Colo-rectal Cancers in Malaysia
Dr Teo Boon Chin
Consultant General & Colorectal Surgeon
Hospital Pantai Indah

Colorectal cancers are the second most common cancer in Malaysia. It is the number one cancer among men in all races in Malaysia and the third most important cancer among women, after breast and uterine cervical cancer in Chinese and Malays.

The incidence of colorectal cancers has been rising slowly in Malaysia. Changes in the diet, such as an increase in dietary fat, decrease in dietary fiber and overall total energy consumption are thought to pre-dispose people to colorectal cancers.

In year 2002, Malaysia recorded at least 2778 cases of both colon and rectal cancers. When we consider ethnic differences, Chinese have a highest incidence of colorectal cancers, there were 59.6% of cases (1656 cases) involved Malaysian Chinese. The incidence of colorectal cancer increased exponentially after age of 40 for both sexes. The cumulative lifetime risk for rectal cancer for Chinese males was 1 in 48, for Indian males is 1 in 71, and for Malay males are 1 in 91.

In the presentation of colorectal cancer, signs and symptoms always indicate moderate or advanced stage of disease. The important symptoms associated with colorectal cancers are as below:

-         altered bowel habit ( constipation alternating with diarrhea).

-         Passing blood or mucous in the stool.

-         Intermittent mild colicky abdominal pain or abdominal
      distension.

-         Anemic symptoms

-         Loss of appetite and loss of weight.

Colorectal cancers can be diagnosed by:

-         Colonoscopy and biopsy.

-         Barium enema or CT scan abdomen

-         High tumour marker (CEA ) indicate advanced disease.

In the treatment of colorectal cancers, surgical resection is indicated for all cases if possible to prevent local complications such as obstruction, perforation, bleeding or local infiltration to other structures. Post operative adjuvant chemotherapy and radiotherapy is indicated for more advanced cases with possibility of local or distant spread.

Early detection is the key factor in fighting colorectal cancer. Polypectomy (removal of colonic polyps) through colonoscopy is the only effective way to prevent malignant transformation. Colonoscopy should be done routinely for population aged 50 and every 5 yearly subsequently.