Understanding the Growing Prevalence of Colorectal Cancer among Young Adults in Malaysia

An urgent call to action

Research shows approximately 49,000 people in Malaysia were estimated to be newly diagnosed with cancer in 2020, and the number is expected to rise to 66,000 new cases annually by 2030. Of the more prevalent cancer types, colorectal ranks among the highest in terms of prevalence.

Jenson Sow, Clinical Oncology, Aurelius Hospital Nilai

Colorectal cancer (CRC) is a pervasive and life-threatening disease that affects millions of people worldwide. Developing in the colon or rectum, which are critical components of the digestive system, CRC ranks as the third most prevalent form of cancer globally. Despite advancements in medical research and technology, the global burden of cancer is still increasing at an alarming rate, with an expected 75 per cent rise in new cases annually by 2030. Furthermore, the incidence of CRC is on the rise among young Malaysian adults, a trend that is particularly concerning since the disease has traditionally been associated with older people.

A 2018 study published in the Malaysian Journal of Medical Sciences revealed that the incidence of CRC among individuals aged 20-39 years old in Malaysia was 4.4 per 100,000 population. Additionally, according to the Malaysia National Cancer Registry

Report 2012-2016 by the Ministry of Health, CRC is the most common cancer among Malaysian men and the second most common cancer among Malaysian women. The report also indicated that the incidence of the disease was highest among Chinese, followed by Malays and Indians.

A look at the past and present CRC has become a significant public health issue in Malaysia due to its increasing incidence rate over the years.

Historically, CRC was not prevalent in Malaysia; however, the disease's incidence has risen rapidly over the past few decades. In the 1980s, the incidence of CRC in Malaysia was around 10 cases per 100,000 people. However, by the 2000s, the incidence rate had doubled to around 20 cases per 100,000 people. This trend highlights the need for increased awareness and action to address the growing burden of CRC in the country.

This type of cancer was once more prevalent in urban areas, but recent studies indicate that it is now affecting people from both urban and rural areas. Moreover, while CRC was traditionally more common among men, the incidence rate among women has been increasing in recent years. These trends suggest that it is becoming a significant public health issue across all demographics in Malaysia, and more targeted efforts are needed to address the disease.

The incidence of CRC in Malaysia continues to rise, with an estimated 6,000 new cases being diagnosed each year. This trend is attributed to changes in lifestyle and dietary habits, as well as an ageing population. Malaysians are increasingly consuming processed foods and red meat, both of which are known risk factors for CRC. Furthermore, a lack of physical activity and an increase in obesity rates are also contributing factors. These behavioural and demographic changes underscore the need for more comprehensive public health initiatives aimed at preventing CRC in Malaysia.

Factors contributing to the rise of CRC in young Malaysian adults

Several factors may contribute to the increasing incidence of CRC in young adults in Malaysia. One of the primary contributors is the changing diet and lifestyles. Many Malaysians now consume more processed and highfat foods, which are low in fiber and other essential nutrients that promote colorectal health. This dietary shift has been linked to an increased risk of CRC, particularly among younger populations. Addressing these dietary and lifestyle factors is crucial to reducing the incidence of CRC in Malaysia, particularly among young adults.

In addition to dietary factors, lack of physical activity and sedentary lifestyles are also contributing factors to the development of CRC, particularly among young adults in Malaysia. Many young adults in Malaysia spend long hours sitting in front of computers or televisions, leading to a lack of physical activity. The rapid urbanisation and industrialisation in the country may have contributed to changes in lifestyle and dietary habits that have led to the increased incidence of CRC among young adults. Addressing these lifestyle factors is critical in reducing the burden of CRC in Malaysia, particularly among young adults.

The increasing prevalence of obesity in is another factor contributing to the rising incidence of CRC among young adults. Obesity is a known risk factor for CRC, and the rise in obesity rates may be linked to the increasing incidence of the disease in this population. Genetics may also play a role in the increasing incidence of CRC in young adults in Malaysia. Certain genetic mutations can increase the risk of developing CRC, and these mutations can be inherited from one's parents. Understanding the genetic factors that contribute to the development of CRC is critical for identifying individuals at higher risk and developing targeted prevention strategies.

Despite the numerous risk factors for CRC, there is a lack of awareness and screening among young adults in Malaysia. Many young adults are not aware of the risk factors for CRC and may not seek screening until they experience symptoms. Moreover, symptoms of CRC such as rectal bleeding, abdominal pain, and changes in bowel habits are often ignored or attributed to other causes. A delay in diagnosis can lead to the cancer metastasising and becoming more challenging to treat. Increasing awareness about the importance of early screening and the symptoms of CRC is crucial in reducing the burden of this disease in young adults in Malaysia.

Symptoms of Colorectal Cancer

It is important to be aware of systemic symptoms that may indicate colon cancer. These symptoms do not only affect the colon but can also affect the entire body. However, it may be difficult to associate these symptoms with colon cancer due to their general nature. Despite this, they should not be ignored as they serve as an important warning sign. Some of the systemic symptoms to watch out for include unexplained weight loss, loss of appetite, nausea, vomiting, weakness, and fatigue. It is worth noting that these symptoms can also be indicative of other health conditions, which is why it is important to seek medical attention and undergo appropriate testing to rule out other issues.

