Colorectal Cancer Awareness: How Truly Aware Are We?

March has been chosen as the 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). While much progress has been made in fighting this deadly disease, it remains to be worldwide the third most common cancer in men and contributed to 10.6% of the total all men cancer, whilst in women, it was the second most common (9.4%) after breast cancer (24.5%).

In Malaysia, colorectal cancer is the second most common cancer among the general population. According to Malaysia National Cancer Registry (MNCR) 2012-2016, colorectal cancer is the most common cancer amongst males (16.9%) and the second most common (10.7%) cancers amongst females in Malaysia. It has overtaken lung cancer in men, which was the highest incidence in recent past.

Fortunately, colorectal cancer is highly preventable and treatable when caught early, and knowing early warning signs can help patients have more open discussions with their physician about concerning symptoms and screening options.

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.

Based on a cross-sectional study conducted from November 2015 till December 2016 by a group of Family Medicine Physicians, generally, awareness of CRC is poor among the urban population of Klang Valley. Some patients have zero knowledge of CRC. The level of education and confidence in detecting warning signs are significantly associated with the level of knowledge for warning signs of CRC. CRC awareness programs should be increased to increase awareness in both rural and urban populations, perhaps leading to screening in high-risk patients and earlier diagnoses and better prognoses for CRC.

So why do we need to increase the awareness?  Simple, increased awareness will mean the population will understand the red flag signs of colorectal cancers. Upon experiencing these symptoms, they will in turn present to their local GP or seek consultation from qualified specialists. Early presentation equals to a life saved.

The most common symptoms of CRC include:

• Altered bowel habit, meaning change in a person’s usual bowel habit; be it the frequency, consistency of stool or pain or sensation during passing of motion.

• Blood in stool, which is often dismissed as a haemorrhoid or just a result of ‘heaty’. This is a false sense of awareness, as having blood in stool is very abnormal and should be investigated.

• Unexplained or unintentional weight loss with no reduction in diet / exercise programme

• Anaemia or low blood haemoglobin

• Intestinal obstruction where a person can’t pass stools or even gas, it is an emergency.

What is the habit or condition which may lead to increase in colorectal cancers? These are known as risk factors for CRC:

Active smokers have 16% greater risk of developing CRC compared with those who have never smoked. There is a clear correlation between smoking and colorectal cancer. Uncontrolled diabetic individuals and overweight individuals have an increased risk of CRC. Excessive alcohol consumption is also positively associated with increased risk for CRC. 

Therefore, besides seeking TREATMENT for any symptoms which are present, it is wise to seek for SCREENING. Screening is subjecting oneself to a test despite not having any symptoms. It is quite possible that you have a relative or family member who had colorectal cancer. Hence, getting a test done even if you are not symptomatic may help detect early cancer or precancerous conditions (such as polyps).

In fact, in countries like Japan, Taiwan, screening is offered for all individuals above a certain age (40 and 50 in some countries) and part of the national health initiative.

Screening Modalities include:

• Faecal occult blood test – test which is used to detect human blood in stool which is not visible. Hence it may detect the presence of cancer / cancerous lesions in the colon. However this test must be followed by a colonoscopy if positive.

• 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.

Therefore, its extremely important that awareness of Colorectal cancers, its symptoms, screening modalities, various treatment and prognosis is well understood by everyone. Please seek early consultation to your preferred qualified doctors as soon as possible if you are symptomatic or at risk.

Article by, 

Dr. Kamalbarathi N.Barathilingam
Consultant General Surgeon