KUALA LUMPUR, March 16 – Colorectal cancer has emerged as a critical health issue in Malaysia, and is now the second most prevalent cancer in the country after breast cancer.
According to the Ministry of Health’s (MOH) National Strategic Plan for Colorectal Cancer 2021-2025, about 70 per cent of colorectal cancer cases are detected only in stages three and four of the disease.
The report’s findings highlight the importance of increasing awareness and taking proactive measures to prevent, detect, and treat colorectal cancer. Given that early-stage colorectal cancer is often asymptomatic, it underscores the importance of remaining vigilant for any potential symptoms that may arise.
Dr Chong Hoong Yin, resident consultant general and colorectal surgeon at Sunway Medical Centre, recently discussed colorectal cancer awareness in Malaysia, including screening protocols, recovery strategies, and treatment options, in an email interview with CodeBlue.
Which Group Of People Are Most Likely To Get Colorectal Cancer?
Colorectal cancer affects both men and women of all races and ethnicities. However, according to the Malaysia National Cancer Registry Report (2012-2016), colorectal cancer is our country’s second most common cancer.
The data in the report shows a higher incidence in people of Chinese ethnicity, as one in 43 people contract the disease. The study also indicates that the incident rate increases significantly from age 55 and that the incident rate is higher in males at 14.8 per cent compared to females at only 11.1 per cent.
There are both modifiable and non-modifiable risks. Non-modifiable risks include Malaysians above 50, males and those with a history of colon cancer. Certain genetic conditions may also increase the risk of colorectal cancer if your family have a history of familial adenomatous polyposis (FAP), Peutz-Jeghers Syndrome, or Lynch Syndrome.
You may also be at higher risk if you have a history of colonic polyps or inflammatory bowel disease.
Meanwhile, modifiable risk factors include physical inactivity, smoking, consumption of alcohol, and a diet high in red meat and processed food, high in fat, but low in fruit and vegetables or fibres.
What Causes Colorectal Cancer?
Colorectal cancer develops when abnormal cells in the colon or rectum grow uncontrollably (polyp), leading to the formation of invasive cancer. The exact cause of colorectal cancer is not yet fully understood, but there are several risk factors that have been identified:
Certain genetic conditions (FAP, Lynch syndrome, Peutz-Jeghers syndrome) can be passed down through families and may increase the likelihood of developing colorectal cancer.
More common than genetic factors and do not pass down through families. Those factors include smoking, heavy consumption of alcohol, physical inactivity, obesity, and a diet high in red meat and fat and low in fibre.
What Are The Signs To Look Out For Possible Colorectal Cancer Symptoms?
The early stages of colorectal cancer are asymptomatic. However, as it progresses, signs or symptoms of colorectal cancer include:
- Rectal bleeding.
- Changes in bowel habits, such as diarrhoea or constipation.
- Feeling of incomplete evacuation.
- Abdominal pain or discomfort.
- Unexplained weight loss.
- Fatigue, weakness, loss of appetite.
Is Colorectal Cancer Preventable?
Yes, colorectal cancer is a highly preventable disease. The most effective way is through screening, which can detect precancerous polyps or early-stage cancers. Screening tools include stool-based tests, sigmoidoscopy, or colonoscopy.
In addition to screening, we can reduce the modifiable risk factors by:
- Regular exercise and maintaining a normal body mass index (BMI).
- Eating a healthy diet that is high in fibre, vegetables, and fruits, and low in red meat, processed food and fat.
- Quit smoking and reduce alcohol consumption.
Is It Possible To Cure Colorectal Cancer And What Treatment Options Are Available?
Yes, colorectal cancer is curable. However, the chances of curing colorectal cancer are higher if detected at an early stage.
The treatment options available for colorectal cancer depend on the stage of cancer at diagnosis, the tumour’s location, and the patient’s overall health.
Here are some treatment options:
Surgery: Surgery is the primary treatment method, involving the removal of the tumour along with the surrounding lymph nodes. In some cases, a temporary or permanent stoma may be necessary. Surgical options in treating colorectal cancer include open surgery, laparoscopic or “keyhole” surgery, and robotic surgery.
Chemotherapy: Chemotherapy is a treatment method that uses drugs to kill cancer cells, administered orally or intravenously, before or after surgery. We use this in cases of advanced or metastatic cancer cases.
Radiotherapy: Radiotherapy is when we use high-energy radiation to kill cancer cells, mainly for rectal cancer treatment. We use this treatment method before or after surgery or in combination with chemotherapy.
Targeted therapy: This treatment method uses drugs designed to target specific molecules or proteins involved in the growth and spread of cancer cells. We use this method for cancers that have reached Stage IV and have metastasised.
Immunotherapy: This is a treatment method that helps bolster the body’s immune system to fight the cancer.
