Colorectal Cancer

Colorectal Cancer

What is Colorectal Cancer?

Colorectal Cancer (also known as bowel cancer and colon cancer) is cancer found in the colon or rectum (part of large intestines).

Image source: OncoLink

Most colon cancer start as a growth on the inner lining of the colon called polyps. Over time, these polyps can change into cancer.

Image source: National Cancer Institute

Factors which can increase chance of cancer include:

i) If polyp is larger then 1cm

ii) If more than 2 polyps are found

iii) If the cells in the polyp show pre-cancerous changes called dysplasia

How does the colon look like?

Image source: Mayo Clinic

The colon is around 5 feet long for undigested food to pass through before coming out as waste. The first section is called ascending colon, second section is the transverse colon and the third section is the descending colon. The last 2 sections are the sigmoid and rectum where the waste products sits and wait before being excreted. If you are constipated, the waste sits here longer.

How does Colon Cancer spread?

Over time a polyp can grow into the wall o the colon deeper into the layers of the wall and finally into blood vessels or lymph nodes. The final 4th stage is when the cancer has spread to other parts of the body. The chance of surviving the cancer gets LESS with each increasing stage.

Image source: My Support 360

What are the risk factors?

1) Age (most colon cancers start after 50 years old)

2) Diet

  • Long term consumption of read meat or processed meat
  • High temperature cooking such as barbecuing and pan-frying
  • Low fibre intake (constipation increases time toxins in contact with the colon)

 

3) Smoking

  • Smoking increases the risk of colon cancer and chance of dying from colon cancer

 

4) Family history

  • The increase in life time risk related to family history ranges from two to six fold
  • Risks are greatest in relatives of patients diagnosed young, tow or more affected relatives or relatives of patients with colon cancers

5) Obesity

  • Being overweight, having high fat diet and physical inactivity increases the risk of colon cancer

 

Why screen for colon cancer?

It is important to undergo screening for colon cancer because detecting colon cancer EARLY increases the chances of survival. Late stage cancers (such as stage 3 or 4) have worse prognosis. In fact at the polyp stage, the removal of polyp eliminates the chance of it progressing to later stage of cancer.

For those who have had polyps in the past should arrange for one or two yearly screening/surveillance. The screening of colon is by using a flexible endoscope called colonoscopy.

Screening is the testing of asymptomatic individuals to determine the risk of developing colon cancer and surveillance is the ongoing monitoring of individuals who have an increased risk for the development of the disease.

In conclusion, colon cancer is a major public health concern and is the 2nd most common cancer in Malaysia.

Cancer statistics in Malaysia:

 

Source: National Cancer Registry Report 2007-2011 (Oct 2016)

Screening lowers the incidence and mortality of colon cancer and colon cancer is preventable through removal of premalignant polyps and is curable if detected and treated early.

References: Johns LE et al. Am j Gastroenterol. 2001;96(10):2992, Morb mortal Rep 2011;60(26):884, Globocan 2012

Download Teleme’s mobile app and consult Dr Meheshinder, Colorectal Surgeon or Dr Mahendra, Gastroenterologist (gut physician) about Colorectal Cancer

 Dr. Meheshinder

Dr. Meheshinder

Colorectal Surgeon

 

 Dr. S. Mahendra Raj

Dr. S. Mahendra Raj

Gastroenterologist (gut physician)

Everything you wanted to know about breast cancer but afraid to ask

Everything you wanted to know about breast cancer but afraid to ask

Statistics of breast cancer

In the USA 1 in 8 women will get breast cancer.  In Malaysia, the incidence has been discovered to be 1 in 19 women and accounts for around 30% of all new cancers. Around 5,000 Malaysian women are diagnosed with breast cancer every year, most of them aged between 30 and 60 years, where nearly half of those affected are under 50-years of age. Malaysian patients have poor survival rate due to lack of awareness of the signs and symptoms fear of screening and delay in medical treatment when traditional alternative is preferred.

High risk factors

  • Family history of breast or ovarian cancers
  • BRCA gene positive (more than 50% chance of getting breast cancer)

Lifestyle Risk Factors

  • Smoking
  • Alcohol consumption
  • Overweight (BMI more than 25)
  • Lack of exercise
  • Early menarche or 1st pregnancy at a late age in life.

Breast cancer

Breast cancer either begins in the cells of the lobules (known as the milk-producing glands) or the ducts (known as milk passages) and rarely from fatty and fibrous tissue of the breast.  It can spread via the lymph nodes into other parts of the body. The breast cancer’s stage refers to how far the cancer has spread beyond the original tumour.

 

Symptoms or signs of breast cancer

There may be no symptoms at all.  Usually there is a breast lump, breast pain, skin dimpling, changes at the nipple such as in-turning, discharge, rash or redness.

Breast screening

  • Mammogram is recommended every 2 years for women age 50 to 74 years
  • Should not be denied in women between 40-49 even if they are low or intermediate risk,
    Malaysian Clinical Practice Guidelines (2010)

Treatment of breast cancer

Breast cancer is treated with a combination of surgery, chemotherapy or radiation and the choice depends on the cell type and stage of cancer.  Surgery aims to remove the entire cancer with a some surrounding normal tissue and lymph nodes where necessary.

What are the risks for recurrence?

  • Stage of cancer at the time of diagnosis (more advanced stage has worse prognosis)
  • Grade of cancer (higher grade with more undifferentiated cells have worse prognosis)
  • Cancer cell type (invasive cells have worse prognosis)
  • ER / PR hormone receptor positive (amenable to hormone therapy)
  • HER2 gene positive (worse prognosis)

Follow up schedule after breast cancer treatment

  • After initial surgery/chemotherapy/radiotherapy, you are recommended to see the doctor Every 3 months for the first 2 years
  • After that, every 6 months for 3 years
  • After that, every year for 5 years
  • After that, as advised by the doctor

For more references:
www.moh.gov.my | www.acadmed.org.my | www.cancer.org.my |
http://www.cancerresearch.my/research/breast-cancer/ |
http://www.nationalbreastcancer.org/early-detection-of-breast-cancer 

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Dr. Azlina Firzah

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Dr. Mastura Md Yusof

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