There are no pain receptors in the colon, which would make the early stages of colorectal cancer (also known as colon cancer) asymptomatic.
Lack of awareness on colorectal procedures and newer cancer treatments leave Malaysians in the dark
MANY Malaysians find themselves at the end of an earth-shattering call from their doctor with a late-stage diagnosis of colorectal cancer – one of the most prevalent cancer in Malaysia.
According to Prince Court Medical Centre consultant colorectal surgeon Dr Lim Hiong Chin, colorectal cancer (cancer of the colon and rectum) is one of the most common cancer among men – with lack of awareness as the main cause of late diagnosis.
“The awareness of colorectal cancer in Malaysia is lacking and we see a lot of patients coming in at the later stages as compared to more developed countries.
“Once we diagnose a more advanced stage of cancer, our options are limited – from minimal and less invasive surgery compared to major surgery, to the survival rate which is worse if the condition is picked up later.”
Dr Lim says almost all colorectal cancers are asymptomatic at early stages.
‘It is the embarrassment of having to open themselves to the doctors and most people just live with it,’ says Dr Lim of people with haemorrhoids.
“Usually when people begin to complain or show symptoms they are most likely at an advanced stage. Even if they start to bleed they associate the bleeding with haemorrhoids.
“What we fear is that the bleeding might not come from haemorrhoids but from something higher up. Therefore, if there are risk factors and the age group is right, any patient with haemorrhoids will be recommended for colonoscopy to ensure we do not miss the cancer, if any.
“It is not uncommon for people to ignore haemorrhoids. It is the embarrassment of having to open themselves to the doctors and most people just live with it.”
He says that conventionally haemorrhoids are treated with surgery but the downtime needed for recovery is not ideal for the productive workforce.
“One of the latest treatments is laser haemorrhoid treatment. It involves making a small puncture in the haemorrhoid itself and passing laser fibre into the haemorrhoid, burning it from the inside.
“It does two things. It clots the blood in the haemorrhoid immediately which causes it to shrink. This causes inflammation around the haemorrhoid.
“Our body will heal itself naturally and inflammation will lead to scarring which is what we want. The scarring will pull the hemorrhoid to the wall,” he says, adding that the healing process can take a few months but the patient can go about his day as usual.
Dr Lim says IV chemotherapy might not be able to reach every aspect of the body at times such as the abdomen. Therefore, hyperthermic intraperitoneal chemotherapy (HIPEC) is designed to solve this and the heated chemotherapy is delivered straight to the abdomen.
“The aim is to remove all the microscopic cancer cells. Cancer cells that can be seen by the naked eye need to be removed surgically.
“But HIPEC is not suitable for all cancers. The suitable cancers include cancer of the appendix, ovaries, stomach and primary cancer of the abdomen’s inner lining,” he says.
Dr Lim says that HIPEC is a major surgery and the surgery itself takes a long time to complete, so a thorough evaluation of the patient needs to be made to achieve a certain amount of benefit before the procedure is offered.
An incision will be made under the rib cage all the way till the upper pelvic bone, with the longest operation lasting some 15 hours for Dr Lim.
“We won’t offer this treatment if the risk outweighs the benefits. The risk can be seen from two aspects – the risk of surgery and the risk of anaesthesia.
“Risk of surgery is that we will need to remove all cancer with the naked eye.
“If there are more things for us to remove, then the surgical risk will increase exponentially especially after eight to 10 hours on the operating table.
“The risk of anaesthesia is similar. The longer we anaesthetise our patients, the more complications can develop,” he says.
“To make the HIPEC procedure a success is not solely based on technical aspects but the support of the hospital as well,” he adds, explaining that support comes in the form of anaesthesiologists, nursing team, clinical oncologists and team, pharmacists, dietitians, physiotherapists, ICU and the ward.
“I think the most important (part of the job) is the support. We can’t do it alone and we need help from other (specialists),” says Dr Lim.
KKLIU 0934/ Expiry Dec 31, 2025
