An Expert View on Colorectal Cancer

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Kemas kini Tarikh 11/05/2020 . 4 minit bacaan
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Lifestyle-related causes of colorectal cancer

Cancers are not only unpleasant, they are complex in nature. It is difficult for lay people to grasp the concept behind the condition as it involves complex interactions between one’s genetic susceptibility with environmental factors. Recently, Malaysia had infamously topped the list of South East Asia’s fattest nations and as we all know, obesity has been largely linked with a myriad of disorders including cancers.

Does this mean that those who are not obese have reduced risk of developing colorectal cancer? Certainly not. Virtually anyone can be diagnosed with it, and yes, this hinges on several lifestyle-related factors. Some of them include excessive red meat consumption, low fiber intake, physical inactivity or factors that promote the formation of pre-carcinogenic agents.

In retrospect, people used to lead more active lifestyles compared to these days. They used to walk longer distances without the luxury of vehicles, cycle as a mode of transportation from point A to B, be more involved in outdoor activities such as sports, just to name a few. Today, in an era of technological advancement, people tend to be more sedentary, for instance being glued to their tablets and mobile phones at home, and using ride-sharing apps to get to and from short distances. Technology has somewhat embedded a culture of being “lazy” into what used to be regular lives, and it is a worrying trend to say the least.

Other lifestyle-related factors which can influence the risk of getting colorectal cancer include smoking and inherent factors such as ulcerative colitis.

Symptoms of colorectal tumour locality

Not every individual with cancer (of any form) would bear symptoms. The early stage of cancer is usually silent, hence the importance of undergoing screening.. However, for a specific kind of cancer (in this case colorectal cancer), the symptoms would depend on the locality of said tumour. If it sits near the rectum, patients are more likely to experience symptoms which resemble haemorrhoid such as bleeding per rectum, mucus discharge and painful defecation. Other symptoms include:

  1. Alteration in bowel habits (constipation or diarrhoea)

  2. Tenesmus

  3. Loss of appetite

  4. Sudden weight loss

If the tumour is located on the right side of the colon, most of the symptoms would point to the possibility of occult bleeding (bleeding without visualisation). They usually experience symptoms of anaemia (lack of red blood cells) such as:

  1. Tiredness

  2. Lethargy

  3. Weakness

  4. Shortness of breath

If early intervention is not administered, these tumour could spread to other organs, causing back pain (backbone) and shortness of breath (lungs). However, it is not easy to distinguish between symptoms of cancer and other medical conditions as they are known to bear stark resemblances. According to Dato’ Dr Meheshinder, around one in five of his patients seek intervention in an emergency condition. This nominal bracket of patients typically bear symptoms of intestinal obstruction, in which the tumour grows to an extent where it occludes lumen, causing inability to pass motion. Patients usually experience abdominal distension, constipation and vomiting, all of which typically indicate a large bowel obstruction.

Screening test for colorectal cancer

In Dato’ Dr Meheshinder’s umpteen years of practice, approximately 80% of those who receive treatment for colorectal cancer are aged 50 years and above. Age itself serves as an independent risk factor for all sorts of disorders (including cancer), thus emphasizing the importance of early detection through medical screening. This would make way for discussions on intervention options that can be executed.

There are certain criteria that should be fulfilled by a test before it can be considered as a relevant screening test. It must be cost effective, widely accessible, safe and should cover all layers of the population demographics (not specific to a targeted group). Thus far, the most useful screening tools that we have at our disposal for detecting colorectal cancer is the faecal immunochemical test (FIT). It fulfils all the aforementioned criteria but the downside is, it must be performed on an annual basis (once per year).

Other means such as colonoscopy is not considered as a screening tool as it is not cost effective and is more invasive. This does not mean that it is not a reliable test. In fact, those who have tested positive on the FIT should be studied further with colonoscopy. In many ways, FIT is considered a useful tool in minimising unnecessary colonoscopy procedures.

The Ministry of Health (MOH) Malaysia has even focused its efforts on supplying FIT kits to every Klinik Kesihatan (Wellness Clinic) and government hospitals across the country. Unfortunately, the kit has not gained traction with the mass population as initially expected. This is due to the fact that colonoscopy is ubiquitously perceived as the sole method in detecting colorectal cancer.

Treatment options for colorectal cancer

Surgery is arguably the most ideal treatment modality for colorectal cancer patients. However, prior to the procedure, specific tests and examinations would be conducted to confirm the patient’s fitness for an invasive procedure. Patients with chronic diseases such as diabetes and hypertension should be referred to their respective physicians for consultation to ensure that their conditions are well-controlled or at least optimised prior to going under the knife.

Other treatments which could serve as an adjunct to surgeries include chemotherapy and radiation therapy. Rectal cancer patients are occasionally  subjected to preoperative chemoradiation therapy to downsize the tumour and increase the possibility of sphincter preservation hence avoiding a permanent stoma. Prior to surgery, patients would be presented with all the required steps so as to invoke an informed consent. Should patients be presented to the doctor in a condition of emergency, the operation would be carried out immediately following the initial preoperative optimisation. The key to a successful operation for colorectal cancer depends largely on patient-doctor planning and exploration of all available options.

Colorectal cancer is indeed a preventable and treatable condition if detection is performed at an early stage. The success rates of surgery and survival rates for cancer varies across stages. Stage 1 can be as high as 95%, Stage 2 sits between 75-80%, Stage 3 is perched between 40-60%, while Stage 4 drops to between 5-10%. Remember to always be aware of the risk factors involved in developing colorectal cancer and perform your due diligence to stay clear of it in the long-run.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Hello Health Group tidak memberikan nasihat perubatan, diagnosis atau rawatan.

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