exudates and Colorectal-Neoplasms

This study aims to provide an analytical overview of the changing burden of colorectal cancer and highlight the implementable control measures that can help reduce the future burden of colorectal cancer in Malaysia.. We performed a MEDLINE search via OVID with the ​Medical Subject Headings (MeSH) terms "Colorectal Neoplasms"[Mesh] and "Malaysia"[Mesh], and PubMed with the key words "colorectal cancer" and "Malaysia" from 1990 to 2015 for studies reporting any clinical, societal, and economical findings associated with colorectal cancer in Malaysia. Incidence and mortality data were retrieved from population-based cancer registries/databases.. In Malaysia, colorectal cancer is the second most common cancer in males and the third most common cancer in females. The economic burden of colorectal cancer is substantial and is likely to increase over time in Malaysia owing to the current trend in colorectal cancer incidence. In Malaysia, most patients with colorectal cancer have been diagnosed at a late stage, with the 5-year relative survival by stage being lower than that in developed Asian countries. Public awareness of the rising incidence of colorectal cancer and the participation rates for colorectal cancer screening are low.. The efficiency of different screening approaches must be assessed, and an organized national screening program should be developed in a phased manner. It is essential to maintain a balanced investment in awareness programs targeting general population and primary care providers, focused on increasing the knowledge on symptoms and risk factors of colorectal cancer, awareness on benefits of screening, and promotion of healthy life styles to prevent this important disease.

Topics: Adult; Colorectal Neoplasms; Developing Countries; Early Detection of Cancer; Ethnicity; Female; Humans; Incidence; Malaysia; Male; Middle Aged; Needs Assessment; Risk Assessment; Socioeconomic Factors; Survival Analysis

The incidence of colorectal cancer has been increasing in many Asian countries including Malaysia during the past few decades. A physician recommendation has been shown to be a major factor that motivates patients to undergo screening. The present study objectives were to describe the practice of colorectal cancer screening by primary care providers in Malaysia and to determine the barriers for not following recommendations. In this cross sectional study involving 132 primary care providers from 44 Primary Care clinics in West Malaysia, self-administered questionnaires which consisted of demographic data, qualification, background on the primary care clinic, practices on colorectal cancer screening and barriers to colorectal cancer screening were distributed. A total of 116 primary care providers responded making a response rate of 87.9%. About 21% recommended faecal occult blood test (FOBT) in more than 50% of their patients who were eligible. The most common barrier was "unavailability of the test". The two most common patient factors are "patient in a hurry" and "poor patient awareness". This study indicates that colorectal cancer preventive activities among primary care providers are still poor in Malaysia. This may be related to the low availability of the test in the primary care setting and poor awareness and understanding of the importance of colorectal cancer screening among patients. More awareness programmes are required for the public. In addition, primary care providers should be kept abreast with the latest recommendations and policy makers need to improve colorectal cancer screening services in health clinics.

Topics: Adult; Colorectal Neoplasms; Cross-Sectional Studies; Diagnostic Tests, Routine; Early Detection of Cancer; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Health Services Misuse; Humans; Malaysia; Male; Patient Participation; Practice Patterns, Physicians'; Primary Health Care; Prognosis; Surveys and Questionnaires

According to the Malaysian National Cancer Registry (MNCR), more than 70% of colorectal cancer (CRC) cases in Malaysia are presented in the advanced stages of the disease, leading to poor survival rates while taxing the health care system. This study aims to explore the barriers to and facilitators of CRC screening uptake in the perspectives of the general population, health care providers, and policymakers. In-depth, semi-structured interviews were conducted with 25 purposively sampled respondents comprising general population above the age of 40, health care providers, and policymakers. Commonly reported barriers to CRC screening included psychological, poor knowledge and awareness, lack of physicians' recommendation, and inadequate implementation of CRC-related campaigns at systemic level. Facilitating factors for CRC screening included family support and family history of CRC. A comprehensive understanding of barriers and facilitators is relevant for designing an effective intervention and policy to increase CRC screening rates in Malaysia.

