Cancers which arise from the large intestine – the colon and rectum, better known as colorectal cancer, is the most common cancer among Malaysian men and second most common among Malaysian women. The age-speciﬁc incidence curve rises exponentially after the age of 50 years.
Leading the Way in Colorectal Health
Subang Jaya Medical Centre (SJMC) has written this booklet to help patients with colorectal cancer and their families and friends better understand this disease. We hope others will read it as well to learn more about colorectal cancer. As a comprehensive cancer centre, SJMC Cancer and Radiosurgery Centre is nationally recognised for its expertise and leadership in advances in cancer treatment. It is a one-stop cancer centre designed to provide patient-focused care in a comfortable and safe environment.
It is our hope that this brochure will provide you with relevant information and coping techniques as well as answer some of the questions you may have. This brochure only serves as a guide and its contents are not to be taken as medical advice. You will still need to discuss with your doctor the best treatment option for you
Doctors and staff at the Centre are committed to enhancing each patient’s well-being, both physically and emotionally. Their goals are to ensure that all patients receive the highest quality care, from seeking prevention and screening services to receiving treatment or coping with a cancer diagnosis. Supportive care services and support groups provide emotional and psychological beneﬁts that can ease many aspects of daily life.
About Colorectal Cancer
The colon is the part of the digestive system where the waste material is stored. The rectum is the end of the colon adjacent to the anus. Together, they form a long muscular tube called the large intestine (also known as the large bowel). Tumours of the colon and rectum are growths arising from the inner wall of the large intestine.
Cancer of the colon and rectum (also referred to as colorectal cancer) can invade and damage adjacent tissues and organs. Cancer cells can also break away and spread to other parts of the body (such as the liver and the lungs) where new tumours form. The spread of colon cancer to distant organs is called metastasis of the colon cancer.
There is no single cause of colorectal cancer. Most cancers start as a noncancerous (benign) polyp, which slowly develops into cancer. Amongst the risk factors for colorectal cancer are:
The great majority of people diagnosed with colorectal cancer are older than 50 years of age.
High in animal fat, high red meat and preserved meat, low in fruits, vegetables and ﬁbre.
Flexible sigmoidoscopy every 5 years* Colonoscopy every 10 years Double-contrast barium enema every 5 years* CT colonography (virtual colonoscopy) every 5 years*
American Cancer Society recommends the following early detection tests to find polyps and cancer for colorectal cancer: flexible sigmoidoscopy every 5 years*, colonoscopy every 10 years, double-contrast barium enema every five years*, CT colonography (virtual colonoscopy) every five years*.
Tests that mainly ﬁnd cancer: guaic-based faecal occult blood test (gFOBT) every year*,
** Faecal immunochemical test (FIT) every year*,
** Stool DNA test every 3 years* *Colonoscopy should be done if test results are positive
**Highly sensitive versions of these tests should be used with the take-home multiple sample method.
Diagnosing Colorectal Cancer
After history taking and physical examination, several different types of tests are performed for any evidence of colon cancer, including:
Digital rectal exam: The doctor inserts a lubricated glove ﬁnger into the rectum to feel for lumps and abnormalities.
Faecal occult blood test: a chemical test done by the laboratory on small samples of stool that detects the presence of small amounts of blood that cannot be seen with the naked eye.
Endoscopic Ultrasound (EUS): An endoscope is inserted into the rectum. A probe at the end bounces high-energy sound waves (ultrasound) off internal organs to make a picture (sonogram). Also called endosonography.
Blood test for carcinoembryonic antigen (CEA): CEA is a protein, or tumour marker, made by some cancerous tumours. This test can also be used to ﬁnd out if the tumour is growing or has come back after treatment.
Colonoscopy: Doctors can examine the entire colon and rectum with a colonoscope (a thin lighted tube) inserted through the rectum into the colon and polyps or tissue may be removed for biopsy. A sensitive and accurate test, biopsies can be taken for histopathological diagnosis.
At SJMC, fuse colonoscopy is available which feature cameras at the tip as well as on the sides of the scope providing your physician with a panoramic 330-degree view of the colon. Fuse colonoscopy has been shown to greatly reduce the number of pre-cancerous polyps missed by traditional colonoscopies.
Imaging tests that can be carried out include:
- CT (Computed Tomography) scan
- MRI (Magnetic Resonance Imaging) scan
- PET/CT (Positron Emission Tomography) scan
- Virtual Colonoscopy or CT (Computed Tomography) colonoscopy
Tumour Molecular Proﬁling
Tumour molecular proﬁling can be used to develop a cancer treatment plan personalised to your needs. Prior to delivering chemotherapy, we may perform tumour molecular proﬁling to identify chemotherapy drugs and other targeted therapies that are more likely to work for you.
A sample of tissue during a biopsy or surgery is tested for the presence of a variety of enzymes, proteins and genes to identify which therapies are likely to be most effective. By choosing more effective drugs, we can avoid unnecessary toxicity to you and target cancer cells as aggressively as possible from the start.
Making Decision About Treatment
It is very important to have a skilful multidisciplinary team to treat colorectal cancer as there are numerous treatment options
• SJMC brings together the most advanced resources to manage the treatment of patients with early or advanced colorectal cancer
• Our multidisciplinary team includes gastroenterologists, clinical oncologists, colorectal surgeons, pathologists and radiologists working together to create the most effective treatment plan
• Our doctors make sure that each patient thoroughly understands factors such as the stage and grade of his tumour and the range of treatment options, as well as the potential side effects of each therapy
• Doctors here can guide patients through the sometimes complicated choices posed by these factors
The most common form of treatment for colorectal cancer is surgery as it is the ﬁrst option for many patients because it offers the best chance of cure.
The type of surgery depends on the stage and location of the tumour:
Polypectomy: A colonoscope, which is a long tube with a camera on the end, is inserted into the rectum and guided to the polyp. A tiny, scissor-like tool or wire loop removes the polyp.
Colectomy: The area of the colon where the cancer is, along with some healthy surrouncling tissue, is removed. The associated lymph nodes are removed (biopsied) and looked at under a microscope. Usually the surgeon then rejoins the parts of the colon. This surgery is also called a hemicolectomy or partial colectomy.
Your doctor will decide whether it is best to perform traditional open surgery or minimally invasive laparoscopic surgery.
With minimally invasive surgery, small cuts are made in the abdomen. A tiny camera and surgical instruments are inserted. The surgeon then uses video imaging to perform the surgery.
A Patient’s Guide to Colorectal Cancer