Colorectal Surgery

Colorectal Cancer

Colorectal Cancer occurs in the colon or rectum and is sometimes referred to as colon cancer or rectal cancer, depending entirely on the location the cancer first appears. Colon cancer usually begins anywhere in the colon (5 feet long) and absorbs water from the stool. On the other hand, rectal cancer begins in the rectum (5 inches of the colon) that assists the body in storing stools until you have a bowel movement.

Tumour growths may be benign but malignant and cancerous tumours can spread to other parts of the body. Colon cancer and rectal cancer are often grouped together because they have various features in common. The occurrence of cancer comes about when the cells in the body start to grow out of control.

The Origin of Colorectal Cancer and Its Prevalence in Malaysia

Colorectal cancer is the most common cancer to occur among Malaysian men (14.8/100,000), and the second most common cancer to occur among Malaysian women (11.1/100,000). Besides other cancers, colorectal cancer is the 2nd most common cancer in Malaysia and the 3rd most common cause of cancer death among Malaysians. Reason being, about 66% of colon cancer in men and 65% of colon cancer in women are often detected at a later stage (3rd or 4th stage).

Colorectal cancer starts off as a growth on the inner lining of the colon or rectum. These are known as polyps. Over the years, some polyps would turn cancerous and the chances of polyps turning cancerous depend entirely on the type of polyp that is formed in the colon and rectum.

Types of Colorectal Cancer

There are various types of colorectal cancer that are often present among men and women. The types include:

• colorectal adenocarcinoma
• gastrointestinal carcinoid tumours
• primary colorectal lymphomas
• gastrointestinal stromal tumours and
• leiomyosarcomas

Risk Factors

Like any other cancer, colorectal cancer has its fair share of risk factors as well. The risk factors of developing colorectal cancer include:

• Finding a polyp larger than 1cm
• Finding more than 3 polyps
• Finding dysplasia (a pre-cancerous condition, in which the polyp in the affected area looks abnormal, however, it hasn’t become cancerous) in the polyp after it is removed.
• Age – colon cancer may be diagnosed at any age (young or old), however, a majority of people diagnosed are older than 50 years. The rate of colon cancer among young people is, however, on an increase
• A personal history of colorectal cancer or polyps – There is a greater risk of colon cancer if you’ve been diagnosed with colon cancer or non-cancerous colon polyps before.
• Low-fibre, high-fat diet – Studies have found an increased risk of colon cancer in people who consume diets high in red and processed meat, which is a typical western diet.

Stages of Colon Cancer

The TNM staging system is a tool used by oncologists to discover and describe the different stages of colorectal cancer. Oncologists use the results from the diagnostic tests and scans to answer the following questions:

• Tumour (T): Has the tumour grown into the wall of the colon or rectum? If so, how many layers?

• Nodes (N): Has the tumour spread to the lymph nodes? If so, where and how many?

• Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are then combined to determine the stage of cancer for each individual.

Being at the Frontline of Colorectal Surgery

ParkCity Medical Centre (PMC) has taken the first step in leading the way in Colorectal Health. PMC is committed to delivering the right diagnosis and treatment and sharing their expertise for anyone who requires assistance in colorectal health. Our long list of experts at our Colorectal Clinic includes colorectal surgeons, physicians, oncologists and rehab specialists to ensure we always provide optimised patient care.

Colon cancer screening

Colon cancer screening should be an important part of routine health care as colon cancer (CRC) is the most common cancer among Malaysian men, the second most common cancer among Malaysian women, and the third leading cause of cancer deaths in the country.

About 66% of male CRC cases and 65% of female CRC cases are detected at a late stage, increasing the risk of cancer death. However, it doesn’t have to be that way because getting a colon cancer screening test could save your life if you are 50 or older. 

Screening tests are used only when one does not have irritable bowel syndrome symptoms. Colorectal cancer often develops from precancerous polyps (abnormal growth) in the rectum or colon.  Screening tests can detect precancerous polyps, allowing them to be removed before they turn into cancer. Regular screening can also help detect colorectal cancer while it is still in the early stages, when treatment works best. Current screening methods are divided into stool-based tests and visual (structural) exams.

Types of Colon Cancer Screening Tests

• Stool-based tests

These tests look for signs of colorectal cancer or polyps in the stool. Because these tests can be done at home, it is more convenient and easier for some people than getting a test instead of colonoscopy. However, these tests must be done more frequently. If one of these stool tests returns a positive result, a colonoscopy test is required to determine whether you have cancer.

• Faecal immunochemical test (FIT)

Looking for occult (hidden) blood in the stool is one way to screen for colorectal cancer. The faecal immunochemical test (FIT) looks for hidden blood in the lower intestines' stool.

• Guaiac-based faecal occult blood test (gFOBT)

The guaiac-based faecal occult blood test (gFOBT) uses a chemical reaction to detect occult (hidden) blood in the stool. It works differently than the FIT, but, like the FIT, it cannot distinguish between blood from the colon and blood from other parts of the digestive tract (such as the stomach).

• Stool DNA test

A stool DNA test, also known as a multitargeted stool DNA test, looks for abnormal DNA sections from cancer or polyp cells, as well as occult (hidden) blood. DNA mutations in specific genes are common in colorectal cancer or polyp cells. Cells with these mutations frequently end up in the stool, where tests may be able to detect them.

