A panel of specialists from Mahkota Medical Centre (MMC) in Malacca City suggest a lesser-known approach to patient care for colorectal cancer by “having varied expertise within one cohesive team.” MMC has organised a workshop “A Multidisciplinary Approach to Treating Colorectal Cancer,” to encourage awareness and collaborative solutions for enhanced cancer care.
Colon care is often neglected until a dire problem arises, such that develops into colorectal cancer. Colorectal cancer is the second most common cancer in Malaysia, with 69% of patients diagnosed at later stages, said Dr. Azali Hafiz Yafee Bin Amar, a General & Colorectal Surgeon at MMC.
Colorectal cancer impacts people 50-years-old and above the most, with 80% of those diagnosed in this age bracket. It begins with pre-cancerous growths (polyps) in the colon or rectum – a person is more at risk of developing cancer if a polyp larger than 1cm is found, if more than three polyps are located, or dysplasia is identified in the polyp.
[Dysplasia is an area in a polyp or in the lining of the colon or rectum with an abnormal development of cells.]
This characteristic of colorectal cancer makes it the most preventable type of cancer, as discovering and getting rid of polyps can prevent cancer formation.
A General & Colorectal Surgeon at MMC, Dr. Ang Chin Wee, highlighted that routine screening in the risk groups would help detect early signs of the condition. This is imperative as most people with colorectal cancer do not show any symptoms in the earlier stages. But, if detected early, the 5-year survival rate for colorectal cancer is promising.
“Those who suffer from inflammatory bowel disease or have a strong family history of colorectal cancer should begin screening before the age of 40 [via] a colonoscopy. It is the only test where the entire colon can be visualised using a colonoscope, and pre-cancerous polyps can be removed. Doctors can take tissue samples during colonoscopies to assess if it’s cancerous,” Dr. Ang said.
A positive diagnosis requires different treatments: in the early stages, minimally invasive laparoscopic surgery may provide the best result; for patients with advanced cancers that have spread to the lining of the abdomen, complex surgeries such as cytoreductive surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) can be performed with the aim for a cure.
Dr. Ang explained that in CRS + HIPEC, cancerous tumours are removed surgically whilst heated chemotherapy drugs are applied directly inside the abdomen to eliminate possible remaining cancerous cells. In Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC), a treatment reserved for patients not eligible for CRS-HIPEC, chemotherapy drugs are administered through a spray directly into the abdomen.
MMC has recently initiated a multidisciplinary “Tumour Board” to encourage collaboration between specialists needed for the treatment. This board consists of pathologists, radiologists, nuclear medicine specialists, operating surgeons, and oncologists.
“Complex or challenging cases will be discussed among all members of the board before the treatment to identify the best treatment option for the patient,” said Dr. Shum Weng Yoon, a Clinical Oncologist at MMC.
“For example, neoadjuvant chemotherapy (prelude chemotherapy a patient receives before the main course of treatment) will be performed to downstage (shrinking cancer tumour) large cancers that can’t be removed surgically or metastasised colorectal cancer to the liver or lung. Upon completing this treatment, the board will assess if it is safe to
the shrunken tumour. Unique cases such as these benefit from multiple expertise discussions and assessments.
“For advanced patients, while cancer can’t be cured, it can be highly manageable with current treatment options. However, cancer patients must take the necessary steps to adhere to their medications, follow-ups, and tests. There will be side effects as with all treatment, and your oncologist can help you manage and monitor these symptoms. Open communication with your doctors is essential in managing not just colorectal cancer but all cancers.”
Dr. Shum further recommends having a physical exam and tests every three to six months for those who have no signs of remaining cancer, usually for the first two of years and then, every six months or so for the following years.
The MMC team is always ready to provide cancer patients and caregivers with professional support and actively participates in the battle against colorectal cancer.
Stanley Lam, CEO of MMC, concluded, “It is necessary to treat each patient individually according to their cancer type, as this improves patient outcomes. Introducing a tumour board brings us one step closer to enhancing our patients’ journey towards achieving more incredible results.”