Colorectal Cancer: Understanding Risks, Screening, and Modern Treatment

By Dato' Dr Luqman Mazlan and Dr Chong Hoong Yin

March 03, 2026

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Colorectal cancer refers to cancer that begins in the colon or rectum, which together make up the large intestine. The colon absorbs water and nutrients from food, while the rectum stores stool before it leaves the body.

Most colorectal cancers start as small growths called polyps, which are usually harmless at first. Over time — often over many years — some polyps can turn into cancer. This slow progression is exactly why colorectal cancer is considered one of the most preventable cancers. If polyps are detected and removed early, cancer can often be avoided entirely.

According to the Malaysia National Cancer Registry (NCR), colorectal cancer is:

MALE STATISTICS

The most common cancer among men in Malaysia

FEMALE STATISTICS

The second most common cancer among women

What is more concerning is that a large proportion of patients in Malaysia are diagnosed at Stage III or Stage IV, when symptoms become obvious and treatment is more complex. Early-stage colorectal cancer, on the other hand, often causes no symptoms at all.

Who Is at Risk of Colorectal Cancer?

Colorectal cancer can affect anyone, but certain factors increase a person’s risk. Understanding these risks can help individuals take proactive steps toward prevention and early detection.

1. AGE

Age is one of the strongest risk factors. The majority of colorectal cancer cases occur in people aged 50 years and above. However, recent NCR data show an increasing number of cases among younger adults, reminding us that symptoms should never be ignored simply because someone is "too young."

2. FAMILY HISTORY AND GENETICS

Having a first-degree relative (parent, sibling, or child) with colorectal cancer significantly increases risk, especially if the cancer occurred at a young age. Certain inherited conditions, such as familial adenomatous polyposis (FAP) or Lynch syndrome, also carry a much higher lifetime risk.

3. LIFESTYLE FACTORS

Modern lifestyles play a major role in colorectal cancer risk. Factors linked to higher risk include:
Diets high in red and processed meats
Low intake of fibre, fruits, and vegetables
Physical inactivity
Obesity
Smoking
Regular alcohol consumption

4. MEDICAL CONDITIONS

People with long-standing inflammatory bowel diseases, such as ulcerative colitis or Crohn's disease, have a higher risk of developing colorectal cancer over time and usually require closer surveillance.

Symptoms: Often Silent at First

One of the biggest challenges with colorectal cancer is that it often develops quietly. Early stages may not cause any noticeable symptoms. When symptoms do appear, they may include:

Changes in bowel habits (diarrhoea or constipation)

Blood in the stool

Persistent abdominal pain or bloating

Unexplained weight loss

Fatigue or anaemia

These symptoms are common and can be caused by many benign conditions, which is why they are sometimes ignored or delayed. However, persistent or unexplained symptoms should always be checked by a doctor.

The Importance of Screening and Early Detection

Screening means testing people before symptoms appear, with the goal of detecting disease early or preventing it altogether.

When colorectal cancer is detected early:

Treatment is usually simpler

Cure rates are significantly higher

Patients often avoid major surgery or prolonged chemotherapy

Quality of life is better

The NCR consistently shows that early-stage colorectal cancer has far better survival rates compared to advanced disease. Yet, screening uptake in Malaysia remains low.

COMMON SCREENING TESTS

Several screening options are available:

Faecal Immunochemical Test (FIT / iFOBT): A simple stool test that looks for hidden blood
Colonoscopy: A procedure that allows doctors to directly examine the colon and remove polyps at the same time. Colonoscopy remains the gold standard, as it is both diagnostic and preventive.

WHO SHOULD BE SCREENED?

1 Average-risk individuals should consider screening from age 50
2 Those with family history or higher risk may need earlier and more frequent screening
3 Screening should always be individualised based on medical history and risk factors

At Hospital Picaso, screening recommendations are tailored to each patient rather than using a one-size-fits-all approach.

Why Many Patients Are Diagnosed Late?

Despite clear benefits, many people delay screening due to:

Fear of discomfort or embarrassment

Misconceptions about colonoscopy

Lack of symptoms

Busy schedules

Limited awareness

Education is crucial. Screening is far less difficult than treating advanced cancer, and modern techniques have made procedures safer and more comfortable than ever before.

When Is Surgery Required in Colorectal Cancer?

Surgery plays a central role in the management of colorectal cancer and is often the main treatment when the disease is detected early.