Regular screening is recommended for individuals who are at average risk of developing CRC, starting at age 45. However, for those with a family history of the disease or other risk factors, such as inflammatory bowel disease or genetic syndromes, screening may be recommended at an earlier age. There are several screening options available, including colonoscopy, fecal immunochemical test, and stool DNA test. It is essential for individuals to discuss with their healthcare provider to determine the best screening option based on their risk factors and preferences.

It is crucial to keep in mind that the symptoms of colon cancer can be similar to those of non-cancerous gastrointestinal disorders or other types of cancer. Additionally, there are rare and unusual symptoms that may be linked to a diagnosis of colon cancer. Even though these symptoms may be due to a non-cancerous condition, it is important to be mindful of any changes in your health and seek medical attention promptly if you experience persistent symptoms.

Uncommon symptoms of colon cancer should never be ignored, as they could indicate a more serious underlying issue. Some of these include sharp abdominal pain, bloatedness, severe constipation, stools that appear narrower or thinner than usual, continuous fatigue, iron deficiency that doesn't improve with treatment, and gradual weight loss. Even if these symptoms suggest another condition, seeking medical attention is important to rule out the possibility of colon cancer.

A doctor can run appropriate tests to make an accurate diagnosis and provide proper treatment.

Diagnosis of Colorectal Cancer

Early detection is crucial for optimal treatment outcomes, therefore individuals experiencing these symptoms should promptly seek medical attention. Diagnostic tests for CRC may include a biopsy, blood tests to detect signs of cancer or abnormalities, colonoscopy, flexible sigmoidoscopy, computed tomography (CT) colonography (also known as virtual colonoscopy), and fecal tests such as fecal occult blood tests (FOBT) and fecal immunochemical tests (FIT). In cases where blood is not visible in fecal matter, a Guaiac-based fecal occult blood test (gFOBT) may be performed. Additionally, a fecal DNA test can be done to detect genetic mutations and blood products.

Colonoscopies are typically performed on an outpatient basis and are relatively painless thanks to modern anaesthesia techniques. During the procedure, a flexible tube with a light and camera on the end is inserted into the colon. The doctor navigates through the colon and sends images to a computer screen for examination. The length of the procedure typically ranges from 60-90 minutes. With advancements in medical technology, health screenings have become more comfortable and less daunting for patients. Regular screenings can help detect health issues early and allow for discussions with the doctor regarding next steps if needed.

Treatment of Colorectal Cancer

The management of CRC among young Malaysian adults may be determined by factors such as the stage of cancer, the tumour's location, and the patient's overall health. The most prevalent treatment for CRC is surgery, and the surgeon may opt for colonoscopy, laparoscopic surgery, or open surgery, depending on the tumour's position.

In addition to surgery, patients with CRC may undergo chemotherapy, radiation therapy, targeted therapy, or immunotherapy depending on various factors such as the stage of cancer and the patient's overall health. Targeted therapy involves drugs that target specific proteins or genes that promote the growth of cancer cells. Immunotherapy stimulates the body's immune system to attack cancer cells and is often recommended for advanced CRC that has spread to other parts of the body.

It is important to note that treatment options for CRC are personalised and should be made in consultation with a medical professional. Early detection and diagnosis can improve the effectiveness of treatment, so regular screening and check-ups are recommended, particularly for those with a family history of CRC.

Prevention of Colorectal Cancer

Although there is no fool proof method to prevent CRC, there are measures you can take to minimise your risk of developing the disease. These include adopting a balanced diet that is rich in fibre, fruits, and vegetables. Regular exercise is also crucial — doing at least 30 minutes of moderate physical activity, such as brisk walking or cycling, most days of the week can help reduce the risk. Additional preventative measures include maintaining a healthy weight, abstaining from smoking and excessive alcohol consumption, and undergoing routine CRC screenings.

The incidence rate of CRC among young adults in Malaysia has significantly increased over the years, making it a critical health issue. However, it is important to note that CRC is curable. Early detection through regular screening increases the chances of a cure. It is crucial to recognise the symptoms and seek medical attention promptly if there are any doubts about having the disease. Ignoring symptoms associated with CRC may lead to a delay in diagnosis, which could negatively impact the effectiveness of treatment.

Jenson Sow is a Clinical Oncologist at Aurelius Hospital Nilai. He pursued oncology as his specialty and has since provided oncology services at various hospitals including Hospital Kuala Lumpur, Sabah Women and Children Hospital, and Institut Kanser Negara. Committed to his profession, Dr. Jenson strives to provide better public understanding and education on cancer.

In conclusion, CRC is a serious health issue that requires prompt attention and regular screenings. Early detection and diagnosis are crucial in improving treatment outcomes and increasing the chances of a cure. While there are various treatment options available, prevention remains the best course of action. Adopting a healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking and excessive alcohol consumption, can significantly reduce the risk of developing CRC. By being proactive in our health and recognising potential symptoms, we can take steps to protect ourselves and reduce the impact of this disease.