What Are The Taboos And Misconceptions, And What Can The Community Do To Move Forward From These Taboos And Misconceptions?
Unfortunately, there are still misconceptions and taboos surrounding colorectal cancer due to the lack of awareness and education on the topic.
Let’s debunk some of the most common misconceptions and taboos on colorectal cancer:
It only affects older people: Although there is a higher risk of getting colorectal cancer as your age progresses, colorectal cancer can occur in anyone at any age. There happens to be a rising trend in younger people getting colorectal cancer.
It only affects men: This is a false misconception, as colorectal cancer can occur in both men and women.
Patients will need to carry a stoma bag permanently after operating: Not all surgery for colorectal cancer requires the patient to have a stoma bag after surgery, as it depends on the tumour’s location. The surgeon will discuss the requirement for a stoma bag before the surgery.
The surgical treatment causes cancer to spread faster: This claim is untrue, and there is no scientific evidence to support this claim.
Chemotherapy is debilitating: The side effects of chemotherapy are minimal, and most patients who undergo this treatment can tolerate it. Chemotherapy has also proven to be one of the most effective treatments in treating more advanced colorectal cancer.
A screening colonoscopy is painful: You will be sedated adequately before a colonoscopy. You won’t feel a pinch if done by an experienced surgeon or physician.
It is vital to increase awareness regarding colorectal cancer to move forward from these misconceptions and taboos. Through social media, public health campaigns, community outreach programmes and colorectal cancer survivor support groups, people can become more aware, and this will reduce the misconceptions and taboos.
Through these awareness campaigns, there should also be an emphasis on early detection and the importance of screening to prevent a late-stage diagnosis.
Which Demographic Should Be Getting Screened For Colorectal Cancer?
It is recommended that screening for all Malaysians above the age of 45 be done at least once every ten years.
For individuals with a family history of colorectal cancer or who have certain genetic syndromes like FAP, Peutz-Jeghers Syndrome, or Lynch Syndrome should get screened earlier and more frequently.
It is important to consult and discuss with your doctor when and how often you need to be screened and the screening options available.
Does The Stigma Against Colonoscopies For Being Invasive Impact Screening For Colorectal Cancer?
Yes. Some people may avoid screening colonoscopy due to fear, anxiety, or embarrassment related to the invasiveness of colonoscopies.
However, a colonoscopy detects polyps and can remove these simultaneously. To address this stigma, health care providers should discuss the risks and benefits of colonoscopies for colorectal cancer screenings with their patients and address any concerns or misconceptions.
Are There Non-Invasive Tests Available? What Are The Pros And Cons Of These Tests Provided By Health Care Centres?
Yes, there are several non-invasive, stool-based screening tests for colorectal cancer. These tests involve collecting a small stool sample. These tests include:
Faecal occult blood test (FOBT): This test detects hidden blood in the stool sample. However, it has a high rate of false positives.
Faecal immunochemical test (FIT): Like the FOBT, this test also detects blood in the stool but uses antibodies to detect human blood specifically. It is more sensitive and specific compared to FOBT.
Stool DNA test: This test looks for specific DNA changes in stool associated with colon cancer. It is more accurate than the FOBT and the FIT but also more expensive. Therefore, I do not recommend using this for people with a high risk of colon cancer.
M2-PK Quick stool test: This test is a visual immunochromatographic rapid test for detecting the enzyme M2-PK (M2-pyruvate kinase) in stool samples. It is typically used for colorectal cancer screening. It indicates bleeding and non-bleeding colorectal polyps and tumours, colorectal cancer, acute and chronic inflammatory bowel disease and other digestive tract diseases.
Another non-invasive screening test is a CT colonography. This test uses a CT scan to create images of the colon. However, it does require bowel preparation and may miss small polyps.
The pros of these non-invasive tests are that they are less invasive, do not require sedation and are generally less expensive than a colonoscopy. In addition, most of the necessary stool-based test samples can also be collected at home.
The cons are that false positives and negatives can occur, leading to unnecessary follow-up tests or missed diagnoses. Also, a follow-up colonoscopy is needed to confirm the diagnosis if the test returns positive.
Colorectal cancer is a curable disease. Screening and early detection of colorectal cancer offer a higher chance of cure. Do not ignore symptoms such as rectal bleeding, altered bowel habits, and abdominal discomfort.
If you have any doubts, consult a health care provider immediately, as these symptoms may be related to colorectal cancer. Finally, discuss with your health care provider about screening options, especially if you are in the high-risk group.
Sunway Healthcare Group will be offering free colorectal cancer screenings from April 10 to May 31, 2023, in conjunction with Colorectal Cancer Awareness Month, through the Brave the Cancer campaign funded by the Sunway Cancer Support Fund. Registrations are open here. For more information about the Sunway Cancer Support Fund and Brave the Cancer free screenings, please WhatsApp 011-3322 6645.