Colorectal cancer is the second most common cancer in Malaysia and the most common cancer among man. As its name implies, it arises from the colon or the rectum. It usually starts off as a polyp, which is growth on the inner lining of the colon or rectum. Not all polyps become cancerous, but some types do transform into cancer over time.

Early diagnosis and treatment of cancer is important for its outcome. Hence, screening for colorectal cancer is important to detect while it is still at an early stage.

Symptoms

Early stage of the illness may not show any symptoms. Some may present as:

Iron deficiency anaemia

Blood in stool
(appear darker than usual)

Rectal Bleeding

Change in bowel habit
(prolonged constipation)

Diarrhea or alternating
between both

Weight loss and fatigue

RISK FACTORS

Risk factors for colorectal cancer can be divided to modifiable and non-modifiable:

Non-Modifiable Factors
Non-Modifiable Factors
Age
more common in older age group > 50 years
Overweight or obese
History of colorectal polyps or colorectal cancer
Sedentary lifestyle
History of Inflammatory Bowel Disease
such as Ulcerating colitis or Crohn’s disease
Diet high in red meat and processed meat, high animal fat, low dietary fibre, low intake in fruits and vegetables
Family History
of colorectal polyps or colorectal cancer
Smoking
Inherited gene changes,
most common two are:

1. Lynch Syndrome, also known hereditary non-polyposis colon cancer (HNPCC) is the most common hereditary colorectal cancer syndrome.

2. Familial adenomatous polyposis (FAP) is caused by inherited changes in the APC gene.
Heavy alcohol intake

TYPES OF SCREENING FOR COLORECTAL CANCER

TYPES OF SCREENING FOR COLORECTAL CANCER
Stool-Based Screening Tests And Intervals Are as Follows:
  1. Guaiac-Based Fecal Occult Blood Test (FOBT), Every Year
  2. Fecal Immunochemical Test (FIT), Every Year
  3. FIT-DNA, Every 1 Or 3 Years
Direct Visualization Screening Tests And Intervals Are as Follows:
  1. Colonoscopy, Every 10 Years
  2. Computed Tomographic (CT) Colonography, Every 5 Years
  3. Flexible Sigmoidoscopy, Every 5 Years

RECOMMENDED SCREENING AGE

  • A person with average risk (no family history) or symptoms of colorectal cancer should start regular screening at age of 50 to 75 years.
  • A person with a family history of colorectal cancer (first-degree relative – FDR) should have a colonoscopy done at 40 years old or 10 years younger or whichever is younger when diagnosed.

    If the FDR was affected:
    • before the age of 60, it is recommended to repeat colonoscopy every 3-5 years; even if normal.
    • at age >60 years, repeat colonoscopy every 10 years.
  • For those with inflammatory bowel disease or hereditary colorectal cancer syndrome (or suspected to have),
    screening will need to start earlier and more frequent.

Colonoscopy is the only screening method used here.

TYPES OF SCREENING FOR COLORECTAL CANCER

Stool-Based Screening Tests And Intervals Are as Follows:
  1. Guaiac-Based Fecal Occult Blood Test (FOBT), Every Year
  2. Fecal Immunochemical Test (FIT), Every Year
  3. FIT-DNA, Every 1 Or 3 Years
Direct Visualization Screening Tests And Intervals Are as Follows:
  1. Colonoscopy, Every 10 Years
  2. Computed Tomographic (CT) Colonography, Every 5 Years
  3. Flexible Sigmoidoscopy, Every 5 Years

RECOMMENDED SCREENING AGE

  • A person with average risk (no family history) or symptoms of colorectal cancer should start regular screening at age of 50 to 75 years.
  • A person with a family history of colorectal cancer (first-degree relative – FDR) should have a colonoscopy done at 40 years old or 10 years younger or whichever is younger when diagnosed.

    If the FDR was affected:
    • before the age of 60, it is recommended to repeat colonoscopy every 3-5 years; even if normal.
    • at age >60 years, repeat colonoscopy every 10 years.
  • For those with inflammatory bowel disease or hereditary colorectal cancer syndrome (or suspected to have),
    screening will need to start earlier and more frequent.

Colonoscopy is the only screening method used here.

TYPES OF SCREENING FOR COLORECTAL CANCER
Stool-Based Screening Tests And Intervals Are as Follows:
  1. Guaiac-Based Fecal Occult Blood Test (FOBT), Every Year
  2. Fecal Immunochemical Test (FIT), Every Year
  3. FIT-DNA, Every 1 Or 3 Years
Direct Visualization Screening Tests And Intervals Are as Follows:
  1. Colonoscopy, Every 10 Years
  2. Computed Tomographic (CT) Colonography, Every 5 Years
  3. Flexible Sigmoidoscopy, Every 5 Years
RECOMMENDED SCREENING AGE
  • A person with average risk (no family history) or symptoms of colorectal cancer should start regular screening at age of 50 to 75 years.
  • A person with a family history of colorectal cancer (first-degree relative – FDR) should have a colonoscopy done at 40 years old or 10 years younger or whichever is younger when diagnosed.

    If the FDR was affected:
    • before the age of 60, it is recommended to repeat colonoscopy every 3-5 years; even if normal.
    • at age >60 years, repeat colonoscopy every 10 years.
  • For those with inflammatory bowel disease or hereditary colorectal cancer syndrome (or suspected to have),
    screening will need to start earlier and more frequent.

Colonoscopy is the only screening method used here.

TREATMENT

Surgical resection of tumour is the mainstay of treatment. Chemotherapy and radiotherapy are used to reduce tumour size, as an adjunct therapy or palliative therapy.