Topics: Asian People; Colorectal Neoplasms; Early Detection of Cancer; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Mass Screening

The Colorectal Cancer Screening Intervention for Malaysia (CRC-SIM) was a CRC study of home-based testing designed to improve low screening uptake using the immunochemical fecal occult blood test (iFOBT) in Malaysia.. This quasi-experimental study was informed by the Implementation Research Logic Model and evaluated with the RE-AIM framework. Trained data collectors recruited by phone, randomly selected, asymptomatic adults aged 50-75 years from Segamat District, who previously completed a health census form for the South East Asia Community Observatory (SEACO). Participants were posted an iFOBT kit and asked to return a photo of the completed test for screening by health care professionals. A regression analysis of evaluation data was conducted to identify which variables were associated with the outcome indicators of 'study participation' and 'iFOBT completion' and the CRC-SIM was evaluated in terms of its appropriateness, feasibility and acceptability.. Seven hundred forty-seven eligible adults (52%) agreed to participate in this study and received an iFOBT kit. Participation was significantly lower amongst Chinese Malaysians (adjusted OR 0.45, 95% CI 0.35 - 0.59, p<0.001) compared to Malays and amongst participants from the rural sub-district (Gemereh) (adjusted OR 0.71, 95% CI 0.54 - 0.92, p=0.011) compared to the urban sub-district (Sungai Segamat). Less than half of participants (42%, n=311/747) completed the iFOBT. Test-kit completion was significantly higher amongst Chinese Malaysians (adjusted OR 3.15, 95% CI 2.11 - 4.69, p<0.001) and lower amongst participants with a monthly household income ≥RM 4,850 (adjusted OR 0.58, 95% CI 0.39 - 0.87, p=0.009) compared to participants with a lower household income. The main reported reason for non-participation was 'not interested' (58.6%) and main implementation challenges related to invalid photographs from participants and engaging iFOBT positive participants in further clinic consultations and procedures.. Home-testing for CRC (test completion) appeared to be acceptable to only around one-fifth of the target population in Malaysia. However, mindful of the challenging circumstances surrounding the pandemic, the CRC-SIM merits consideration by public health planners as a method of increasing screening in Malaysia, and other low- and middle-income countries.

Topics: Adult; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Humans; Malaysia; Mass Screening; Occult Blood; Regression Analysis

The 2020-2022 research project 'Colorectal Cancer Screening Intervention for Malaysia' (CRC-SIM) evaluated the implementation of a home-based CRC screening pilot in Segamat District. This budget impact analysis (BIA) assessed the expected changes in health expenditure of the Malaysian Ministry of Health budget in the scenario where the pilot programme was implemented nationwide vs current opportunistic screening.. Budget impact analysis. Assumptions and costs in the opportunistic and novel CRC screening scenarios were derived from a previous evaluation of opportunistic CRC screening in community health clinics across Malaysia and the CRC-SIM research project, respectively.. National level (with supplement analysis for district level). The BIA was conducted from the viewpoint of the federal government and estimated the annual financial impact over a period of 5 years.. The total annual cost of the current practice of opportunistic screening was RM1 584 321 (~I$1 099 460) of which 80% (RM1 274 690 or ~I$884 587) was expended on the provision of opportunistic CRC to adults who availed of the service. Regarding the implementation of national CRC screening programme, the net budget impact in the first year was estimated to be RM107 631 959 (~I$74 692 546) and to reach RM148 485 812 (~I$103 043 589) in the fifth year based on an assumed increased uptake of 5% annually. The costs were calculated to be sensitive to the probability of adults who were contactable, eligible and agreeable to participating in the programme.. Results from the BIA provided direct and explicit estimates of the budget changes to when implementing a population-based national CRC screening programme to aid decision making by health services planners and commissioners in Malaysia about whether such programme is affordable within given their budget constraint. The study also illustrates the use and value of the BIA approach in low-income and middle-income countries and resource-constrained settings.

