In Malaysia, colorectal or colon cancer is the most common form of cancer among males, the second most common among females and the third most common cause of death.
This form of cancer occurs in the colon or rectum and is caused when cells grow out of control and form polyps.
Speaking about the condition, consultant gastroenterologist and hepatologist at ParkCity Medical Centre (PMC) Dr Saravana Kumar said, “The risk factors contributing to colorectal cancer include smoking, consuming alcohol, eating a low-fibre diet, obesity and lack of exercise. You are also at a higher risk of contracting colorectal cancer if you are over 50 years old, male and Chinese.
“Other factors include a family history of colon cancer, polyps or certain inflammatory conditions.”
Why screening can save lives
With a rising number of cases recorded among those in the 45-50 age group, it is advisable that those 45 years old and above be screened every five years to ensure a healthy bowel.
Dr Saravana explained that while most people do not exhibit any particular symptom of colorectal cancer, this can change depending on the location of the tumour.
If the tumour is located closer to the rectum, it can cause bleeding. This however, would prompt a person to seek medical attention and increase their chances of detecting the tumour early after a screening has been conducted.
However, if the tumour is further up the colon, individuals tend to ignore the typical symptoms that do show up. These include abdominal pain, change in bowel habits and stool texture, a low blood count or increased frequency of bowel movement.
The most effective method to detect polyps is a colonoscopy. During a colonoscopy, a camera is inserted into the rectum and passed through the colon for polyp detection.
Polyps detected are then removed during the procedure and sent to a pathologist to determine if the mass is cancerous, pre-cancerous or benign.
Removing pre-cancerous polyps reduces the risk of developing colon cancer in the future hence the need for regular screening, Dr Saravana said.
The various stages of colon cancer
There are four stages of colon cancer. When a patient is in the fourth stage, it means that the cancer cells have spread to other parts of the body. A general surgeon will perform various tests such as a CT and PET scan to diagnose the stage of cancer in a patient.
Apart from scans, serum cancer marker levels (CEA) determine the tumour load in the body. The higher the CEA levels, the greater the spread of the cancer.
Consultant general surgeon at PMC Dr Zakry Onn Yahya explained that during the staging period, physicians are able to determine if the patient requires chemotherapy after colorectal cancer surgery.
This is called adjuvant chemotherapy and it is usually implemented in cases of third or fourth stage colorectal cancer. Chemotherapy can also be used in stages one or two in cases where the tumour has perforated in the abdomen.
“Regardless of the stage, surgery is the best option. The tumour is surgically removed, along with parts of the healthy bowel that is located close to the cancer site. This includes the surrounding fat and blood supply.
Once this is done, an attempt is made to join the healthy tissue back together. If it is not feasible to join it back, a stoma is sometimes created,” Dr Zakry shared.
A stoma is an opening in the abdomen where the colon is connected to an external bag (colostomy) to allow the excretion of faeces.
During the colostomy surgery, the surgeon will determine if reversal of the colostomy is possible in the future. After three months, the patient will undergo another colonoscopy to confirm the health of the bowel before a reverse colostomy is arranged.
However, Dr Zakry explained that there are several factors that can contribute to a stoma being a permanent option. This is when the distal part (the part further away from the tumour) is not healthy enough to be joined back or if the tumour is still present after surgery.
In cases where the tumour is still present post-surgery, the only option is to undergo chemotherapy or radiotherapy to reduce the size of the tumour before another surgery is performed.
To conclude, Dr Saravana and Dr Zakry reiterated the importance of early and regular screening, ideally every five years, particularly among males aged 45 and above. This is regardless of a patient’s surgical history.
For colon cancer survivors, continuous follow-up sessions every one, three or five years are necessary since surveillance is advised to ensure there is no recurrence of the cancer.
For more information, call 03-6279 1616.
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