One of the primary cause of deaths in Malaysia is colon cancer and regardless to this, the lack of awareness of the symptoms and signs of colon cancer remains low, which causes delayed in presentation and treatment. The awareness of the prevalence of colorectal cancer is indeed very low and frightening.
Colon cancer happens when unusual or in the long run malignant cells develop in the tissues of the large intestines known as the colon and/or rectum. Collectively this tumours are defined as colorectal cancer.
In Malaysia, colorectal cancer is the second most common cancer in males and the third most common cancer in females and it is also the second highest cause of cancer deaths amongst women after breast cancer and cervical cancers. The economic burden of colorectal cancer is significant and is expected to intensification over time in Malaysia owing to the present trend in colorectal cancer incidence.
Colorectal cancer symptoms might grow insidiously, such as anemia, due to blood loss or even non-specific such as weight loss. Usually, patients complain of a change in bowel habits; either diarrhoea, constipation or even alternating bowel movements. Low left sided tumour especially in rectum may cause a feeling of incomplete bowel emptying called tenesmus. Change in the form or colour of stools particularly if bright red or very dark blood can also be a warning sign of bleeding due to colorectal cancer.
Development of abdominal pain such as frequent bloating, fullness and cramps with infrequent bowel movements may indicate impending bowel obstruction which may present as emergency. This may be preceded by stools appearing thinner. Patients may also present with more worrisome symptoms such as pain due to the enlarged liver due to metastases or experience an unexplained loss of weight and appetite causing unexplained fatigue.
Screening & Diagnosis
Screening for colorectal cancer of the general population is used to detect cancer before there are any symptoms.
Individuals who attends the physicians for colorectal cancer screening, need to see a doctor to ascertain your risk with full clinical and physical examination to identify their risk group and determine the level of surveillance required. Certain groups of individuals may have a higher risk than normal, may require a more frequent surveillance and may start their screening earlier.
Screening for colorectal cancer using fecal occult blood testing (which detects blood in the stool), sigmoidoscopy or colonoscopy in adults may be recommended.
The doctor may perform some tests to make a diagnosis. Colonoscopy is done to look into the intestine to confirm diagnosis. During this procedure, the doctor can remove any abnormal lesions such as polyps or obtain tissue for further examination. Blood tests and other imaging tests may also be useful.
As with any disease, prevention is better than cure, while individuals may not be able to inhibit colorectal cancer, the risk of developing this disease can be reduced with a diet rich in fibre, exercise and with retaining a healthy weight. Early detection followed by prompt, suitable treatment significantly increase an individual’s chances of positive treatment and cure.
Stage I – Cancer is confined to the inner lining of the colon or rectum.
Stage II – Cancer spreads through the wall of the colon or rectum.
Stage III – Cancer spreads to nearby lymph nodes.
Stage IV – Cancer spreads to distant parts of the body, such as the liver or lungs.
Like most cancers, the treatment of colorectal cancer be determined by on the explicit location and degree of the disease.
Surgery is the most common treatment for colorectal cancer, and aims to remove the tumour and part of the healthy intestine and the nearby lymph nodes.
Some individuals may require a colostomy, which is a surgical opening through the abdomen to provide a pathway for the waste to exit the body into a bag worn by the patient. This opening is usually temporarily but may be permanent in some cases.
Following surgery for colorectal cancer, some patients may require chemotherapy to reduce the risk of the cancer returning.
Chemotherapy (and also targeted therapy) are used in patients with advanced stage cancer to help patients live longer and to improve their cancer symptoms. Older patients may also benefit from these treatments.
Radiotherapy, has specific indication and is usually used before surgery for rectal cancers. It is painless and does not involve electrical currents on patients, as is often thought.
Targeted Therapy, while standard chemotherapy affects all cells in the body, targeted therapy directs drugs or other specially created substances (e.g., immune system proteins developed in the lab) to attack cancer cells. The goal of targeted therapy is to interfere with genes or proteins involved in tumor growth to block the spread of the disease.are drugs or other substances designed to block the growth and spread of cancer by preventing cancer cells from dividing or by destroying them directly. Targeted therapies serve as the foundation of precision medicine, which uses information about a tumor’s DNA profile to identify additional treatment options. Tailored treatments target abnormalities that may be found in each tumor’s DNA profile. This innovation marks a shift from traditional treatments designed for the average patient, toward more precise therapies. Targeted therapy is an evolving science, and not all cancer types may be treated with targeted drugs.
Certain conditions may make an individual more susceptible to developing colon cancer. Factors that increase your risk may indicate that you may need to be careful about developing colon cancer but does not necessarily mean that you will develop the disease.
Risk factors that are associated with development of colorectal cancers include:
- Those with personal history of polyps or colorectal cancer
- Those with a family history of colorectal cancer
- Those with history of inflammatory bowel cancer
- Those with family history of breast, ovary or uterus cancer
- Eating a diet that is high in red meat, processed meat, fat and low in fibre
- Smoking and drinking alcohol
- Genetic factors