Topics: Budgets; Colorectal Neoplasms; Cost-Benefit Analysis; Early Detection of Cancer; Humans; Malaysia; Mass Screening

The rise in colorectal cancer (CRC) incidence becomes a global concern. As geographical variations in the CRC incidence suggests the role of area-level determinants, the current study was designed to identify the spatial distribution pattern of CRC at the neighbourhood level in Malaysia.. Newly diagnosed CRC cases between 2010 and 2016 in Malaysia were identified from the National Cancer Registry. Residential addresses were geocoded. Clustering analysis was subsequently performed to examine the spatial dependence between CRC cases. Differences in socio-demographic characteristics of individuals between the clusters were also compared. Identified clusters were categorized into urban and semi-rural areas based on the population background.. Most of the 18 405 individuals included in the study were male (56%), aged between 60 and 69 years (30.3%) and only presented for care at stages 3 or 4 of the disease (71.3%). The states shown to have CRC clusters were Kedah, Penang, Perak, Selangor, Kuala Lumpur, Melaka, Johor, Kelantan, and Sarawak. The spatial autocorrelation detected a significant clustering pattern (Moran's Index 0.244, p< 0.01, Z score >2.58). CRC clusters in Penang, Selangor, Kuala Lumpur, Melaka, Johor, and Sarawak were in urbanized areas, while those in Kedah, Perak and Kelantan were in semi-rural areas.. The presence of several clusters in urbanized and semi-rural areas implied the role of ecological determinants at the neighbourhood level in Malaysia.  Such findings could be used to guide the policymakers in resource allocation and cancer control.

Topics: Aged; Cluster Analysis; Colorectal Neoplasms; Female; Humans; Malaysia; Male; Middle Aged; Residence Characteristics; Spatial Analysis

Current evidence suggests that dietary and lifestyle factors may play an important role in colorectal cancer risk but there are only a few studies that investigated their relationship with colorectal adenomas (CRA), the precursors for colorectal cancer. A case-control study was conducted to determine the relationship between dietary and lifestyle factors associated with CRA risk among 125 subjects with CRA and 150 subjects without CRA at Hospital Canselor Tuanku Muhriz UKM (HCTM), Malaysia. We used dietary history questionnaire (DHQ) and International Physical Activity Questionnaire-Short Form (IPAQ) to estimate the diet and physical activity. The findings of this study showed that male gender [OR = 2.71 (95% CI= 1.01-7.27)], smoking [OR = 6.39 (95% CI= 1.04-39.30)], family history of cancer [OR = 6.39 (95% CI= 1.04-39.30)], high body fat percentage [OR = 1.25 (95% CI= 1.04-1.51)], high calorie and fat intake [OR = 1.03 (95% CI= 1.01-1.06)], [OR = 1.01 (95% CI= 0.95-1.09)] and red meat intake more than 100 g per day [OR = 1.02 (95% CI= 1.01-1.04)] increased CRA risk. High fiber [OR = 0.78 (95% CI= 0.64-0.95)] and calcium intake [OR = 0.78 (95% CI= 0.98-1.00)] was found to decrease CRA risk. Some of these modifiable risk factors could be advocated as lifestyle interventions to reduce risk of CRA.

