Colorectal cancer is one of the most prevalent cancers in both men and women worldwide. When colorectal cancer is found early, it can often be cured. The death rate from this type of cancer has been declining since the mid-1980s, possibly because it is usually diagnosed earlier now and treatments have improved.

Colorectal Cancer Treatment In Malaysia



Colorectal cancer most often begins as a polyp and recognizing and removing precancerous polyps can prevent colorectal cancer. Most colorectal cancers are called adenocarcinoma. Other types of cancer that occur far less often in the colon or rectum include carcinoid tumor, gastrointestinal stromal tumor (GIST), small cell carcinoma, and lymphoma.

Most colorectal cancers (about 95%) are considered sporadic, meaning the genetic changes develop by chance after a person is born, so there is no risk of passing these genetic mutations on to ones children. Inherited colorectal cancers are less common (about 5%) and occur when genetic mutations are passed down from 1 generation to the next (see “family history of colorectal cancer” below).

 

Risk Factors

Age and gender
More than 90% of colorectal cancers occur in people older than 50. Men have a slightly higher risk of developing colorectal cancer than women.
Hereditary colorectal cancer syndrome
Members of families with certain uncommon inherited conditions also have a significantly increased risk of colorectal cancer, as well as other types of cancer. These include familial adenomatous polyposis, Gardner syndrome and Lynch syndrome.
Personal history of certain types of cancer
People with a personal history of colorectal cancer and women who have had ovarian cancer or uterine cancer are more likely to develop colorectal cancer themselves.
Smoking
Recent studies have shown that smokers are more likely to die from colorectal cancer than nonsmokers.
Family history of colorectal cancer
Colorectal cancer may run in the family if first-degree relatives (parents, brothers, sisters, children) or other family members (grandparents, aunts, uncles, nieces, nephews, grandchildren, cousins) have had colorectal cancer. This is especially true when family members are diagnosed with colorectal cancer before age 50. If you have a family history of colorectal cancer, talk with our trained genetic counselors at Onco Life Centre about the role of genetic testing to determine if you may have a genetic mutation.
Inflammatory bowel disease
People with IBD, such as ulcerative colitis or Crohns disease at increased risk of colorectal cancer.
Adenomatous polyps (adenomas)
People who have had adenomas have a greater risk of additional polyps and of colorectal cancer, and they should have follow-up screening tests regularly.
Physical inactivity and obesity
 

Screening And Prevention Of Colorectal Cancer

Talk to our oncologists at Onco Life Centre about when screening should begin based on your age and family history of the disease. Using the guidelines below, you should begin colorectal cancer screening earlier and more often if you have any of the following risk factors:

Prior history of colorectal cancer or adenomatous polyps.
Strong family history of colorectal cancer or polyps (first-degree relative younger than 50 or in 2 first-degree relatives of any age).
Personal history of chronic IBD.
Family history of any hereditary colorectal cancer syndrome.

 

Treatment overview

In order to tailor your treatment plan, our oncologists at Onco Life Centre will review factors such as your pre-existing medical conditions, your overall health and nutritional status, and potential treatment side effects.

Surgery

Surgical resection is the removal of the tumor, some surrounding healthy tissue and nearby lymph nodes. Some patients may be able to have laparoscopic colorectal cancer surgery. The incisions are smaller and the recovery time is often shorter than with standard colon surgery. Laparoscopic surgery is as effective as conventional colon surgery in removing the cancer. Less often, a person with rectal cancer may need to have a colostomy. Sometimes, the colostomy is only temporary to allow the rectum to heal, but it may be permanent. With modern surgical techniques and the use of chemo-radiation before surgery, most people who receive treatment for rectal cancer do not need a permanent colostomy.

Radiation therapy

For rectal cancer, radiation therapy may be used before surgery, called neo-adjuvant therapy, to shrink the tumor so that it is easier to remove. It may also be used after surgery to destroy any remaining cancer cells. Chemotherapy is often given at the same time as radiation therapy, called chemo-radiotherapy, to increase the effectiveness of the radiation therapy. Chemo-radiation therapy is often used in rectal cancer before surgery to avoid colostomy or reduce the chance that the cancer will recur.

Chemotherapy

Chemotherapy destroys cancer cells, usually by stopping the cancer cells ability to grow and divide. Chemotherapy may be given after surgery to eliminate any remaining cancer cells. For some people with rectal cancer, chemotherapy is given with radiation therapy before surgery to reduce the size of a rectal tumor and reduce the chance of the cancer returning.

Targeted therapy

Targeted therapy is a treatment that targets the cancers specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. To find the most effective treatment, our oncologists at Onco Life Centre may run tests to identify the genes, proteins, and other factors in your tumor.

Anti-angiogenesis Therapy

Anti-angiogenesis therapy is a type of targeted therapy that is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to starve the tumor. In 2004, the FDA approved the first anti-angiogenesis monoclonal antibody along with chemotherapy as first-line treatment, for advanced colorectal cancer. An oral anti-angiogenesis tyrosine kinase inhibitor was approved in 2012 for patients with metastatic colorectal cancer who have already received certain types of chemotherapy and other targeted therapies. Subsequently, newer anti-angiogenesis monoclonal antibodies combined with chemotherapy in the second-line setting for metastatic colorectal cancer, were approved by the US FDA.

Epidermal growth factor receptor (EGFR)

Epidermal growth factor receptor (EGFR) inhibitors are a type of targeted therapy that stop or slow down the growth of colorectal cancer. Currently, two FDA approved EGFR monoclonal antibodies are recommended for use only in patients with tumors that express non-mutated, or wild type, RAS genes. Our oncologists at Onco Life Centre may test your tumor for other molecular markers, including BRAF, microsatellite instability, and others.

 

Treatment Options By Stage

In general, stages 0, I, II, and III are often curable with surgery. However, many patients with stage III colorectal cancer, and some with stage II, receive chemotherapy after surgery to increase the chance of eliminating the disease. Patients with stage II and III rectal cancer will also receive radiation therapy with chemotherapy either before or after surgery.

 

 
Stage 0 colorectal cancer

The usual treatment is a polypectomy, or removal of a polyp, during a colonoscopy.

 
Stage 1 colorectal cancer

The usual treatment is a polypectomy, or removal of a polyp, during a colonoscopy.

 
Stage 2 colorectal cancer

Surgery is often the first treatment. Patients with stage II colorectal cancer can talk to our oncologists at Onco Life Centre about whether adjuvant chemotherapy is needed after surgery to destroy any remaining cancer cells. For patients with stage II rectal cancer, radiation therapy is usually given in combination with chemotherapy, either before or after surgery.

 
Stage 3 colorectal cancer

Treatment usually involves surgical removal of the tumor followed by adjuvant chemotherapy. For patients with rectal cancer, radiation therapy may be used along with chemotherapy before or after surgery, along with adjuvant chemotherapy.

Metastatic (stage 4) colorectal cancer

Colorectal cancer can spread to distant organs, such as the liver, lungs, the tissue called the peritoneum that lines the abdomen, or a womans ovaries. Our oncologists at Onco Life Centre will help you tailor your treatment plan, which may include a combination of surgery, radiation therapy, and chemotherapy. In colorectal cancer, if the cancer has spread only to the liver and if surgery is possible either before or after chemotherapy”there is a chance of complete cure. Even when curing the cancer is not possible, surgery may add months or even years to a persons life. Determining who can benefit from surgery for cancer that has spread to the liver is often a complicated process that involves doctors of multiple specialties working together to plan the best treatment option.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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