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Medical Tribune Empowering The Public On Colorectal Cancer

13-20 May 2010

Cancer, more often than not,is detected too late. This is especially so for cancers that give few warning signs, such as colon cancer. So, what is the best strategy for surviving this type of cancer? The answer is simple: spread the word, increase public awareness and, most importantly, screen for the disease. Dr. Christina Ng, a consultant oncologist, said, “We hope the public will come to understand how important early detection is in increasing a patient’s chance of surviving this disease.” “Cancer is not a death sentence, [and] patients are now able to make informed decisions and take the right steps towards proper treatment.” Many people, she added, are unaware that colorectal cancer is the most common cancer affecting Malaysian men and the third most common in women, with the highest incidence occurring amongst the Chinese community. [National Cancer Registry. Available at; Malaysian Oncological Society. Available at www.malaysianoncology. org. Accessed on 14 April] While the precise cause of colon cancer is yet unknown, it is possible to detect the disease early, thereby increasing the patient’s chance of a successful recovery. However, risk awareness and proactive screening for early detection remain a challenge. Thus, triggering public awareness about the prevalence of colorectal cancer, and the importance of its early detection, is an essential component in saving the lives of patients who may not even know they have the disease, said Ng. In conjunction with this, EMPOWERED (the Cancer Advocacy Society of Malaysia) recently launched a community-wide awareness and screening initiative specific to the disease. Ng, who is also president and founder of EMPOWERED, said participants in the project will be given a fecal immunohistochemical test (FIT) kit and taught how to use it. The used kits will then be collected and the samples examined. In the event of abnormal test results, personal counseling sessions will be arranged and the patients will be sent for a follow-up colonoscopy at appointed screening hospitals. “FIT has been shown to have superior detection rates of advanced colonic lesions compared with the older guaiac-based fecal occult blood test, with greater simplicity of sample collection and better patient adherence rates. “Based on recent prevalence studies, the pick-up rate for blood with FIT is 7 percent. However, as blood may be due to other conditions (ie, hemorrhoids or polyps) and not colon cancer, patients will require a colonoscopy to identify the speci c cause of blood in the stool.” While the precise cause of colon cancer is yet unknown, said Dr. Colin Ng, a consultant general and colorectal surgeon, and member of the Malaysian Society of Colorectal Surgeons, many factors play a role in the disease over the longterm. Consequently, it is possible to detect colon cancer early and, therefore, increase the chances of a successful recovery.

Colorectal risk factors include:

  • Age – risk increases with age. More than 90 percent of cases occur in those aged >50.
  • Polyps.
  • Family history.
  • Diet (a high fat, low  ber diet has been linked to colon cancer).
  • Smoking – increases the risk of polyp formation.
  • Sedentary lifestyle.
  • Inflammatory bowel disease a known risk factor in western countries but rare in Malaysia.

The treatments available for colorectal cancer, said Dr. Melvin Raj, a consultant gastroenterologist at Hospital Kuala Lumpur and member of the Malaysian Society of Gastroenterology and Hepatology, are radiotherapy, surgery, colostomy and chemotherapy. When a FIT test is positive, he said, patients will be counseled before a diagnosis of colon cancer is made. Financial support is a signi cant factor when dealing with colorectal cancer, especially for the underprivileged, said Datin Paduka Khatijah Sulieman, vice president of the National Council of Welfare and Social Development (MAKPEM). Therefore, EMPOWERED, MAKPEM and other partners are working with the Social Welfare Department to assist patients who need to take time off from work to undergo further testing and treatment