World Cancer Day: CMScript on Colon cancer

As we mark World Cancer Day on 4 February, attention is being drawn to cancers that are common, often preventable, and more treatable when detected early. In support of this awareness, the Council for Medical Schemes (CMS) is sharing a new CMScript on colon cancer to help you understand the condition and the support your medical scheme may provide under the Prescribed Minimum Benefits (PMBs).

What is colon cancer?

Colon cancer starts in the large intestine (colon) when cells in the inner lining grow uncontrollably and form a tumour. Most colon cancers develop slowly over time and often begin as small, non-cancerous growths called polyps. If these polyps are not found and removed early, some can turn into cancer.

Signs and symptoms

In the early stages, colon cancer may cause no symptoms at all. When symptoms do occur, they may include:

• Tiredness or weakness, often due to anaemia.
• A feeling that the bowel does not empty or ongoing changes in bowel habits, such as diarrhoea or constipation.
• Abdominal pain, cramping or bloating and unexplained weight loss.
• Blood in the stool (bright red blood or dark, tar-like stools).

Risk factors and ways to reduce your risk

The risk of colon cancer increases with:

• Age (especially over 50).
• A family history of colon or rectal cancer.
• Diets high in red and processed meats and low in fibre.
• Physical inactivity, obesity, smoking and heavy alcohol use.
• Certain medical conditions, such as inflammatory bowel disease and Type 2 diabetes.

You can lower your risk by being physically active, eating a high-fibre diet, maintaining a healthy weight, avoiding smoking, limiting alcohol, and taking part in screening when recommended.

Diagnosis

If colon cancer is suspected, a healthcare provider may use:

• Clinical assessments to review symptoms, bowel habits and family history.
• Stool tests such as the faecal occult blood test (FOBT) or faecal immunochemical test (FIT) to detect small amounts of blood in the stool that cannot be seen with the naked eye.
• Endoscopy (camera tests):
  • Colonoscopy, where a flexible tube with a camera is used to examine the entire colon and take tissue samples (biopsies).
  • Flexible sigmoidoscopy, which examines the lower part of the colon and rectum.
• Imaging tests such as CT, MRI or PET/CT scans to assess how far the cancer has spread, along with blood tests including a full blood count and liver function tests.

Prescribed Minimum Benefit (PMB) level of care

Colon cancer falls under the PMB category: “Cancer of the gastrointestinal tract, including oesophagus, stomach, bowel, rectum, anus – treatable.” The stated PMB treatment for this diagnosis is: “Medical and surgical management, which includes chemotherapy and radiation therapy.”

This means that PMB level of care includes:

Diagnosis

• Consultations, colonoscopy with biopsy, imaging, and blood tests, as per evidence-based guidelines.

Treatment

• Surgery to remove the tumour when appropriate.
• Chemotherapy as needed, including after surgery or for advanced disease.
• Radiation therapy, part of standard gastrointestinal cancer care.

Ongoing Care

• Follow-up visits, surveillance colonoscopies, and imaging.
• Management of treatment-related side effects linked to PMB-level care.

PMB cover is not unlimited or unconditional. As a medical scheme member, it is important to understand that:

• Medical schemes may require members to use Designated Service Providers (DSPs) (specific hospitals, doctors, or networks). If a member chooses not to use a DSP without a valid reason, co-payments may apply.
• Treatment must be in line with evidence-based protocols and formularies (approved lists of medicines) adopted by the scheme, as long as these are consistent with the regulations and PMB principles.

Read the full CMScript here.