Colorectal cancer is a common type of cancer among men and women in Malaysia. Colorectal cancer, also known as bowel cancer, colon cancer or rectal cancer. Public awareness of the rising incidence of colorectal cancer is still low.
Colorectal cancer starts in the colon (large intestine) or rectum. It usually begins with normal tissues forming on the wall lining of the colon or rectum, that become polyps (pre-cancerous growth). Over time, some of these polyps can grow in size, go through cellular changes to become cancer.
Colorectal cancer symptoms may be minor or non-existent during the early stages of the disease, although there may be some early warning signs.
Early symptoms of colorectal cancer:
- Unexplained weight loss
- Persistent abdominal pain
- Narrow stools (Pencil-thin stools)
- Rectal bleeding, either bright or dark red color
- Anaemia caused by iron deficiency due to chronic bleeding
- Tenesmus, which is the feeling that you have to empty your bowel but nothing passes
In its advanced stages, symptoms of colorectal cancer may include:
- Appetite loss
- Uncontrolled weight loss
- Deterioration of physical condition
- Abdominal pain/bloating/bowel obstruction
Certain conditions make an individual more susceptible to developing colorectal cancer. Factors that increase your risk may indicate that you may need to be careful about developing colorectal cancer but does not necessarily mean that you will develop the disease.
Risk factors that are associated with the development of colorectal cancers include:
- Personal history of polyps or colorectal cancer
- Family history of colorectal cancer
- History of inflammatory bowel cancer
- 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
Screening for colorectal cancer of the general population is used to detect cancer before there are any symptoms. An individual who wants to do a colorectal cancer screening needs to see a specialist to determine the risk with a full clinical and physical examination. Our specialist will identify the risks and determine the level of follow-up that you may require.
Our colorectal cancer specialist uses a variety of tests and tools designed for diagnosing colorectal cancer, evaluating the disease and planning your individualized treatment. Diagnostic tests include:
- Fecal occult blood test (FOBT) / Fecal Immunochemical test (FIT) – To detect occult (hidden) blood or by-products of degraded blood in the stools, which cannot be seen with the naked eye.
- Sigmoidoscopy – To examine the lower part of the colon.
- Colonoscopy – A thin and flexible tube with a video camera attached at the end is inserted through the anus and into the rectum and the colon, to check for polyps or anything unusual that may be inside your colon or rectum.
- Biopsy – A procedure to remove tissue samples, used to determine whether any of the tissue cells are cancerous or precancerous. During the colonoscopy procedure, a specialized device is also attached at the end of the thin and flexible to snip tissue samples.
- Blood tests – Colorectal cancer often bleeds into the large intestine or rectum, people with this cancer may become anaemic. A complete blood count (CBC), can indicate that bleeding may be occurring. Kidney and liver functions, as well as tumour markers, can be measured for any abnormalities. Some tumour markers may be raised in colorectal cancers.
- Ultrasound – An ultrasound is a scan that uses penetrating sound waves to produce detailed images of the internal organs to find out if cancer has spread.
- PET-CT scan – PET-CT scan is an imaging test in which a radioactive drug (radiotracer) is administered into the person to help reveal how the tissues and organs are functioning. The tracer will collect in the area of your colon or rectum that has higher levels of chemical activity, which correspond to areas of disease. This imaging scan may sometimes spot cancer before it appears on other imaging tests.
Discovery™️ IQ PET-CT at Beacon Hospital enables:
- High accuracy and fast scanning which improves patient comfort and enables shorter breath-hold.
- Outstanding Image Quality
- Reduced Dosage of Radiotracer which lowers the patient’s exposure to radiation.
- MRI – An MRI scan uses magnetic fields to produce detailed images of the body, and can be used to measure the tumour’s size. A unique dye (contrast medium) is administered into a vein before the scan to see the details better. This is helpful especially in planning for surgery in rectal cancers.
Staging of Colorectal Cancer
Stage 0 – Cancer has not spread beyond the inner lining (mucosa) of the colon or rectum.
Stage I – Cancer has spread into the intestinal wall, through the mucosa and into the submucosa.
Stage IIA – Cancer has spread into the outmost layers of the colon or rectum, but has not spread out of it.
Stage IIB – Cancer has spread past the wall of the colon or rectum, but has not spread into the surrounding tissues, organs or lymph nodes.
Stage IIC – Cancer has spread past the wall of the colon or rectum, and has spread into surrounding tissues or organs, but has not spread to nearby lymph nodes or distant organs.
Stage IIIA – Cancer has spread past the wall of the colon or rectum, and may have grown into the muscle. Cancer has spread to up to three lymph nodes near the site of the primary tumour.