Topics: Adenoma; Case-Control Studies; Colorectal Neoplasms; Diet; Humans; Malaysia; Male; Risk Factors

Topics: Breast Neoplasms; Colorectal Neoplasms; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Mass Screening

Colorectal cancer is a major public health problem with significant number of cases and death in the population. This study aimed to determine the 5-year overall survival rate and the prognostic factors for colorectal cancer patients in Sabah.. This was a retrospective cohort study conducted using secondary data from Malaysian National Cancer Registry (MNCR) database. A 5-year overall survival and the median survival time were determined with Kaplan-Meier survival curve. Cox regression analysis was done to determine the prognostic factors on survival.. A total of 1,152 patients were included in this study. The majority of the patients had colon cancer and presented at late stage (stage III and IV) as compared to early stage (stage I and II). From the analysis, the 5-year overall survival for colorectal cancer was 23.2% (95% CI: 21.8, 24.6) and the median survival time was 16 months (95% CI: 14.3, 17.7).  Higher survivals are seen in males (23.6%, 95% CI: 20.4, 24.7), aged 50-74 years old (24.2%, 95% CI: 22.4, 26.0), Chinese (25.5%, 95% CI: 23.0, 28.0), lived in Keningau (25.6%, 95% CI: 20.8, 30.4), colon as primary tumor site (24.5%, 95% CI: 22.5, 26.4), diagnosed with stage I (55.6%, 95% CI: 48.7, 62.5) and received surgery with chemotherapy or radiotherapy (31.3%, 95% CI: 27.8, 34.8). The significant prognostic factor was the stage at diagnosis. Patients with stage IV colorectal cancer (HR: 11.18; 95% CI: 3.48, 35.93) had eleven times risk of dying as compared to stage I.. The survival rate for colorectal cancer patients in Sabah was comparatively lower than other states in Malaysia and in some Asian countries. Those patients who presented at later stage had poorer survival. Health promotion and community-based screening program should be emphasized in addition to encouraging early diagnosis to improve survival.

Topics: Aged; Borneo; Cohort Studies; Colorectal Neoplasms; Humans; Malaysia; Male; Middle Aged; Prognosis; Retrospective Studies; Survival Rate

Colorectal cancer (CRC) incidence in Malaysia is increasing, and most CRC patients are diagnosed at a late stage. This study investigated participant awareness of CRC and their perceptions and views about CRC screening, barriers, benefits, and facilitators towards CRC screening participation as well as health-seeking behaviour and the use of preventative health services.. Eleven focus group discussions (FGDs) were conducted with a purposive sample of 89 participants aged > 50 from the major ethnic groups in the Segamat District, Johor State. FGDs were audiotaped, transcribed verbatim, and translated into English. Data were analysed using thematic analysis.. We identified trust in doctors as a key reason for whether or not to seek health care. Generally, the participants had low awareness of CRC sign/symptoms and screening. Emotional and logistic concerns about sending a stool sample to a clinic emerged as the main barriers to screening. Simplified illustrated instructions about stool collection in Malay, Chinese and Tamil, free screening at health clinics and reminders to complete the iFOBT test were perceived to facilitate engagement in screening, and posited as strategies that were likely to increase iFOBT uptake.. Primary care physicians play a crucial role in terms of reducing patient's misperceptions, recommending screening to patients, enhancing attendance, and improving uptake of CRC screening. There is a need for further research to investigate ways in which to reduce identified barriers and implement and test potential facilitative strategies as well as examine adherence by doctors to clinical guidelines about CRC screening.

Topics: Colorectal Neoplasms; Early Detection of Cancer; Humans; India; Malaysia; Mass Screening; Occult Blood

Colorectal cancer (CRC) is the second most common cancer in Malaysia and cases are often detected late. Improving screening uptake is key in down-staging cancer and improving patient outcomes. The aim of this study is to develop, implement and evaluate an intervention to improve CRC screening uptake in Malaysia in the context of the COVID-19 pandemic. The evaluation will include ascertaining the budgetary impact of implementing and delivering the intervention.. The implementation research logic model guided the development of the study and implementation outcome measures were informed by the 'Reach, Effectiveness, Adoption, Implementation and Maintenance' (RE-AIM) framework. This CRC screening intervention for Malaysia uses home-testing and digital, small media, communication to improve CRC screening uptake. A sample of 780 people aged 50-75 years living in Segamat district, Malaysia, will be selected randomly from the South East Asia Community Observatory (SEACO) database. Participants will receive a screening pack as well as a WhatsApp video of a local doctor to undertake a stool test safely and to send a photo of the test result to a confidential mobile number. SEACO staff will inform participants of their result. Quantitative data about follow-up clinic attendance, subsequent hospital tests and outcomes will be collected. Logistic regression will be used to investigate variables that influence screening completion and we will conduct a budget impact-analysis of the intervention and its implementation. Qualitative data about intervention implementation from the perspective of participants and stakeholders will be analysed thematically.. Ethics approval has been granted by Monash University Human Research Ethics Committee (MUHREC ID: 29107) and the Medical Review and Ethics Committee (Reference: 21-02045-O7G(2)). Results will be disseminated through publications, conferences and community engagement activities.. National Medical Research Register Malaysia: 21-02045-O7G(2).

