Hajji Alejandro’s battle highlights colon cancer threat
When the news broke several weeks ago that singer Hajji Alejandro was in the hospital with Stage 4 colon cancer, fans and friends of the original “Kilabot ng mga Kolehiyala” were shocked. His longtime girlfriend Alynna Velasquez said in an online interview with Julius Babao that Alejandro was in Vigan when he reported feeling bloated and having a hard time breathing. A CT scan was ordered and he was informed by the doctor that the 70-year-old had cancer.
Alejandro is now home, but his battle with cancer is just starting.
Colorectal or colon cancer is a form of cancer that develops slowly over a period of many years. According to the website of the Department of Science and Technology, “it commonly develops from a tumor, an abnormal tissue—which can be benign or malignant—or from a polyp, a noncancerous tumor.”
In the Philippines, colorectal cancer ranks fourth among the cancer-related deaths of Filipinos. According to the Philippine Cancer Society Inc., almost 75 percent of the individuals affected were age 50 and above, and estimated that one out of 1,800 Filipinos yearly will develop the cancer.
The World Health Organization (WHO) lists colon cancer as the third most common cancer worldwide, accounting for approximately 10 percent of all cancer cases, and is the second leading cause of cancer-related deaths. It also noted that it affects older individuals, those 50 and above, although there has been an increase in diagnoses of those under 50—like Hollywood actor Chadwick Boseman, who was only 39 when he was diagnosed.
Only after Boseman’s death in 2020 was it revealed that he had been living with colon cancer. The 43-year-old actor who famously starred in the superhero film “Black Panther” was known for keeping his personal life separate from his public persona. A statement posted on his Instagram account after his death said that he had been diagnosed in 2016 with Stage 3 colon cancer that had progressed to Stage 4.
Last November, another Hollywood actor, James Van Der Beek, 47, who starred in the ’90s series “Dawson’s Creek” and the more recent “Varsity Blues,” announced that he had colon cancer. “I have colorectal cancer. I’ve been privately dealing with this diagnosis and have been taking steps to resolve it with the support of my incredible family,” he said then.
Stigma
Neither Boseman nor Van Der Beek touched on it, but there is a stigma surrounding colon cancer because one of the symptoms is blood in the stool or the rectum. More awareness is needed for people to get past this and to realize that prescreening is the best way to check whether one is predisposed to getting colon cancer.
The Department of Health has been conducting awareness campaigns for the past two decades, informing the public that colon cancer can be cured if detected early. March is National Colorectal Cancer Awareness Month. To decrease the risk of developing the disease, the DOH advocates maintaining a healthy lifestyle with good diet and physical exercise, and avoiding smoking as well as reducing alcohol intake.
The Philippine Cancer Control Program recommends screening for all persons 50 and above for colorectal cancer. Dr. Sherwin Feir, an internist and gastroenterologist, however, pointed out that those with first-degree relatives—a parent or sibling—who have already been diagnosed with colon cancer to get themselves screened 10 years before the age of the index patient.
“This means that if the parent was diagnosed at age 45, their child or children should get a colonoscopy when they reach the age of 35 or turn 40 years old, whichever comes first,” Feir told Lifestyle.
A colonoscopy is considered by doctors as the “gold standard” when it comes to screening and is the preferred way to diagnose gastrointestinal cancers. Before a patient undergoes it, he or she has to prepare in advance.
Patients are typically instructed to go on a low-fiber diet for three days before the procedure and/or liquid diet a day before. They are limited to ingesting only clear soups, tea, juice, milk, water, plain lugaw (gruel), and plain noodles.
This writer who underwent colonoscopy two years ago was also instructed to take two tablets of Dulcolax, a laxative, and to drink a solution of Surelax (polyethylene Glycol) the day before and on the day itself. The instructions may differ depending on the doctor but they are essentially the same.
The procedure is done under sedation and may take 30 to 60 minutes.
Real challenge
“The real challenge in the Philippines, however, is getting people who are due for a colonoscopy to actually schedule the procedure,” Feir said. “Many Filipinos only have themselves checked when they notice changes in their bowel movements, blood per rectum (rectal bleeding), anemia, or pallor (pamumutla). Sometimes they even put off the checkup, hoping symptoms will clear up eventually.”
If polyps or growths are discovered during the colonoscopy, the doctors are trained to surgically cauterize them, and then have a sample of the tissue sent for testing to rule out cancer. Feir said that if the results are benign, patients can schedule their next colonoscopy after 10 years.
“If the family history indicates incidents of colon cancer, however, the doctor may require the patient to undergo screening every three years,” he said.
According to the WHO, “the primary treatment for early stage colorectal cancer (i.e. tumor limited to the bowel or local lymph nodes, with no metastatic dissemination to distant organs) is surgical removal or the tumor and nearby lymph nodes.”
Feir said the cost of the procedure—from P18,000 and up—might be one of the reasons Filipinos put off getting a colonoscopy, but said that the amount covered by Philhealth for all endoscopic procedures by its members was recently increased.
“Maybe this will move some doctors to lower their professional fees so that more Filipinos who are at risk of colon cancer or are due for the procedure will finally undergo it,” he said.