Stage IIIB – cancer has spread past the outmost layer of the colon or rectum, and may have spread into nearby organs or tissues. Cancer has spread to up to three lymph nodes near the original site, but has not spread to distant organs.
Stage IIIC – cancer has spread past the outermost layer of the colon or rectum, and may have spread to four or more lymph nodes near the original site. Cancer has also spread to nearby organs.
Stage IVA – cancer may or may not have spread past the outermost layer of the colon or rectum, or even nearby lymph nodes, but it has spread to one different organ.
Stage IVB – cancer may or may not have spread past the outermost layer of the colon or rectum, or even nearby lymph nodes, but it has spread to more than one different organ.
Like most cancers, the treatment of colorectal cancer will be determined by the explicit location and degree of the disease.
- Colon Surgery– The most common treatment for colorectal cancer. It aims to remove the tumour, part of the healthy intestine and the nearby lymph nodes. After surgery for colorectal cancer, some patients may require chemotherapy to reduce the risk of cancer returning.
Polypectomy – Non-invasive procedure used to expel polyps from within the colon, likewise called the large intestine. A polyp is a strange assortment of tissue. The procedure is typically done simultaneously as a colonoscopy.
Laparoscopy – Non-invasive procedure that involves a thin tube (laparoscope) is inserted into the abdomen through a small incision.
Colectomy – Procedure involving the removal of any part of the colon.
- Radiotherapy – External-beam radiotherapy or radioactive material placed directly near cancer cells. For rectal cancer, external-beam radiation is the most common form of radiotherapy. It is often used in combination with chemotherapy before surgery to reduce the risk of relapse of the disease. External Beam Radiation Therapy (EBRT), which is usually delivered by a machine called a linear accelerator that focuses high-energy X-rays from the outside of the body to the tumour.
Halcyon Radiotherapy System at Beacon Hospital enables:
- Fast and precise X-ray dose delivered to each tumour with high accuracy over a minimum number of treatment sessions
- Reduces unwanted radiation dose, thus, minimising side effects
Unlike any other radiation delivery system, the Halcyon technology’s beam-on time could be as fast as 1-minute plus. Its gantry rotates 4 times faster than a standard linear accelerator and its multi-leaf collimator (MLC) can move twice faster than traditional MLCs. All of these features help in improving the time it takes to treat the patients.
TrueBeam 2.7 Radiosurgery/Radiotherapy System at Beacon Hospital offers:
- HyperArc™ High-Definition Radiotherapy and Radiosurgery
HyperArc™ high-definition Radiotherapy system represents a significant step forward for high quality Linac-based Radiosurgery, with an easy delivery of non-coplanar Stereotactic Radiosurgery (SRS) treatments. HyperArc™ could irradiate multiple tumours at the same time without repositioning the patient, which provides better management of patient motions while saving time for the patient and the clinical team. HyperArc™ ensures the planners achieve extremely compact dose distributions consistently and efficiently while maintaining patient safety.
- Chemotherapy– The most common treatment option for patients with stage III or stage IV. Chemotherapy drugs are given to destroy cancer cells or impede their ability to grow and reproduce.
Type of chemo drugs:
- Alkylating agent is a type of chemo drug that is capable of damaging the DNA of a cancer cell to ensure that the cell doesn’t make more copies of them.
- Topoisomerase inhibitor is a compound that can block the human enzymes that contribute to the growth of cancer cells.
- Antitumor antibiotic is an anticancer drug that is capable of slowing down or stop the growth of cancer cells.
- Antimetabolites is a chemo drug that is capable of interfering with more than one enzyme that’s necessary for the growth of DNA inside the cancer cell.
- Mitotic inhibitor is a type of chemo drug that is capable of stopping the body from producing the protein which contributes to cancer cell growth.
- Corticosteroids are man-made steroids used to help reduce the side effects of chemotherapy
- Targeted Therapy – Targeted therapy directs drugs or other specially created substances (e.g., immune system proteins developed in the lab) to attack cancer cells. Targeted therapy may be used alone or in combination with other treatments, such as chemotherapy.
Type of Targeted Therapy drugs:
- Cetuximab is an anti-cancer targeted therapy drug, which can rapidly destroy cancer cell from dividing by targeting particular proteins on the cell surface.
- Immunotherapy – A type of treatment that uses the body’s immune system to fight cancer by stimulating the immune system to help it do its job more effectively. For instance, drugs called checkpoint inhibitors can be used for people whose colorectal cancer cells have tested positive for specific gene changes, such as a high level of microsatellite instability (MSI-H), or changes in one of the mismatch repair (MMR) genes. Immunotherapy can be used to treat some people with advanced colorectal cancer.