• Visual (structural) exams

These tests examine the insides of the colon and rectum for any abnormalities that could signify cancer or polyps. These tests can be done less frequently than stool-based tests, but more planning is required ahead of time and may carry additional risks not seen with stool-based tests.

• Colonoscopy

The doctor uses a colonoscope, a flexible tube about the width of a finger with a light and small video camera on the end, to examine the entire length of the colon and rectum. It is inserted through the anus, into the rectum, and into the colon. If necessary, special instruments can be passed through the colonoscope to get a biopsy (take a sample) or remove any suspicious-looking growths like polyps.

• CT colonography (virtual colonoscopy)

This is a more advanced computed tomography (CT) scan of the colon and rectum that can detect abnormalities such as polyps or cancer. Special computer programmes create 3-dimensional images of the colon and rectum using x-rays and a CT scan.

• Flexible sigmoidoscopy)

A flexible sigmoidoscopy is similar to a colonoscopy in that it examines the colon. However, the doctor will only be able to see less than half of the colon and the entire rectum.  A sigmoidoscope is inserted through the anus, into the rectum, and then into the lower colon. Images from the scope are displayed on a video screen, allowing the doctor to identify and potentially remove any abnormal areas.

Finding the Right Tests For You

There is no such thing as the “best test” for anyone. There are pros and cons for each test. Consult our highly experienced colorectal specialists about which test or tests are suitable for you and how often should one be screened. At ParkCity Medical Centre, our colorectal specialists provide exceptional care for gastrointestinal conditions by utilising advanced clinical techniques and innovative technologies.

When Should You See a Colorectal Specialist

Colorectal cancer is becoming more common in adults under the age of 50. Many of these cases are being diagnosed at later stages of the disease, when the cancer is more difficult to treat. In most instances, young people do not recognise the symptoms of colorectal symptoms, pay any attention to the signs, and are unsure of what to do or who to contact regarding this matter. So, when should you see a colorectal specialist?

It is important for one to be familiar with colorectal cancer and its symptoms, so that they may take appropriate action to increase the chances of being diagnosed as early as possible and receive the best treatment from a colorectal specialist. 

Symptoms of colorectal cancer may include:

• Weight loss with no explanation
• Persistent abdominal pain
• Narrow or pencil-thin stools
• Rectal bleeding, either dark or bright red colour
• Anaemia from iron deficiency due to chronic bleeding
• Tenesmus (the feeling that you need to empty your bowel but there is no excretion)

Colorectal cancer symptoms in its advanced stages may include:

• Nausea
• Vomiting
• Loss of appetite
• Uncontrollable weight loss
• Deteriorating physical condition
• Abdominal pain, bloating or bowel obstruction

Risk Factor

Certain conditions increase a person's risk of developing colorectal cancer. It is better to be safe than sorry when it comes to health, so take these factors into consideration and consult our colorectal specialists to reduce your chances of getting colorectal cancer.

The following risk factors have been linked to the development of colorectal cancer:

• Having a personal history of colon, rectum, or ovarian cancer
• Having a first-degree relative with a history of colon or rectal cancer
• Having inherited changes in certain genes that put you at risk of developing familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary nonpolyposis colorectal cancer)
• Having or had chronic ulcerative colitis – Crohn's disease for at least 8 years
• History of inflammatory bowel cancer
• Breast, ovarian, or uterine cancer in the family
• A diet high in red meat, processed meat, fat, and low in fibre
• Smoking and drinking alcohol
• Being obese

As you grow older, age becomes the main risk factor for most cancers and the chances of you getting cancer increases.

Diagnosis

A patient who wants to do a colorectal cancer screening must see a colorectal specialist for a full clinical and physical examination to determine the risk. At ParkCity Medical Centre, our colorectal specialists can conduct multiple tests to detect colorectal cancer in patients. Should there be a risk or if you show signs of colorectal cancer, PMC’s colorectal specialists will discuss the risks with you, the treatments and the follow-up appointments that you may require.

The following tests and procedures to diagnose colorectal cancer are:

• Physical exam and health history
• Digital rectal exam
• Colon cancer screening

Our colorectal specialist will determine the best treatment plan for you based on multiple factors, such as:

• The location of the cancer in your colon
• How far the cancer has spread

Colon Cancer Surgery Preparation

As always, surgery should never be taken lightly. However, there are several things you can do to increase the possibility of a successful surgery.

• Follow your doctor's diet recommendations, which usually include consuming only clear liquids for 1 or 2 days before surgery
• Stop smoking and, if you drink, temporarily abstain from alcohol
• Do not eat anything after midnight on the day before surgery
• Before surgery, cleanse your bowels with laxatives or an enema

Post-surgery, you will be encouraged to live on a liquid or soft food diet. This is until your bowels are healthy enough to form normal stools. You should be able to consume the food you love and resume your regular activities once you have fully recovered.

At ParkCity Medical Centre (PMC), our patients receive extensive cancer care . We strive to provide a wide range of cancer care pathways, support, and treatments to meet the individual needs of each patient.