Topics: Colorectal Neoplasms; COVID-19; Early Detection of Cancer; Humans; Malaysia; Pandemics

This study aimed to identify new genes associated with CRC in patients with normal mismatch repair (MMR) protein expression.. Whole-genome sequencing (WGS) was performed in seven early-age-onset Malay CRC patients. Potential germline genetic variants, including single-nucleotide variations and insertions and deletions (indels), were prioritized using functional and predictive algorithms.. An average of 3.2 million single-nucleotide variations (SNVs) and over 800 indels were identified. Three potential candidate variants in three genes-. This study provides a new spectrum of insights into the potential genes, variants and pathways associated with CRC in Malay patients.

Topics: Colorectal Neoplasms; DNA Mismatch Repair; Genetic Predisposition to Disease; Genome, Human; Humans; Malaysia; Mutation; Proteins; Whole Genome Sequencing

The uptake of the immunochemical faecal occult blood test (iFOBT) in many countries with an opportunistic colorectal cancer (CRC) screening programme remains suboptimal. This study aimed to determine the rate, associated factors and reasons of refusal to perform the iFOBT test offered under an opportunistic CRC screening programme in semi-urban communities. This cross-sectional study was conducted among the average-risk individuals living in semi-urban areas, who sought care from public primary care centres across Kedah state, Malaysia. The information regarding the sociodemographic and clinical characteristics of individuals who were offered the iFOBT between January and April 2019, along with their willingness to perform the test, was gathered. The factors associated with the refusal were further explored using the logistic regression analysis. The individuals offered the iFOBT (n = 920) were mainly female (52.4%) and had a mean age of 58.7±10.6 years. The refusal rate of the iFOBT was 32.2%. Patients who did not have hypertension (adjusted OR: 3.33; 95% CI: 2.44, 4.54), did not have CRC symptoms (adjusted OR: 3.15; 95% CI:1.26, 7.89), had the test offered by either medical assistants (adjusted OR: 2.44; 95% CI: 1.71, 3.49) or nurses (adjusted OR: 2.41; 95% CI 1.65, 3.51), did not have diabetes (adjusted OR: 1.99; 95% CI: 1.42, 2.77),and were not active smokers (adjusted OR: 1.74; 95% CI: 1.22, 2.47), were more likely to refuse the iFOBT. The common reasons of refusing the test included "feeling not ready for the test" (21.6%) and "feeling healthy" (14.9%). The iFOBT was refused by one-third of the average-risk individuals from semi-urban communities. The associated factors and reasons of refusal found in this study could guide policymakers in developing targeted interventions to boost the uptake of CRC screening in Malaysia.

