Colorectal cancer screening tests can help to find pre-cancerous growths or lesions and remove them, reducing patients’ risk of developing the disease and its related morbidity and mortality issues. It is highly treatable if detected early.

However, because the standard screening age in Malaysia is 50 and patients are often unaware of the prevalence of colorectal cancer, the disease is often overlooked, resulting in diagnosis at later stages.

“General awareness of colorectal cancer is quite low and I don’t think people realise that it is one of the most common malignancies not just all over the world, but especially in Malaysia,” says Datin Dr Wendy Lim, consultant gastroenterologist and hepatologist at Sunway Medical Centre. “The important thing to know is that it is preventable.”

Dr Lim shares that colorectal cancer is the second most common cancer among men in Malaysia and the third most common cancer among women, according to a 2003-2005 study by the Health Ministry on cancer incidence in peninsular Malaysia.

“People are happy to screen for breast, cervical or prostate cancer, but when we ask them to screen for colorectal cancer, there’s always that moment of hesitation. When it involves procedures such as testing stool samples or undergoing a colonoscopy, they tend to shy away,” she adds.

“We want to get people thinking about their own risk. So much depends on people coming forward and asking after screening methods to protect themselves from the risk of developing colorectal cancer.

“There are a lot of studies looking at exactly when it happens and when exactly the risk increases. The age at which colorectal cancer occurs in Malaysians is much lower compared to Western patients, so what we are advocating for is that screening begins at 40 in this country.”

Nipping It In The bud

Implementing a nationwide screening programme can help medical professionals detect cancer early in the population. Colorectal cancer screening tests can also find pre-cancerous growths or lesions and remove them, reducing patients’ risk of developing the disease and its related morbidity and mortality issues.

It is common in Malaysia for colorectal cancer in individual cases to get picked up a lot later compared to people in similar age groups in countries with nationwide screening programmes. In those countries, people are given notice once they turn 50 to undergo screening for colorectal cancer.

These notices include test kits that recipients have to return to screening facilities with stool smear samples. Those with negative screening results are given the all-clear and will start receiving test kits annually. Those who are tested positive, however, are referred to hospitals for a colonoscopy.

According to Dr Lim, this national initiative for a screening programme is what we sorely lack in Malaysia.

“As opposed to screening tests such as ones for breast cancer, where if you discover a lump,cancer has already developed, colorectal cancer screening is more about preventing cancer from developing. If polyps are found while screening, they can be removed almost immediately. Polyps are often non-cancerous growths, but are pre-cancerous, which means some can develop into cancer.”

She adds that since the risk of colorectal cancer increases from age 40 onwards, screening people at an earlier age could help detect the disease in its earlier stages and lead to better prognoses for patients.

“In a way, screening will not only decrease mortality rates but also result in substantial cost savings to the nation’s healthcare by avoiding putting patients through expensive chemotherapy, radiotherapy and palliative care as well as reducing loss of productivity from patients’ inability to work,” shares Dr Lim.

Dr Lim shares that colorectal cancer is more common than we think, and that men and women are equally affected.

Looking Out For indicators

“Unfortunately, there are little to no visible symptoms for colorectal cancer. That is why we currently push for people to undergo screening from age 50. There are some who present with bleeding in their stool or black stool.

Abdominal pain, unexplained weight loss and loss of appetite are also some indicators people should take notice of. If someone comes in with these symptoms, we forgo the stool test and go straight to the colonoscopy,” says Dr Lim.

Patients should also ask questions and be informed about the different screening procedures available. For instance, colonoscopies should be done by a trained gastroenterologist who has extensive experience in endoscopy and is skilled in detecting and removing polyps.

She adds that, for now, Malaysians aged 40 and up should commit to regular screening for colorectal cancer.

“It is not a hugely demanding task. Someone with an average risk with no family history of colorectal cancer would be subject to a general colonoscopy only once every 10 years. Stool tests and sigmoidoscopies (lower large intestine and rectum examinations) are annual, and virtual colonoscopies can be done once every five years,” asserts Dr Lim.

“Of course, technology plays a part as well. There are advanced gadgets such as wide-angled, high-resolution colonoscopes that can help us differentiate between benign and non-benign lesions.”

She continues, “I hope we can inform the public that colorectal cancer is more common than we think, and that men and women are equally affected. As mentioned before, there is a certain aversion to the topic of colorectal cancer, but we need to be more open about the rising risk of this disease.”

Debunking myths on colonoscopy

Dr Wendy Lim is of the opinion that having every hospital treat each colorectal cancer case the way it does in notifying the Health Ministry of infectious disease cases would be helpful in contributing to a comprehensive cancer registry.

“Information on screening procedures should be transparent, and since there are several methods available, people can choose one or a combination they are most comfortable with.

“For instance, if you are of average risk, you don’t necessarily have to go for a colonoscopy if you are squeamish about the process. Research the various screening methods, explore preferred and alternative methods, and choose the ones most suited to you,” says Dr Lim.

Many people are concerned about colonoscopies, and understandably so. For your gastroenterologist to perform an ideal scan of your colon, the colon first has to be cleansed and emptied. Colon preparation, or “prep” as it is known, is an essential step to emptying the colon.

Below are some myths about colonoscopies debunked, so you may undergo screening for colorectal cancer with peace of mind.

Myth
I have to drink a large amount of laxative solution to empty my bowel during prep.

Fact
Most prescribed laxative solutions now are taken in split doses, allowing you to drink half the solution the night before and the other half the morning of your procedure.

Myth
I cannot eat or drink anything but water during prep.

Fact
Clear liquids and food low in fat and fibre are completely fine to consume during prep. Anything from clear broth to popsicles are allowed, as long as nothing is artificially dyed red, blue or purple. However, it is advisable to stop eating or drinking four hours before your procedure.

Myth
Colonoscopies can be painful.

Fact
Most patients are either fully or lightly sedated during the procedure, and the flexible scope minimises the chance of you feeling any pain. Some slight discomfort is to be expected.

Myth
My colon may be perforated during the procedure, so it is too risky.

Fact
Colonoscopies are extremely safe when performed by highly trained and experienced professionals. Your risk of experiencing a perforated colon during a colonoscopy is less than 0.2%.

Myth
I will be passing gas for days after the procedure.

Fact
Air is introduced into the colon during a colonoscopy for the gastroenterologist to better view the intestinal walls. You can expect to be passing gas for a while after the procedure, but it should not last for days.