of permanent healing and to do so with less invasive therapies. “The very important fact is that nine out of ten cases could be prevented if everyone did the checks, but half of Italians do not take the opportunity – he clarifies. Sarah Longardi, Acting Director of Oncology 3 at the Veneto IRCCS Institute of Oncology in Padua —. There is an effective, free (in Italy) and completely painless method of eliminating precancerous lesions before they turn into a real neoplasm: the fecal occult blood test (FOB).. Colorectal carcinomas develop from adenomas or polyps that take an average of ten years to transform into malignant forms and it is in this window of time that screening with the Sof allows you an early diagnosis And eliminate intestinal polyps before they acquire dangerous properties and grow into a malignant tumor. If the Sof is positive, the patient is sent for a colonoscopy which allows you to mark and remove any precancerous lesions or perform a biopsy.

Symptoms and who is most at risk

Colon cancer does not show obvious signs in the beginning. “The signs of early illness are non-specific and include changes in bowel habits, abdominal pain, weight loss and persistent fatigue – continues Lonardi -. When the pathology is more advanced, they can manifest bleeding during bowel movements, abdominal pain, nausea or vomiting. Unfortunately, 20% of cases are discovered late. A crucial role in prevention is instead given by a healthy and balanced diet: nutritional factors such as the consumption of red meat and sausages, refined flours and sugars and the consumption of salted, preserved or smoked foods increase the danger of getting sick, such as excessive consumption of alcoholic beverages and the smoke. The opportunities also increase for who it is overweight, obese and does little exercise. A protection, on the other hand, can be produced by the consumption of fruits and vegetables, unrefined carbohydrates, vitamin D and calcium. «Colon cancer in Italy is the second most common after breast cancer – underlines Cinieri -: as we try to make up for the delays caused by Covid, it is essential that everyone does their best to prevent it. Territorial differences in screening with the Sof test must also be bridged, as membership stands at 45% in the north, 31% in the center and only 10% in the south. It is also important that the test is also extended to people over 70, so we can save more lives. Only five Regions exceed the target of 50% participation: Veneto is the most virtuous (almost 70%), followed by Trentino, Valle d’Aosta, Emilia-Romagna and Friuli Venezia Giulia».

20% of cases detected in the metastatic stage

In Italy, 65% of patients are alive five years after diagnosis and there are more and more patients who, even if they cannot recover, they manage to live even several years with the neoplasm and a good quality of life. So much so that about 513,000 compatriots are alive today after receiving the news of colon cancer. Unfortunately, 20% of cases are still detected late today, when metastases have already occurred, but the prognosis of these patients has improved significantly in recent years. «The steps forward are linked on the one hand to new biological knowledge, on the other hand toidentification of certain molecular targets that are the target of innovative therapies,” says Lonardi. That is, knowing the DNA mutations present in a patient’s neoplasm, the molecular features of the single tumor, is essential today to guide therapeutic choices: in fact, there are genetic changes which, if any, can provide the clinician with very important information about the biological aggressiveness of the tumor and its ability to respond or fail to respond to therapies. “This way we can determine the best strategy for the individual patient, with savings for the health system,” recalls Cinieri.

Genetic mutations: why the test is needed

Colorectal cancer is an extremely heterogeneous neoplasm from a genetic-molecular point of view. Phillip Pietrantonio of gastroenterological medical oncology at the IRCCS Foundation Istituto Nazionale Tumori di Milano -. Most patients with metastatic colorectal cancer are ineligible for potentially curative surgery. At the start of treatment, the evaluation of the mutation status of the genes designated by the acronym RAS (KRAS and NRAS), of BRAF and of those involved in the DNA repair functions “mismatch repair” and of the “high microsatellite instability ”. These genes (which are an indicator of a faulty DNA repair system) function as “switches” that activate cancer cells’ growth and replication mechanisms. and they can be in the normal or mutated state: today we know that this disturbance is a predictive factor for the response to certain drugs». About 5% of patients present with metastases high instability of microsatellitesfrom which a large number of mutations ensue: a feature that seemed to reduce the likelihood of benefiting from traditional chemotherapy, but is now becoming something of an advantage, as it allows a subset of patients who respond strongly to immunotherapy. “The normal KRAS and NRAS status, which accounts for approximately 40-45% of total cases of metastatic colorectal cancer, indicates that the patient is more likely to respond to monoclonal antibody anti-EGFR therapy,” he concludes. Pietrantonio, who is a member of the national executive of Aiom -. The BRAF mutation is detected in approximately 10% of cases and is associated with a poorer prognosis, because the tumor is more aggressive and for greater resistance to therapies. The V600E mutation is most common in those with BRAF and the risk of mortality in these patients is more than doubled compared to those who are “unmutated”. However, in these cases, the availability of a targeted therapy enables improvements in survival.