Bowel cancer in Malaysia: symptoms, free stool test screening and colonoscopy

Bowel cancer in Malaysia

According to the Malaysia National Cancer Registry report for 2017–2021:

• Bowel (colorectal) cancer made up 14.1% of all cancers, the second most common overall after breast cancer, and the most common cancer in men.
• About 23,900 people were diagnosed in those five years, up 54% from 2012–2016. About 15% were under 50.
• About three in four cases with a known stage were found at stage 3 or 4. Only about 6% were caught at stage 1.
• The lifetime risk is about 1 in 44 for men and 1 in 62 for women, and highest among Chinese Malaysians (1 in 30 men).

Finding it early makes a big difference. In US data, about 9 in 10 people whose cancer is found before it spreads are alive 5 years later, compared with about 1 in 7 when it has spread to distant organs.

Bowel cancer symptoms (kanser usus simptom)

• Blood in your stool, which may look red or black, or bleeding from the bottom
• A change in bowel habit, such as looser stools, constipation or going more often, lasting several weeks
• Feeling you need to go even after you have just been
• Tummy pain, a lump in the tummy, or bloating
• Losing weight without trying
• Tiredness or breathlessness from anaemia (low blood count)

Most people with these symptoms don’t have cancer. Haemorrhoids (piles), for example, are a common cause of bleeding. But you can’t tell the difference yourself, so always get bleeding from the bottom checked by a doctor. Malaysian guidelines advise an urgent colonoscopy within 2 weeks for unexplained rectal bleeding with a change in bowel habit or weight loss, or for iron-deficiency anaemia.

Early bowel cancer often causes no symptoms at all, which is why screening matters.

Who is at higher risk?

• Being 50 or older, though younger adults can get it
• A close relative (parent, brother, sister or child) with bowel cancer, or inherited conditions such as Lynch syndrome
• A history of bowel polyps, or inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Smoking, alcohol, being overweight and being inactive
• A diet high in processed meat (such as sausages, ham and luncheon meat) and red meat, and low in fruit and vegetables. The WHO’s cancer agency classifies processed meat as a cause of bowel cancer.

Free bowel cancer screening: the stool test

Malaysian guidelines recommend that adults aged 50 to 75 at average risk do an immunochemical faecal occult blood test (iFOBT), also called a FIT test. It detects tiny amounts of blood in the stool that you can’t see.

• Where: it is offered free at government health clinics (Klinik Kesihatan), apart from the registration fee. Ask for it at your next visit. Selangor’s Selangor Saring programme has also included the test. Private clinics and pharmacies offer it for a fee.
• How: you collect a small stool sample at home with the kit, and return it to the clinic. There are no diet restrictions.
• How often: the 2017 guidelines recommend yearly testing if negative. Some clinics schedule a repeat every 2 years.
• If positive: you are referred for a colonoscopy. A positive test doesn’t mean you have cancer. Most positives are due to polyps or other causes, but it must be followed up.

Too few Malaysians take part. Between 2014 and 2018, only about 55% of people with a positive stool test went on to have the colonoscopy they needed. In Selangor’s screening programme, only 15–27% of people with abnormal results followed up. If your test is positive, please go for the colonoscopy.

If bowel cancer runs in your family

Malaysian guidelines recommend colonoscopy, rather than the stool test, for people with a family history:

Tell your doctor about your family history, including the age your relative was diagnosed.

What happens during a colonoscopy

A colonoscopy uses a thin, flexible tube with a camera to look inside the large bowel. It can find cancer early, and remove polyps before they turn into cancer.

• Before: you follow a special diet and take a strong laxative to empty the bowel.
• During: the test usually takes 30 to 45 minutes. You are usually offered sedation and painkillers. Polyps can be removed and small samples (biopsies) taken.
• After: don’t drive for 24 hours if you had sedation. Slight bleeding for a day or two is common.
• Risks: serious complications are uncommon. In the UK screening programme, a tear in the bowel happens in about 1 in 1,700 colonoscopies.

Treatment

Surgery to remove the cancer is the main treatment and offers the best chance of cure. Chemotherapy and radiotherapy may be used before or after surgery, and newer targeted treatments and immunotherapy help some people with advanced cancer. Treatment is planned by a team of specialists.

You can lower your risk by staying active, keeping a healthy weight, not smoking, limiting alcohol, eating less processed and red meat, and eating more fruit and vegetables.

Where to ask about bowel cancer screening

Your nearest Klinik Kesihatan offers the free stool test from age 50. Private GP clinics can also arrange a stool test, check symptoms such as bleeding, and refer you for colonoscopy. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states.

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Frequently asked questions