Curative Surgery

For most early-stage and some locally advanced colorectal cancers, surgery aims to completely remove the tumour along with nearby lymph nodes. In colon cancer, this usually involves removing the affected segment of the colon and reconnecting the healthy bowel. In rectal cancer, surgery is more complex because of the narrow pelvic space and the need to preserve bowel, urinary, and sexual function whenever possible.

Surgery for Symptom Relief

In advanced cases, surgery may be required to relieve symptoms such as bowel blockage, bleeding, or perforation. Although this may not cure the cancer, it can significantly improve comfort and quality of life.

Surgery for Accurate Staging

The tissue removed during surgery allows pathologists to determine the exact stage of the cancer. This information is crucial in deciding whether additional treatments such as chemotherapy or radiotherapy are needed.

Modern Colorectal Cancer Treatment Options

Colorectal cancer treatment is rarely limited to one method. Instead, several treatments may be combined depending on the stage and type of cancer.

CHEMOTHERAPY

Chemotherapy uses medicines to destroy cancer cells. It may be given:

Before surgery to shrink the tumour
After surgery to reduce the risk of the cancer returning
As the main treatment if the cancer has spread

RADIOTHERAPY

Radiotherapy is most commonly used in rectal cancer. When given before surgery, often together with chemotherapy, it can shrink the tumour and make surgery more effective while reducing the risk of local recurrence.

TARGETED THERAPY AND IMMUNOTHERAPY

Some colorectal cancers have specific genetic features that allow treatment with targeted drugs or immunotherapy. These treatments focus on cancer cells while sparing normal tissues and are mainly used in advanced disease.

ADVANCES IN MINIMALLY INVASIVE AND ROBOTIC COLORECTAL SURGERY

Surgical techniques for colorectal cancer have evolved significantly over the last two decades.

Minimally Invasive (Laparoscopic) Surgery

This approach uses small incisions and a camera to perform surgery. Compared to traditional open surgery, it offers:

Less pain after surgery
Shorter hospital stay
Faster recovery
Lower risk of wound infections

For many patients, cancer control is just as effective as open surgery.

Robotic-Assisted Surgery

Robotic surgery is an advanced form of minimally invasive surgery. The robotic system provides high-definition 3D vision and highly precise instruments that move with exceptional control. This is particularly beneficial in rectal cancer surgery, where precision is critical.

At Hospital Picaso, robotic colorectal surgery is used to enhance surgical accuracy, preserve important nerves, and support quicker recovery when appropriate.

Multidisciplinary Care: A Team Approach at Hospital Picaso

What Is a Multidisciplinary Team?

An MDT brings together specialists from different disciplines to discuss and plan the best treatment strategy for each patient. This typically includes:

Colorectal surgeons

Medical and radiation oncologists

Radiologists

Pathologists

Specialist nurses

Dietitians and allied health professionals

Rather than working in isolation, the team collaborates to ensure decisions are well-balanced, evidence-based, and personalised. The Multi-disciplinary team (MDT) meets regularly to discuss each patient's case in detail. Together, they:

Review scans, pathology, and test results

Decide on the best treatment sequence

Tailor care to the patient's medical condition and personal needs

Coordinate treatment and supportive care

This approach ensures that patients receive the most appropriate, evidence-based, and compassionate care at every stage.

Personalised Treatment for Every Patient

No two colorectal cancer cases are the same. Treatment may include:

Surgery
Chemotherapy
Radiotherapy
Targeted or supportive therapies

Some patients require a combination of treatments, while others may need only surgery. At Hospital Picaso, treatment plans are customised based on:

Cancer stage and location

Patient's overall health

Lifestyle and work considerations

Personal preferences and goals

Supportive care — including nutritional guidance, stoma education, and emotional support — is also an essential part of treatment.

Life After Treatment and Ongoing Care

Colorectal cancer care does not end after treatment. Survivorship care is just as important. Regular follow-ups, surveillance colonoscopies, lifestyle guidance, and psychosocial support help patients return to daily life with confidence.

Patients are encouraged to:

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Maintain a balanced, fibre-rich diet

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Stay physically active

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Avoid smoking and excessive alcohol

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Attend regular follow-up appointments

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Conclusion

Colorectal cancer is common in Malaysia, but it does not have to be deadly. With awareness, timely screening, and comprehensive multidisciplinary care, many lives can be saved.

At Hospital Picaso, we are committed to walking this journey with our patients. By combining expertise, technology, and patient-centred planning, the hospital ensures that each patient receives comprehensive care that supports both survival and quality of life.

If you are aged 50 and above, have risk factors, or have concerns about your bowel health, speak to your doctor today. Early detection can make all the difference.