Early Detection for Polyps Vital

05 October 2020

No one has zero risk of developing colorectal cancer, but the chances of it happening to us increases with age, says Sunway Medical Centre (SunMed) Consultant Gastroenterologist and Hepatologist Dr Max Hu.

The risk increases after the age of 40 and higher after 70.

However, colorectal cancer was largely preventable, he said, provided people undergo early screening to detect polyps, which are abnormal growths in the colon or rectum.

Over time, if polyps are not detected and removed, some may become cancerous.

"The best way to find and remove polyps from the large intestine is through a colonoscopy, a procedure that examines the insides of the large intestine using a thin, flexible tube with a small lens and light source attached to the tip," he said at the SunMed Colorectal Cancer & SunMed Comprehensive Health Assessment Tool (C.H.A.T.) media session to encourage the public to undergo health screenings.

Dr Hu said in the early stages of colorectal cancer, some people might not have any symptoms at all.

"But the polyps can bleed once the cancer grows large enough," he added.

Dr Hu said polyps usually took between five and 10 years to grow, and he encouraged people to undergo screening within that time frame.

Other risk factors for this disease include a personal or family history of colorectal polyps or cancer, having diabetes, obesity, a diet in high processed food or red meat, tobacco and alcohol consumption as well as a personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease).

He said the symptoms for colorectal cancer were alteration in bowel habits, especially change in stools from formed to loose or liquid, blood in stools or bleeding when passing motion, persistent localised abdominal cramps on the left side, new and persistent sensation of incomplete emptying after passing motion, and unexplained weight loss, usually in the advanced stage.

Dr Hu added that it was important to undergo a colonoscopy and people should not be afraid of the procedure.

"Screening is not only important to detect polyps for them to be removed before they turn into cancer but it can also detect colorectal cancer at an early stage when treatment works best and better prognosis can be achieved.

"Studies revealed that more than 70% of reported cases in Malaysia were detected at late stages (stages three and four)," he stressed.

A colonoscopy takes about 15 to 20 minutes, and only a sedative is required, which is less complicated than a general anaesthetic.

The patient will need to take a low-fibre diet the day before, and then fast and take laxatives the evening before (consumption of clear fluids is allowed). They can be discharged the same day and resume a normal diet if there are no serious findings.

Meanwhile, Consultant Colorectal Surgeon Dr Chong Hoong Yin, in his talk on treating and managing colorectal cancer, said prevention should be the priority.

He said in Malaysia, many younger patients were being diagnosed with colorectal cancer at later stages.

"This is not good data. I have operated on a 23-year-old male patient.

"It is difficult to pinpoint why, but it is mostly due to obesity and poor lifestyle habits.

"Globally, about 7% of colorectal cancer is diagnosed in people under the age of 40," he said.

Dr Chong said early detection was key, because there was a 90% five-year survival rate if it was diagnosed at stage one, 70% to 80% at stage two, 40% to 60% at stage three, and 20% at stage four.

SunMed has also made available a Faecal Immunochemical Test (FIT), which is highly specific to detect and quantify human blood in one’s stool sample, in screening for colorectal cancer.

Dr Hu said 94% of patients without colorectal cancer or advanced polyps would receive a negative FIT result through the testing.

"From a FIT test result perspective, a negative result means that we are 99% sure the patient doesn’t have colorectal cancer or advanced polyps.

"If a patient has a positive FIT result, data shows that 3% have cancer and 24% have advanced polyps.

"FIT can be used to screen people without symptoms without having to consult a doctor beforehand.

"But we always advise those with symptoms to seek medical advice rather than do self FIT testing," he added.

The Malaysian National Cancer Registry Report (2012-2016) revealed that colorectal cancer was the second most common cancer in Malaysia, contributing to 13.5% of the total 115,238 cases registered in that period.

It is the most common cancer among Malaysian men (16.9%) and is the second most common among Malaysian women (10.7%).

In terms of ethnicity, the Chinese (1 in 43 in Chinese men and 1 in 57 in Chinese women) are at greater risk of getting colorectal cancer followed by Malays (1 in 65 Malay men and 1 in 89 Malay women) and Indians (1 in 70 Indian men and 1 in 95 Indian women).

About 80% of colorectal cases in Malaysia were diagnosed in people aged above 50 years, and our ageing population might further increase its prevalence, added Dr Hu.

Source: The Star