Colorectal cancer is the most common cancer among Malaysian males, accounting for 14.8% of the total incidence of cancer in the country, according to the Malaysian National Cancer Registry Report 2012-2016). As such, cancer prevention and early detection have been prioritised in areas of men’s health – Dr. Paul Selvindoss, consultant general surgeon, colorectal and laparoscopic surgeon from HSC Medical Centre, Kuala Lumpur, shares about colorectal cancer, prevention/screenings, and treatment plans suitable for Malaysian men.
Despite being a fairly common cancer in men, colorectal cancer it is often diagnosed in later stages because symptoms are not mutually exclusive; this increases the mortality rate for those who suffer from it. For men, rectal cancer and its treatment both by radiotherapy and surgery can affect the nerves connected to their manhood and urinary bladder, leading to urinary problems and in more severe cases, erectile dysfunction.
Early signs and common symptoms to look out for include chronic diarrhoea (more than three weeks), frequent, bloody and painful stools, and changes in bowel habits. Other non-specific symptoms include sudden weight loss, swelling in the stomach as well as bloating and/or gassiness.
Dr. Paul said these symptoms are especially worrisome for older men, as the risk of developing colorectal cancer increases with age. While genetics and underlying diseases such as inflammatory bowel disease adds to the risk of this cancer, lifestyle factors including consumption of excessive alcohol or red/processed meat and obesity may significantly increase cancer risk as well.
However, a nutritious diet rich in vegetables and fibre may help mitigate the risk; as does keeping active and maintaining a healthy lifestyle. Screening for early detection is also recommended – previously, peak incidents worldwide involved men aged 60 or more; although the screening age in Malaysia is 50, most clinicians recommend patients to go for screening at age 45. This is largely because of the urban diet which is heavy in red meat/processed food, low fibre, and more alcohol.
Treatment meanwhile, varies greatly depending on the stages of the disease: the patient is first diagnosed after a colonoscopy and biopsy; he then undergoes staging – a routine check of the chest, abdomen and pelvis – and an MRI, if necessary. The treatment approach for a positive check then depends on where the cancer cells are located; it will be monitored accordingly by the oncologist, surgeon, radiologist, and pathologist.For most cases, patients need to undergo surgery, usually done laparoscopically, to remove the affected colon and its lymph nodes; in cases of a very large tumour, patients may also be required to undergo chemotherapy.
According to Dr. Paul, colorectal cancer is indeed highly preventable, which is why regular screenings are essential; it can help to save lives. “In private practice, I have seen more people becoming more aware of colorectal cancer screening and spread the knowledge that this cancer is preventable,” Dr. Paul said. “Hospitals should nevertheless offer not just offer blood, ultrasound and/or electrocardiography (ECG) stress tests, but advise patients aged 45 and older to get a colonoscopy done, as it is more accurate than tumour markers.”