The Rising Incidence of Colorectal Cancer in Younger People Must Not Be Ignored

Understanding the Risk Factors and Symptoms for Early Detection and Treatment

Colorectal cancer is the most common cancer in Malaysian men and the second most common in women. Traditionally, this disease primarily affects older individuals, with the risk of developing it increasing with age. However, there has been a concerning rise in cases among younger people, particularly those in their mid-20s to late 50s. One of the key challenges in Malaysia is that many patients are diagnosed at a late stage. Late-stage diagnoses not only lead to poorer prognoses but also place significant strain on the healthcare system. Early detection, however, can make all the difference between a cure and palliative care, highlighting the critical importance of colorectal cancer screening.

A Cross-Gender Issue: Colorectal Cancer is Impacting Younger People More

Dr Khong Tak Loon, Colorectal Surgeon at SJMC.

In Malaysia, colorectal cancer is a major health threat to both men and women, with the Chinese population being particularly at risk. Since 2007, the trend of new colorectal cancer diagnoses among those aged 50 and above has remained largely unchanged (according to the Malaysia National Cancer Registry Report 2012–2016). This is concerning, especially as both the UK and the USA are seeing a decline in new cases among those aged 60 and above, thanks to the aggressive promotion of colorectal cancer screening.

Worryingly, the rise in cases is not confined to the elderly. There is also an increasing incidence of colorectal cancer among young adults aged 20 to 40, who are typically in their prime, productive years. The high-profile death of actor Chadwick Boseman from colon cancer at the age of 43 in 2020 helped raise public awareness of the disease. This growing trend highlights the urgent need for greater emphasis on prevention and early detection.

Dr Khong Tak Loon, a colorectal surgeon at Subang Jaya Medical Centre (SJMC), points out that colorectal cancer was once viewed as a disease primarily affecting individuals aged 60 and above. However, all of us have a 5% lifetime risk of developing colorectal cancer, meaning one in 20 Malaysians will be affected at some point in their lives. Several risk factors increase the likelihood of developing colorectal cancer, including diets high in red meat, sugar, processed foods, and excessive alcohol consumption. Other unhealthy lifestyle choices, such as lack of exercise and smoking, also contribute to the risk.

Colorectal Cancer in Younger Patients Tends to Be More Aggressive

According to Dr Khong, colorectal cancer in younger patients tends to behave more aggressively, with tumours often being more severe and more likely to spread (metastasise). Younger patients frequently show fewer obvious symptoms or may mistakenly attribute their discomfort to less serious conditions, such as general digestive issues. This leads to delayed diagnoses and missed opportunities for early treatment.

As a result, treating colorectal cancer in younger patients is more challenging. These individuals often require longer treatment courses, which may include surgery, chemotherapy, and radiotherapy, all of which can take a physical and emotional toll. Dr Khong further explains that prognosis and survival rates depend heavily on the stage at which the cancer is diagnosed.

Five-Year Survival Rates for Colorectal Cancer

• Stage I: 90% survival rate
• Stage II: 75% to 80% survival rate
• Stage III: 60% to 70% survival rate
• Stage IV: Below 15% to 20% survival rate

Early detection through colorectal screening and timely treatment is vital for improving cure rates and survival outcomes, says Dr Khong. 

Early-stage cancers have a much higher cure rate, with treatments often limited to endoscopic or surgical removal of the tumour. The majority of patients diagnosed at this stage may not require chemotherapy or radiotherapy, and have a high chance of a full recovery while maintaining a good quality of life. On the other hand, late-stage cancers, where the tumour has spread, are much more difficult to treat, with significantly lower survival rates. Early detection through colorectal screening and timely treatment is vital for improving cure rates and survival outcomes.

Screening Methods for Early Detection

Current methods for screening and diagnosing colorectal cancer include:

• Immunochemical Faecal Occult Blood Test (iFOBT): A simple and painless test to detect hidden blood in stool. If abnormalities are found, further tests, such as a colonoscopy, are carried out to confirm the presence of colorectal cancer or polyps.
• Colonoscopy: This is the most accurate method for detecting early-stage colorectal cancer. Advancements in medical technology have made colonoscopy a safe and well-tolerated procedure, commonly performed in most endoscopy units.

Colorectal cancer is preventable.

Surgery: The Preferred Treatment

Surgery remains the primary treatment for colorectal cancer. In recent years, robotic surgery systems have gained attention for their precision in colorectal procedures, especially in areas like the pelvic region. These advanced systems are particularly helpful for male patients undergoing rectal surgery, offering greater flexibility and reducing post-operative complications, leading to faster recovery times.

The development of adjuvant treatments – such as chemotherapy, radiotherapy, targeted therapy, and immunotherapy – has also improved patient outcomes, with fewer side effects and better survival rates.

A common misconception is that surgery for colorectal cancer always results in the need for a stoma or 'bag'. Dr Khong reassures patients that, in most cases, after the intestines are removed, the bowel ends are simply joined together, and a stoma is not necessary. For the small number of cases where a stoma is unavoidable, support groups and specialist therapists are available to help patients cope with the physical and emotional challenges. He encourages patients and the public to adopt an open and rational approach, understanding that life after treatment can return to normal, and to avoid stigmatising colorectal cancer, as this can affect individuals' decisions to seek treatment.

Dr Khong also stresses that colorectal cancer is preventable. By consistently adopting a healthy lifestyle and undergoing regular health screenings, the risk of developing the disease can be significantly reduced.

Tips for Colorectal Cancer Prevention:

• Healthy Diet: Limit red and processed meats, and increase the consumption of vegetables, fruits, and high-fibre foods.
• Regular Exercise: Engage in moderate physical activity to promote overall health.
• Quit Smoking and Limit Alcohol: Reducing smoking and alcohol intake can lower the risk of developing colorectal cancer.
• Regular Check-Ups: Individuals over 45 should have regular colorectal cancer screenings.
  
  

When to Seek Medical Attention

If you experience any of the following symptoms, consult your doctor:

• Changes in bowel habits, such as frequent diarrhoea or constipation
• Blood in stool or changes in stool shape
• Persistent abdominal discomfort, such as pain, bloating, or cramps
• A feeling of incomplete bowel emptying after a movement
• Fatigue
• Unexplained weight loss

Colorectal cancer is invisible to the naked eye, so diagnosis of this disease relies on vigilance and awareness. Dr Khong urges the public to seek medical attention promptly for any gastrointestinal symptoms. Screening is key to defeating this preventable disease.

Source: Nan Yang Siang Pau