What did my body do to you?

I remember growing up having an enormous appetite that my parents used to commend and me being a mommy’s and daddy’s girl, eat I did. After class 8 I had this, should I call it cute? No, I won’t brand it anything as that never crossed my mind. I had this belly and I recall vividly that after meals I’d be so full that the only thing I did afterwards was sleep. I’ve always been useless after meals, especially supper. This perhaps explains why I stopped taking a heavy supper since I have to stay up and function as an adult. So many things to be done.

I had this cute long sleeved white, warm, night dress that had cute little pink flowers all over it and whenever I would wear it to bed, my tummy would stretch it out and no, it never even crossed my mind one bit. Imagine my shock when I grew up(after high school) and started hearing phrases like:

no, tuck you tummy in honey.

With that tummy you shouldn’t buy a body con dress.

Oh no, I’m planning to start hitting the gym, nimenona aki! (I’ve grown fat). Says the lean bodied lady.

Where did we lose it? Is it the magazines? Social media?

The thing with cameras is you can always position them at a certain angle to bring out your best features. So you tuck that tummy in a little, you pop the butt backwards, smile and voilâ, your end product is a goddess (which you already are without all the posing by the way). When you scroll your social media and see your friends all poised and sharp, you start hating on yourself.

Why do my things rub against each other? I want a thigh gap like her.

Why do I have to sweat so much after walking a short distance? She doesn’t.

She’s doing well. I’m not.

Stop. Stop. Stop.

Stop comparing yourself with others. We all grow at different paces and no, there’s no perfect women. By virtue that you’re female, you have the estrogen hormone in your body that is responsible for your feminine features. Trevor Noah, in one of his stand-up comedies said that black is about size and shape. That with a black woman, you can gently slap the right butt cheek and wait for the wave to hit your hand on the left butt cheek hehe. So why are you trying so hard to strip yourself of what makes you you? Your femininity. It’s your biggest strength. Joan Thatiah in her book, Things I will tell my daughter, elucidates that we live in a society where everyone else, who has no experience whatsoever in being a woman, takes it upon themselves to tell you how you should live your life.

Be yourself. No, not like that.

You shouldn’t speak like that, ladies don’t do that.

You should smile more often, it’s unladylike to frown a lot.

I say, tell them to buy a journal and write their opinions in it!

Be you. The world will adjust.

Love your body. If you want to be better a version of yourself, hit that gym, start the morning runs but do not do it because someone body shamed you.

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About colon cancer

In kenya, cancer ranks 3rd as a cause of death after infectious diseases and cardiovascular disease. It causes 7% of the total national mortality each year.

This gives our health care system a mouthful as we have to deal with both communicable and non communicable diseases (double burden of disease). With cancer being the leading cause of death worldwide,accounting for approximately 7.6 million deaths annually, it is only necessary to start dealing with the cancer menace sooner other than later. This is in light of the fact that the cancer mortality rate is predicted to continue to rise with an estimate of 13.1 million people worldwide affected in 2030.

Colon cancer is one of the most common cancers in the world. In kenya, it constitutes 40-50 % of all cancers of the large intestine with the mean age of diagnosis being about 50 years. It is highly curable, particularly if caught early and when localized within the intestine. With time, like most cancers it spreads and hence makes cure more difficult.

Risk factors would include a personal history of colon or any other cancer, Tobacco use, irritable bowel disease, family history of ovarian, endometrial or breast cancer among others.

Early diagnosis and treatment is possible. This is achieved by screening the at risk patients. The screening test is inexpensive and infrequent, to be done after every 3 years. This is the fecal occult blood test (FOBT ) . It is the proper screening test for the at risk population. It is basic stool test that checks for blood that is invisible to the naked eye but can be seen on microscopy. If the stool test is positive then further tests will be recommended and advisable.

The early features of colon cancer are quite nonspecific. They include discomfort, weight loss, changes in bowel habits and tiredness. This can indicate any other gastrointestinal disorder and are not indicative for colon cancer. However the need to seek medical advise cannot be overlooked and a high index of suspicion is required on the side of health professionals for an early diagnosis to be achieved.

Reference; NATIONAL GUIDELINES FOR CANCER MANAGEMENT KENYA.

By Julian Wanjira Wachira

TUMORS OF THE LARGE INTESTINE

Benign

Polyp – a clinical description of any elevated tumor.

Polyps can occur:

  • Singly
  • Synchronously in small numbers or
  • As part of a polyposis syndrome

In familial adenomatous polyposis (FAP), >100 adenomas are present.

Adenomatous polyps

Classification of polyps of the large intestine

Adenomatous polyps vary from tubular adenoma rather like raspberry on a stalk, to the villous adenoma, a flat spreading lesion.

Solitary adenomas are usually found during the investigation of colonic bleeding or sometimes fortuitously.
Villous tumors more usually give symptoms of

  • Diarrhoea
  • Mucus discharge
  • Occasionally hypokalaemia

Risk of malignancy developing in an adenoma increases with increasing size of tumor.

Adenomas larger than 5mm in diameter are usually treated because of their malignant potential. Colonoscopy snare polypectomy click here or diathermy obliteration with hot biopsy forceps click here can be used.

Huge villous adenomas of the rectum can be difficult to remove even with techniques per anus, and occasionally protectomy click here is required ; the anal sphincter can be preserved.

Proctectomy is a surgery to remove all or part of the rectum.

Familial adenomatous polyposis

Clinically defined as presence of >100 colorectal adenomas.

