What was meant to be a routine health check-up turned into a life-changing moment for Tengku Nazeehah Tengku Mahmood. She had always been in good health with no underlying illnesses, so cancer was the last thing on her mind.
But to the 46-year-old homemaker’s shock, she was diagnosed with colorectal cancer.
“My case was a little different because I had no symptoms at all. In April 2021, I underwent a colonoscopy and endoscopy, simply because I had entered my 40s. Honestly, I didn’t even know what colorectal cancer was. So when the doctor told me the news, I was completely stunned. I couldn’t believe it, especially since I had no signs like changes in bowel habits, diarrhoea, constipation, changes in stool consistency, or unexplained weight loss,” she told Bernama.
After the colonoscopy, the doctor told her there was a blockage in her rectum and took a biopsy sample. The very next day, she had to go for a CT scan.
“When I met the gastroenterologist later with the results, he confirmed it was stage three colorectal cancer.”
The mother of three admitted she struggled to process the diagnosis. With no family history of colorectal cancer, it felt even more unreal.
“I remember looking at my husband… his face had gone pale and he was in shock. In our society, stage three or four cancer is often seen as a death sentence,” she said.
Refusing to give in, Tengku Nazeehah began learning everything she could about colorectal cancer and sought treatment at Universiti Malaya Medical Centre. Now, over four years later, Tengku Nazeehah is a cancer survivor, having completed surgery, chemotherapy and radiotherapy.
“Now, I only see my colorectal and oncology specialists once a year. I do a CT scan annually and a colonoscopy every three years,” she said, adding that the unwavering support of her husband and children kept her strong.
Finding purpose through adversity, Tengku Nazeehah has become an active advocate for cancer awareness. She is now part of the Colorectal Cancer Survivorship Society Malaysia (CORUM) and has been trained by the National Cancer Council Malaysia as a peer-support volunteer, offering guidance to patients while regularly giving talks and sharing her journey.
SECOND MOST COMMON CANCER
Colorectal cancer is the second most common cancer in Malaysia after breast cancer.
Dr Nurhashim Haron, a general surgeon and colorectal cancer specialist at KPJ Tawakkal Specialist Hospital here, said colorectal cancer, also known as colon or bowel cancer, develops in the large intestine. The term ‘colorectal’ refers to the colon (the large intestine) and the rectum (the final part leading to the anus).
“Cancer is a disease that occurs when abnormal cells grow and multiply uncontrollably in almost any part of the body. Normally, the cells that grow in our body will survive for two to three weeks, depending on where they grow.
“So, we need to understand that in our body, cells are constantly growing, then dying and shedding on their own. The same goes for the lining of the intestines, where new cells will grow. Usually, these cells live for about two or three weeks before they die. However, there are also cells that grow but do not die, and that is what causes cancer,” he explained.
According to him, colorectal cancer has been on the rise in Malaysia. Data from the National Cancer Registry showed that between 2017 and 2021, colorectal cancer accounted for 18.8 percent of cancer cases among men – an increase from 14.8 percent in 2012–2016.
Among women, colorectal cancer comprised 13.7 percent of cancer cases in the same period (2017-2021), compared to 11.1percent previously (2012-2016).
SYMPTOMS
Dr Nurhashim who is also President Malaysian Society of Colorectal Surgeons said colorectal cancer can sometimes show no symptoms in its early stages. However, bleeding is often the most common warning sign.
Other red flags include changes in bowel habits (for example, from defaecating once a day to two or three times a day, or bowel movements becoming less frequent); abdominal pain that recurs every few weeks; changes in stool consistency (constipation, hard pellet-like stools, bloody or mucus-filled stools); and unexplained weight loss and loss of appetite.
He added that people aged 45 and above are at higher risk, along with those with a family history of colorectal cancer.
“A decade ago, the higher-risk group was 50 and older, but now even those in their mid-40s are also getting this cancer,” Dr Nurhashim said, adding Malaysia records an estimated 4,000 to 4,500 new colorectal cancer cases each year, compared to 3,500 to 4,000 cases a decade ago. Alarmingly, most are detected at stage three or four.
The specialist strongly encourages regular screening, even before symptoms appear.
“Screening allows us to detect cancer early. Colorectal cancer often begins with small growths in the intestine called polyps. Each polyp has a 30 to 40 percent chance of developing into cancer. If we find and remove them early, we can prevent cancer altogether,” he said, adding that polyps can be detected during screening.
One of the screening methods for colorectal cancer is the FOB (faecal occult blood) test, which detects hidden blood in stool samples. This test can be done at home or in clinics.
“If the results are positive, further diagnostic tests like colonoscopy are required,” he said, adding that those with a family history of cancer and aged above 45 are encouraged to take the FOB test.
As for treatment for colorectal cancer, he said it would involve surgery and chemotherapy.
SENSITIVE TOPIC
Despite advances in medicine, colorectal cancer remains a sensitive topic in Malaysia because it involves bowel habits and stool.
“Many people feel embarrassed to talk about stool or rectal symptoms, so they delay seeking help. Some confuse colorectal cancer symptoms with haemorrhoids, which can cause bleeding and mucus but are not life-threatening. The danger is when people dismiss warning signs as haemorrhoids when it is actually cancer,” Dr Nurhashim cautioned.
He shared the case of a 60-year-old man who ignored bloody stools for almost a year after being told by friends it was “just piles”. By the time he sought treatment, he was already pale and had low haemoglobin levels, and was diagnosed with colorectal cancer.
Dr Nurhashim said when patients delay treatment for too long, they may eventually reach a critical stage where the abdomen becomes bloated and they can no longer pass stool or gas. This can lead to a ruptured intestine.
“If this happens and the patient only comes to the hospital at that stage, surgery will be carried out immediately. This is because once the intestine ruptures, stool leaks out, and this can be fatal,” he explained.
He advised the public to stay alert and informed about colorectal cancer as it can be prevented if detected and treated early, giving patients a much better chance of recovery and survival.
“Maintain a healthy lifestyle with regular exercise, avoid smoking and drinking alcohol, and prevent obesity. Those with a family history of colorectal cancer, or anyone concerned about their risks, should see a doctor for screening.
“And if you experience symptoms such as bloody or mucus-filled stools, or changes in bowel habits, seek medical attention immediately,” he said.
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