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July 06, 2012

Added By :
Dr Lee Kim Tiong

Colorectal Cancer or Cancer of Large Bowel is one of the leading cause of cancer related deaths in world wide and also in Malaysia. Dr Khor Boon Pin elaborates on how to combat this deadly cancer by screening.
Epidemiology & Incidence :

Colorectal cancer is the second leading cause of cancer death in the West and it ranks third in cancer incidence worldwide. It has become one of the most important gastrointestinal diseases in the Asia Pacific populations. In Malaysia, according to the National Cancer Patient Registry 2008, colorectal cancer is the most common cancer for males & 2nd most common for females. The incidence per 100,000 populations is 28, 15.5 and 12.4 among Chinese, Malay and Indians respectively. Males accounted for 60% and females, 40%.  Age distribution showed that 80.7% were 50 years and above and 19.3 % were less than 50 years old.

Symptoms of Colorectal cancer :

Symptoms of colorectal cancer include altered bowel habits, passing out blood and/or excessive mucus in stools, constitutional symptoms like significant loss of weight or appetite and abdominal pain (when complicated by intestinal obstruction).

Screening for Colorectal Cancer :

According to the National Cancer Registry Report 2007 Ministry of Health Malaysia, most of the colorectal cancer cases when detected were in the advanced stages of tumour growth. Screening is important and appropriate for colorectal cancer as it allows for early detection of cancer. There is considerable evidence that screening of asymptomatic persons who are at average risk can detect cancers at an early and curable stage, resulting in a reduction in mortality. Furthermore, some screening tests may also detect cancer-precursor lesions or polyps which, if removed, may result in a reduced incidence of colorectal cancer.

The risk factors for colorectal cancer include personal history of colorectal cancer or adenomatous polyps or chronic inflammatory bowel diseases, a strong family history of colorectal cancer or polyps (cancer or polyps in a first degree relative younger than 60 years or in two or more first degree relatives of any age) and a known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis or hereditary non-polyposis colon cancer (HNPCC). If a first-degree relative had colorectal cancer at 50 years of age or older, the lifetime risk of colorectal cancer nearly doubles among his or her family members. Patients with chronic ulcerative colitis or colitis due to Crohn’s disease are at increased risk for colorectal cancer. Environmental factors that influence the development of colorectal cancers are dietary habits such as food high in saturated fats and low in fibre, obesity, physical inactivity and history of chronic smoking and high alcohol intake.

There are several different screening tests, each with its advantages and limitations. Differences among strategies in terms of the sensitivity and specificity of the screening tests, their complexity, and the associated risk complicate the process of informed decision making by clinicians. Stool based tests include the Standard Guaiac fecal occult blood test and the more sensitive Fecal immunochemical test. Structural examinations of the colon include tests such as CT colonography and colonoscopy.

Your doctor should be able to discuss and advise on the options available for screening, its associated advantages & limitations, the cost-effectiveness of the screening tests and the interval of the screening test. It is important to emphasise that treatment is available for colorectal cancer and treatment is associated with a change in outcome for patients.

In summary, colorectal-cancer screening should begin with a process of informed decision making. Patients should be informed by their clinicians that there is strong evidence that screening persons who are at average risk is effective in reducing the risk of death from colorectal cancer, but that there is no perfect screening test and each program has its own advantages, limitations, and uncertainties. People should talk to their Doctors about starting colorectal cancer screening earlier and/or being screened more often if they have any of the colorectal cancer risk factors.


Dr Khor Boon Pin

Consultant Physician & Gastroenterologist.