Confronting Colorectal Cancer

By Meera Murugesan

IN the cancer stakes, it has emerged winner – so ignore it at your own peril.

Colorectal cancer has surpassed lung cancer to become the most common cancer affecting Malaysian men.

More worryingly, many people with the condition are not being diagnosed at an early stage. The majority of patients are being diagnosed late, when the cancer is already at stage three or four. There is no stage five.

“Rarely do we see patients at stage one or two and that’s probably because we do not have an effective screening system in place to screen the high risk groups,” said Dr Raja Badrul Hisham Raja Zezeman Shah, president of the Malaysian Society of Gastrointestinal Disease which was formally registered in February this year.

Those with a family history of colorectal cancer are four times more likely to get the disease as compared to a person without the history – that’s according to Dr Raja Badrul, who spoke during the “1st Congress on issues in Gastrointestinal Tract Cancer: The patient’s perspective”, on June 11. The event was officiated by Health Minister, Datuk Dr Chua Soi Lek.

Among men, it accounts for 14.2 per cent of all cancers affecting them (making it the most common form), while in women, it accounts for 10.1 per cent of all cancers.

“More importantly, these figures may not reflect the true situation, as colorectal cancer often goes unreported and undiagnosed,” said Dr Raja Badrul. “The actual number could be much higher.”

Before this, lung cancer was always thought of as the most common killer of Malaysian men – and that was true, up to 2004. But steadily rising rates of colorectal cancer led to the disease surpassing lung cancer last year.

Other gastrointestinal related cancers, like stomach cancer, cancer of the small bowel, cancer of the oesophagus and the small intestines, although less common, are also showing a rising trend.

Most colorectal cancer cases seen in Malaysia are sporadic cases, meaning they have multi-factorial causes, including environmental, dietary and other factors. There are also cases where the cancer can be linked to a family history of the disease, but sporadic cases form the majority.

Bleeding when passing motion, alteration in bowel habits, gross loss of weight and appetite and abdominal pains are among the symptoms of this disease.

“But some patients may dismiss these symptoms as common complaints,” said Dr Raja Badrul. “For example bleeding when passing motion may be dismissed as haemorrhoids”.

One effective way to detect the disease is through a colonoscopy examination performed by a specialist, where a long, flexible and lighted tube called the colonoscope is used to view the entire colon and rectum for polyps or cancer.

“My advice for anyone with colorectal symptoms – consult your doctor, who may recommend a colonoscopy”. said Dr Raja Badrul.

Colorectal cancer FAQs?

THE colon and rectum are parts of the body’s digestive system, which removes fluids, mostly water, from what we eat and stores waste until it passes out of the body. Cancer of the colon and rectum are referred to as colorectal cancer (CRC).

Colorectal cancer develops from benign tumours called polyps. A polyp is a grape-like growth on the inside wall of the colon or rectum that may turn into cancer. Polyps grow slowly over many (three to 15) years. Most people do not develop polyps until after the age of 50. Approximately one in 20 polyps can become cancerous if not removed.

What are the risk factors?

The exact causes of colorectal cancer are not known. However, studies show that the following risk factors increase a person’s chances for developing colorectal cancer:

AGE As people get older, they are more likely to develop colorectal cancer. About 90 per cent of colorectal cancers occur in people over the age of 50. However, colorectal cancer can occur at younger ages and, in rare cases, in the teens.

DIET Diets high in fat and low in fiber seem to be associated with colorectal cancer.

FAMILY MEDICAL HISTORY

First-degree relatives (parents, siblings, children) of a person who has had colorectal cancer have an increased risk for colorectal cancer.

ULCERATIVE COLITIS AND CROHN’S COLITIS (INFLAMMATORY BOWEL DISEASE)

People who suffer from longstanding ulcerative colitis or Crohn’s colitis, chronic inflammatory disorders of the colon, have an increased risk for colorectal cancer.

Symptomn

* Rectal bleeding A change in bowel habits, especially in the shape of the stool (e.g. narrow like a pencil)

* Diarrhoea, constipation or feeling that the rectum does not empty completely

* Blood (either bright red or very dark) in the stool

* General abdominal discomfort (frequent gas pains, bloating, fullness, and/or cramps)

* Weight loss with no known reason

* Constant fatigue.

NOTE: These symptoms may be caused by colorectal cancer or by other less serious conditions. It is important to consult your health care provider regarding any symptoms you may be experiencing.

How is colorectal cancer treated?

Treatment depends mainly on the size, location, and extent of the tumour and on the patient’s general health. Treatment options include:

* Surgery

* Chemotherapy

* Radiation therapy

Source: American Gastroenterological Association

Gastro-intestinal diseases

GASTROINTESTINAL diseases are a global problem affecting many patients and include diseases which are acute and chronic, cancerous and non-cancerous, according to Health Minister Datuk Dr Chua Soi Lek.

“Many of these conditions are highly dangerous and can lead to death or pain and misery for patients.”

Gastrointestinal diseases ranked seventh among the common causes of death at Government hospitals in a report published last year and were also the seventh most common cause of admission to government hospitals.

According to the 2006 report, 98,955 admissions – or 5.2 per cent – of total admissions were related to gastrointestinal diseases.

Among the more common types of gastrointestinal diseases are colorectal cancer, stomach cancer and cancer of the liver.

“Colorectal cancer has been steadily rising year by year, while stomach cancer, which has seen reduced incidences in other countries, is still detected frequently in Malaysia,” said Dr Chua.

Stomach cancer accounts for 5.1 per cent of all cancers among men and 2.9 per cent of all cancers among women in Malaysia.

The country currently has 31 Gastroenterologists at hospitals under the ministry, and 20 such specialist doctors at universities and in private practice.

There are also nine colorectal surgeons in the country stationed at government hospitals, three at universities (one each at University Putra Malaysia, University Islam Antarabangsa and University Kebangsaan Malaysia) and 10 such specialists in private practice in the country.

“This number is still not enough and the ministry is trying to train more such specialists,” said Dr Chua.

(c) 2007 Sunday Mail; Kuala Lumpur. Provided by ProQuest Information and Learning. All rights Reserved.