Topics: Adult; Aged; Colorectal Neoplasms; Female; Health Personnel; Humans; Immunochemistry; Malaysia; Male; Middle Aged; Occult Blood; Primary Health Care; Treatment Refusal; Urban Population

Colorectal cancer (CRC) is the most common cancer in men and the second most common cancer in women in Malaysia. A major challenge for CRC screening programs is to improve the screening participation rates. In Malaysia, the most critical barrier to the uptake of CRC screening is the lack of patient awareness. This study aimed to determine the intention and the uptake of CRC screening, and to explore the related motivators and barriers after raising awareness with a brief health education.. An analytical cross-sectional study was conducted in a government health clinic of Penang from March to August 2019. Asymptomatic clinic attendees aged 50-75 years who had no prior awareness of CRC screening were recruited by systematic random sampling technique. Participants first received a standardised one to one health education, followed by an interview using a standardised questionnaire to assess their CRC screening intention and the relevant motivators and barriers. A submission of a sample for immunochemical faecal occult blood test (iFOBT) was considered as an uptake of the CRC screening.. A total of 546 participants participated in this study. The mean age of the participants was 62.8 (SD=6.36). Majority of them were females (57.3%), Chinese (78.6%), who had attained primary or higher education (92.0%) and had comorbidities (87.0%).  After a brief health education, 231 participants (42.3%) agreed to undergo iFOBT. The actual screening uptake rate in this study was 28%. Perceived benefit of the test (84.4%) was the most common motivators, while self-perceived non-vulnerability was the biggest impediment to CRC screening intention. Physicians' recommendation was the perceived most effective way in raising CRC awareness.. Participants prefer physicians to provide health education. Standardised brief health education is inadequate to stimulate CRC screening adherence. Future interventions will require in-depth understanding of patients' beliefs, risk perception, and affective responses.

Topics: Aged; Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Health Education; Humans; Intention; Malaysia; Male; Middle Aged; Motivation; Occult Blood; Patient Acceptance of Health Care; Primary Health Care

A patient's survival may depend on several known and unknown factors and it may also vary spatially across a region. Socioeconomic status, accessibility to healthcare and other environmental factors are likely to contribute to survival rates. The aim of the study was to model the spatial variation in survival for colorectal cancer patients in Malaysia, accounting for individual and socioeconomic risk factors. We conducted a retrospective study of 4412 colorectal cancer (ICD-10, C18-C20) patients diagnosed from 2008 to 2013 to model survival in CRC patients. We used the data recorded in the database of the Malaysian National Cancer Patient Registry-Colorectal Cancer (NCPR-CRC). Spatial location was assigned based on the patients' central district location, which involves 144 administrative districts of Malaysia. We fitted a parametric proportional hazards model in which the spatially correlated frailties were modelled by a log-Gaussian stochastic process to analyse the spatially referenced survival data, which is also known as a spatial survival model. After controlling for individual and area level characteristics, our findings indicate wide spatial variation in colorectal cancer survival across Malaysia. Better healthcare provision and higher socioeconomic index in the districts where patients live decreased the risk of death from colorectal cancer, but these associations were not statistically significant. Reliable measurement of environmental factors is needed to provide good insight into the effects of potential risk factors for the disease. For example, a better metric is needed to measure socioeconomic status and accessibility to healthcare in the country. The findings provide new information that might be of use to the Ministry of Health in identifying populations with an increased risk of poor survival, and for planning and providing cancer control services.

Topics: Colorectal Neoplasms; Humans; Malaysia; Proportional Hazards Models; Retrospective Studies; Risk Factors

Colorectal cancer (CRC) is still a major public health threat. In the effort to reduce CRC incidence and mortality, faecal occult blood test (FOBT) is currently the screening tools used for early detection of CRC. However, the uptake of FOBT screening is less than promising. This study aims to identify the prevalence and predictors of Never Screened with FOBT (NS-FOBT).. A cross sectional study was conducted in five health clinics under Kota Kinabalu district, Sabah, Malaysia Borneo involving 162 attendees with age of 50 years old and above. A validated self-administered questionnaire was used to collect the data. Multiple logistic regression analysis was used to determine the predictors of NS-FOBT.. The prevalence of NS-FOBT was 85.8% (n=139). Important predictors of NS-FOBT were age (aOR: 0.922; 95% CI: 0.855, 0.995; p=0.035), Bumiputera ethnicity (vs Non Bumiputera; aOR: 4.285; 95% CI: 1.384, 13.263; p=0.012), knowledge score (aOR: 0.921; 95% CI: 0.856, 0.99; p=0.027), and attitude score (aOR: 0.801; 95% CI: 0.702, 0.913; p=0.001).. There is high prevalence of NS-FOBT. Age, ethnicity, knowledge, and attitude were important predictors of NS-FOBT. Strategies are needed to improve FOBT screening rate among the public. Socio-culturally tailored health promotion strategies as well as strengthening the communication, collaboration, and education to enhance the role of family physician is vital in improving the CRC prevention and care.

