By now, most women – and men – know the basic facts about the two top cancers among women in Malaysia: breast and cervical cancer. We hear and read so much about breast cancer in newspapers and magazines, while there are always signs reminding us to go for our Pap smear test in doctors’ clinics. However, one cancer that is less talked about is colorectal cancer, even though it is the third cancer killer for women above 50 in Malaysia, after cervical and breast cancer.
In the United States, where about one in every 17 women will develop colorectal cancer, it is even more common than cervical or ovarian cancer in women. Sadly, despite colorectal cancer killing so many women in Malaysia every year, most people do not know enough about it and are unable to detect and treat it early. For every women that walks into my clinic with late stage colorectal cancer, I would like to urge many more to be aware of their individual risk so that they can detect it early. Here are some facts you should be concerned with:
Colorectal cancer affects important organs in the body
This form of cancer affects the colon or rectum, which are part of the large intestine in the digestive system. Colorectal cancer occurs when tumours form in the lining of the large intestine, also called the large bowel.
Yes, women do get colorectal cancer
Many people believe that colorectal cancer only affects men, or affects men more than women. There is no truth to this – colorectal cancer strikes women nearly as often as men, within the same age range.
Family history is a risk factor
A large majority of women who develop colorectal cancer have a family history of the cancer. If a woman has many family members ((first degree relative — parent, sibling, child) who have had colorectal cancer, her chances increase even more by 10-15%.
Older women are at risk
About 70 to 80% of colorectal cases occur in women whose only risk is being above age 50. Only in very rare cases do young people or adolescents develop colorectal cancer.
Other high risk CRC group
Another 10-15% of of the high risk group are people with inflammatory bowel disease (ulcerative colitis or Crohn’s disease) or one of the rare familial cancer or multiple polyp conditions.
If detected early, colorectal cancer is practically curable
If a woman is screened for, and diagnosed with, colorectal cancer early, she has a nearly 90% chance of being cured. If it has spread to her lymph nodes, her five-year survival rate goes down to 65%. If it has spread to other parts of her body, she has only nine percent of five-year survival.
You should have a colonoscopy when you reach 50
All these deaths do not have to happen. In the past twenty years we have learned a great deal about the biology of CRC and identifying risk factors. Technology has advanced and screening procedures have been developed. At last, we can now say that preventive screening decreases the death rate from CRC. Better yet, we have found that if adenomatous polyps (a benign growth, which is found in increasing numbers in 40 years old), the precursor lesions of CRC, are found and removed at screening, CRC will be prevented entirely.
Screening Protocols as recommended by the the American Cancer Society:
It takes about 10-15 years for an adenomatous polyp to progress to a cancer. Screening procedures and intervals are geared to take this biology into account. If any first degree relatives have had CRC, subtract 10 years from the age that the youngest relative was diagnosed and start screening then. Or you can just start screening at age 40. If the relative got the cancer at an older age, over 60, there is probably not much increase in risk and you can start screening at the same age, 50, as the average risk person.
Regardless of the age you start the screening, the recommendations are: (1) yearly fecal occult blood test (FOBT) and flexible sigmoidoscopy every five years, (2) colonoscopy every 10 years, or (3) air contrast barium enema (ACBE) every 5-10 years with flexible sigmoidoscopy.
Colorectal cancer may have no symptoms
Some of the symptoms of colorectal cancer can include blood in the stool, narrower stools, a change in bowel habits and general stomach discomfort. However, the cancer does not show any signs or symptoms in its earliest stage – and this is when it is most curable! When symptoms appear, it usually means that the cancer is already at its advanced stage. Therefore, you should have a colonoscopy screening once you reach 50, even if you feel and appear fine.
Colorectal cancer can be treated
Your doctor will first perform some tests to “stage” the cancer, which is to determine whether the cancer has spread to other parts of the body. The most advanced stage is where the cancer spreads to the liver or lungs. Most patients with stage 0, I, II, or III cancers can undergo treatment with the hope of a cure. Colorectal cancer rarely occurs again after 5 years, so most patients who live 5 years are considered cured.
Treatments for colorectal cancer include surgery, chemotherapy, radiation, or a combination of these. The doctor will advise you on which is the best choice of treatment, depending on the size, location, and stage of the cancer and on the your general health.
Colorectal cancer can be prevented
Yes, it’s true, it can be prevented! If a proper screening test like the colonoscopy is done early, it may be able to detect the growth of polyps. Polyps are non-cancerous growths on the inner wall of the colon and rectum, which are the first signs of the disease. Detected early, they can be removed before they become cancerous. A little knowledge about colorectal cancer can go a long way in saving lives. Remember these facts here today and ask your doctor about whether you need a colonoscopy.
Star newspape. Oct 10, 2011
By Datuk Dr Nor Ashikin Mokhtar
