Colorectal Cancer Malaysia

March is Colorectal Cancer Awareness Month. It is a month-long awareness event that runs concurrently all over the world to raise the public’s awareness on colorectal cancer and the importance of early detection and screening. It also serves to promote healthy lifestyle habits that would indirectly decrease an individual’s modifiable risk factors for developing colorectal cancer (CRC).

According to the Malaysian National Cancer Registry Report 2007 - 2011, CRC is the second most common cancer in Malaysia (13.2%) with a reported incidence of 21.3 new cases per 100,000 population.

The reported CRC incidence in males is higher than females with a ratio of 1: 1.33. It is also highest among the Chinese population followed by Malays and Indians.The CRC-associated mortality ratio is also similar to this incidence rate.

Despite the widespread information available on social media, more than 50% (54.3%) of patients still present at late stages of III and IV with only 8.4% being diagnosed at stage I. CRC 

An Introduction

Why the importance of raising awareness for colorectal cancer among the public? 

This is to educate the public on the following:

  1. Be aware of common colorectal cancer symptoms so they know how to seek medical consultation and attention timely 

  2. Understand the risks of CRC and to encourage those with higher risk for CRC to get screened earlier 

  3. Modifying risk factors to reduce the incidence of CRC

The most common symptoms of CRC include:

  • Altered bowel habit (41.7%)

  • Blood in stool (35.5%) 

  • Abdominal pain (31.5%) 

  • Unexplained or unintentional weight loss (31.0%)

  • Anaemia (9.8%) 

  • Intestinal obstruction (9.3%) - presents as emergency

Modifiable risk factors for CRC that can be altered with a healthy lifestyle are: 

  • Smoking

    • Active smokers have 16% greater risk of developing CRC compared with those who have never smoked. 

  • Diabetes mellitus

    • Uncontrolled diabetic individuals have an increased risk of CRC 

  • High body mass index

    • There is a significant positive association between overweight or obese people with CRC

  • Alcohol consumption greater than 30 gram/day (g/d) is positively associated with increased risk for CRC 

  • High red meat consumption increases the risk for developing CRC. It has been recommended to keep consumption of red meat to less than 500 g (18 ounces) per week and to avoid processed meat.

Screening Modalities

  • Faecal occult blood test is a non-invasive tool to screen for CRC by detecting the presence of unvisualized blood & specific proteins e.g. enzyme M2- PK and DNA in the stool.

    • Immunochemical FOBT (iFOBT) and guaiac-based FOBT (gFOBT) are two methods of qualitative FOBT commonly done in GP clinics and Health Clinics. The MOH Health Clinics use iFOBT to screen for CRC among their patients.

    • Faecal M2-PK test has a pooled sensitivity and specificity of 79% (95% CI 73 to 83) and 80% (95% CI 73 to 86) respectively by detecting specific CRC proteins in stool

  • Colonoscopy is the gold standard for screening for CRC as it allows direct visualization of polyps and tumors throughout the colon, biopsy of lesions and with an added benefit of therapeutic interventions like polypectomy. However, it is an invasive procedure.

  • Capsule Endoscopy and CT Colonography are less invasive with potential of missing flat polyps and does not allow interventional procedures.

Colorectal Cancer Awareness Month
  • March 2023