Over 80% of cases come from patients with a positive family history.

20% arise as a result of new mutations in the adenomatous polyposis coli gene (APC).

It is less common that hereditary non-polyposis colorectal cancer (HNPCC) and accounts for <1% of colorectal cancer (CRC).

Although the large bowel is mainly affected, polyps can occur in the stomach, duodenum and small intestine.

It’s inherited and mendelian dominant conditions.

Risk of CRC is 100% in patients with FAP.

Males and females are equally affected.

It can also occur sporadically without any previous sign or history, presumably by new mutations. There’s often, in these cases, a history of large bowel cancer occurring in young adulthood or middle age, suggesting preexisting adenomatosis.

FAP can be associated with benign mesodermal tumors such as desmoid tumors and osteomas. Epidermoid cysts can also occur (Gardner’s syndrome) ; desmoid tumors in the abdomen invade locally to involved the intestinal mesentery and, although non-metastasising, they can become unresectable.

Up to 50 per cent of patients with FAP have congenital hypertrophy of the retinal pigment epithelium (CHRPE), which can be used to screen affected families if genetic testing is unavailable.

Clinical features

Polyps are usually visible on sigmoidoscopy by the age of 15 years and will almost always be visible by the age of 30 years.

Carcinoma of the large bowel occurs 10–20 years after the onset of the polyposis.

One or more cancers will already be present in two-thirds of those patients presenting with symptoms at the time of diagnosis

Symptomatic patients

Are either patients in whom a new mutation has occurred or those from an affected family who have not been screened.

They may have

  • Loose stools
  • Lower abdominal pain
  • Weight loss
  • Diarrhoea
  • Passage of blood and mucus

Colonoscopy is performed with biopsies to establish the number and histological type of polyps.

If over 100 adenomas are present, the diagnosis can be made confidently.

If there are no adenomas by the age of 30 years, FAP is unlikely. If the diagnosis is made during adolescence, operation is usually deferred to the age of 17 or 18 years unless symptoms develop.

Screening policy

  • At-risk family members are offered genetic testing in their early teens.
  • At-risk members of the family should be examined at the age of 10–12 years, repeated every year.
  • Most of those who are going to get polyps will have them at 20 years, and these require operation.
  • If there are no polyps at 20 years, continue with yearly examination until age 50 years; if there are still no polyps, there is probably no inherited gene.

Carcinomatous change may exceptionally occur before the age of 20 years. Examination of blood relatives, including cousins, nephews and nieces, is essential, and a family tree should be constructed and a register of affected families maintained.

Treatment

The aim of surgery is to prevent the development of colorectal cancer. The surgical options are:

  • colectomy with ileorectal anastomosis (IRA);
  • restorative proctocolectomy (RPC) with an ileal pouch-anal anastomosis, the anastomosis may be defunctioned with a loop ileostomy;
  • total proctectomy and end ileostomy (normally reserved for patients with a low rectal cancer).

The patient is almost always young and likely to prefer to avoid a permanent stoma and so the choice is normally between the rst two options.

The advantage of an IRA is that

  • it avoids the temporary stoma frequently required for an RPC
  • avoids the potential compromise to sexual function that accompanies proctectomy.
  • has a lower morbidity and mortality.

However, the rectum is left and requires regular surveillance, as there is a risk of adenomas and carcinomas in the residual large bowel. Even with optimal surveillance of the rectal remnant, up to 10 per cent will develop invasive malignancy within a 30-year follow-up period.

Restorative proctocolectomy has the advantage of removing the whole colon and rectum (although a small cuff of rectal mucosa may be left behind with a stapled anastomosis). However, there is a pouch failure rate of about 10 per cent. In addition, and particularly where a stapled anastomosis has been created, there remains a very small but denite incidence of cancer developing in the small strip of rectal mucosa between the pouch and the dentate line. This is why some colorectal surgeons advocate complete mucosectomy of the residual rectal cuff and a transanal pouch anal anastomosis, although it is acknowledged that this results in worse function.

Postoperative surveillance

  • rectal/pouch surveillance, with biopsy of the pouch-anal anastomosis.
  • Gastroscopies are also carried out to detect upper gastrointestinal tumours.

Even with prevention of colorectal cancer, FAP patients have reduced life span due to the development of duodenal and ampullary cancers and the complications of desmoid tumours.

Hereditary non-polyposis colorectal cancer (Lynch syndrome)

characterised by increased risk of colorectal cancer and also cancers of the endometrium, ovary, stomach and small intestines.

It is an autosomal dominant condition that is caused by a mutation in one of the DNA mismatch repair genes. The most commonly affected genes are MLH1 and MSH2.

The lifetime risk of developing colorectal cancer in Lynch syndrome is 80 per cent, and the mean age of diagnosis is 45 years.

Most cancers develop in the proximal colon.

Females with HNPCC have a 30–50 per cent lifetime risk of developing endometrial cancer.

Diagnosis

Tumours of the large intestine 1163 HNPCC can be diagnosed by genetic testing or the Amsterdam II criteria:

  • three or more family members with an HNPCC-related cancer (colorectal, endometrial, small bowel, ureter, renal pelvis), one of whom is a rst-degree relative of the other two;
  • two successive affected generations;
  • at least one colorectal cancer diagnosed before the age of 50 years;
  • FAP excluded;
  • tumours veried by pathological examination.

Patients with HNPCC are subjected to regular (every one to two years) colonoscopic surveillance.