Dr Hesham Morsey.
By JOHN DOOLEY
SUNRAYSIA residents are equally at risk of developing bowel cancer, with the number of cases diagnosed each year reflecting the national average of one in 13 people, according to Ramsay Specialist Clinic Staff Specialist and general surgeon, Dr Hesham Morsey.
Recent research conducted by Bowel Cancer Australia (BCA) has also found that those born in 1990 have double the risk of developing colon cancer, and quadruple the risk of contracting rectal cancer compared to those born in 1950.
Dr Morsey said that emphasis is generally given to early detection and treatment of the disease, which while vitally important, the underlying cause – diet – is something that should also be highlighted.
“People tend to concentrate on treating the cancer, but not enough attention is paid to preventative measures such as diet and exercise,” Dr Morsey said. “All meat should be cooked to some degree, rather than eaten raw.
“A study was conducted in the United States recently, which concluded that there was an increase in the incidence of bowel disease following the consumption of ham and sausages, as they contain a high level of animal fat and so they present a risk if eaten regularly – consumption of animal fat is a known risk factor.”
Dr Morsey said that this information is freely available in books, magazines and on the internet, and that people can see for themselves what the high-risk factors are in relation to lifestyle and diet.
“Obviously keeping healthy and playing sport or exercising regularly is important. In terms of eating habits, maintaining a well-balanced diet, with plenty of fresh fruit and vegetables, not smoking and drinking alcohol in moderation is recommended,” he said.
Dr Morsey was asked about patients who present with Stage 4 bowel cancer (generally untreatable), and why they would have failed to detect symptoms of the disease.
“Patients will complain of passing blood for a number of years and they believed it was because they have chronic haemorrhoids – well that self-diagnosis is a problem,” he said. “Although the patient may have haemorrhoids, it doesn’t mean it is the cause of the bleeding, and they shouldn’t ignore blood in their faeces, you shouldn’t assume anything and you need to consult your doctor.
“If a patient presents with haemorrhoids, even at a younger age, I would never treat the haemorrhoids without conducting a colonoscopy first, because you have to rule out all other possible causes of blood in the stool.”
Dr Morsey emphasised the importance of bowel screening and early detection which will usually lead to a good prognosis.
“Even if we have to perform surgery to remove part of the bowel, the outcome for the patient can be favourable if caught in time,” he said. “With the bowel screening, we don’t only detect early cancer, we also identify the presence of polyps which can become cancerous, and so we can prevent the cancer from developing.”
THE only sure way of detecting bower cancer and pre-cancer polyps is by undergoing a colonoscopy, which is an internal examination of the bowel, and a procedure requiring sedation in a day-surgery facility.
“The downside is that we would have to perform a large number of colonoscopies to detect these polyps, but such an approach is worth it,” Dr Morsey said.
“It’s been proven in many counties around the world, including Scandinavia, America and the United Kingdom, that conducting large-scale colonoscopy examinations can lead to up to 20 percent of patients being saved because of early detection.”
While the stool testing is effective in identifying ‘suspicious’ blood, the blood detected is non-specific, and so if detected, a colonoscopy is required as a follow-up.
Pointing to the incidence of bowel cancer increasing in younger people, Dr Morsey said this was due to environmental influences, particularly diet.
“If you look at Africa, they have a very low rate of colorectal cancers and diverticular disease which is reflective of their diet comparative to the western world,” he said.
Dr Morsey said that the number of bowel cancer diagnosis in Sunraysia is on a par with the national average, with a higher number of men being diagnosed with the disease.
“It is disappointing to know that only 40 percent of people eligible to use the screening kit are performing the test,” he said. “While I was working in New Zealand, before coming to Mildura, I saw a higher incidence of bowel cancer than here in Australia.
“Some of this can be directly attributed to the fact that in NZ they hadn’t started their bowel screening program until 2017, and so comparative to Australia they were very late in introducing the scheme.”
New Zealand has one of the highest rates of bowel cancer in the world. More than 3000 New Zealanders are diagnosed with bowel cancer each year, and more than 1200 die from it.
“Awareness of bowel cancer in previous years back in the 1950s and ‘60s was very low, we weren’t aware of theses diseases to the degree that we are today, and of course the ability to detect the cancer through colonoscopy and bowel screening has had an impact on the statistics,” Dr Morsey said.
Wentworth resident, Sharon Gatt is a patient of Dr Morsey’s who underwent surgery for bowel cancer in Mildura.
“Sharon’s procedure was an Abdominoperineal Resection, commonly referred to in medical circles as an AP resection or APR,” Dr Morsey said.
AN APR is major surgery which involves the complete removal of the distal colon, rectum and anal sphincter complex using both anterior abdominal and perineal incisions, resulting in a permanent colostomy, a slight inconvenience for Sharon compared with the alternative.
Sharon was diagnosed with bowel cancer in February after visiting her GP when she was unable to use her bowels, for a period prior to this, however, she had noticed the presence of blood.
“I had let it go for over a year, I put the appearance of blood down to haemorrhoids, like a lot of people do,” she said. “I went to my local doctor and he sent me straight for a colonoscopy, and luckily he did, they discovered tumors and I was then referred to Dr Morsey, who diagnosed my condition and I was off to Melbourne immediately to commence my radiation.”
Despite having the surgery, Sharon still has to undergo a further six months of chemotherapy to ensure all the cancer has been defeated, something she can undergo in Mildura.
“They have to send you down to Melbourne for the radiation treatment, which is a real imposition,” she said.
“Bendigo has its own radiation facility, and it’s something Mildura should have, it would make such a difference to people not having to go to Melbourne for five weeks.
“I’m fortunate to be able to stay at the Ryder-Cheshire Homes in Ivanhoe, without whose support I would have been in great difficulty being able to afford accommodation during my treatment.
“It’s a fabulous organisation that provides country Victorians with affordable accommodation and I couldn’t have stayed in Melbourne for five weeks without their help.”
Sharon returned to Mildura after the initial treatment, and waited for about four weeks while the radiation continued to work before the next stage of her treatment could proceed.
“The radiation continues to burn for a while, after which it’s hoped it has done its job, which was to shrink the tumors sufficiently to enable the surgery to be undertaken,” she said. “The radiation is actually horrible, but it did what it was supposed to do – they had to shrink the tumors back into the bowel before they could take it out.”
Sharon looks remarkably well for someone who has been through what she has, but said that while the burning sensation of the radiation has passed, she was still extremely tired, and ahead of her next chemotherapy was a little apprehensive.
“I do fear the chemo, because previously I had it in tablet form which didn’t affect me, but the next round will be administered intravenously, and that usually makes you feel sick and I might also experience some hair loss,” she said.
Sharon’s message to other people is very clear: “Don’t put it off. Do not put off going to your doctor if you have any symptoms, and if you go to a doctor, and they say it’s nothing, go to another doctor.”
“I met a lot of people at Ryder this year who had not been diagnosed in the first instance, and it wasn’t until months later that a positive diagnosis was made, by then things can be a lot worse.”