Topics: Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Follow-Up Studies; Humans; Incidence; Malaysia; Male; Middle Aged; Occult Blood; Primary Health Care; Prognosis

Dysbiosis of the gut microbiome has been associated with the pathogenesis of colorectal cancer (CRC). We profiled the microbiome of gut mucosal tissues from 18 CRC patients and 18 non-CRC controls of the UKM Medical Centre (UKMMC), Kuala Lumpur, Malaysia. The results were then validated using a species-specific quantitative PCR in 40 CRC and 20 non-CRC tissues samples from the UMBI-UKMMC Biobank. Parvimonas micra, Fusobacterium nucleatum, Peptostreptococcus stomatis and Akkermansia muciniphila were found to be over-represented in our CRC patients compared to non-CRC controls. These four bacteria markers distinguished CRC from controls (AUROC = 0.925) in our validation cohort. We identified bacteria species significantly associated (cut-off value of > 5 fold abundance) with various CRC demographics such as ethnicity, gender and CRC staging; however, due to small sample size of the discovery cohort, these results could not be further verified in our validation cohort. In summary, Parvimonas micra, Fusobacterium nucleatum, Peptostreptococcus stomatis and Akkermansia muciniphila were enriched in our local CRC patients. Nevertheless, the roles of these bacteria in CRC initiation and progression remains to be investigated.

Topics: Aged; Akkermansia; Case-Control Studies; Cohort Studies; Colorectal Neoplasms; DNA, Bacterial; Dysbiosis; Feces; Female; Firmicutes; Fusobacterium nucleatum; Gastrointestinal Microbiome; Humans; Malaysia; Male; Middle Aged; Peptostreptococcus; RNA, Ribosomal, 16S

Malaysia is an ethnically diverse nation, comprising Malay, Chinese, Indian and indigenous groups. However, epidemiological studies on colorectal cancer have mainly focused on the three main ethnic groups. There is evidence that the clinico-pathological characteristics of some cancers may differ in indigenous populations, namely that they occur earlier and behave more aggressively. We aimed to determine if there were similar differences in colorectal cancer, focusing on the indigenous populations of Sabah.. Histopathological reports of all patients diagnosed with colorectal carcinoma from January 2012 to December 2016 from public hospitals in Sabah were retrieved from the central computerized database of the Pathology Department of Queen Elizabeth Hospital in Kota Kinabalu, Sabah. Supplementary data was obtained from patients' case files from each hospital. Clinico-pathological data were analysed using the IBM SPSS Statistical Software Version 23 for Windows for descriptive statistics (mean, median, ASR, AR, relative risk) and inferential statistics (Chi square test).. A total of 696 patients met the inclusion criteria. The median age for colorectal cancer in Sabah was 62 years (95% CI 60.3 to 62.3), with an age specific incidence rate of 21.4 per 100 000 population. The age specific incidence rate in the indigenous populations was 26.6 per 100 000, much lower than the Chinese, at 65.0 per 100 000. The risk of colorectal cancer occurring before the age of 50 was three times higher in the indigenous population compared to the Chinese. The tumours were mainly left-sided (56.5%), adenocarcinoma in histology (98.4%) and moderately differentiated (88.7%). Approximately 79.2% of patients received curative treatment.. Indigenous populations in Sabah develop colorectal cancer at an earlier age, and present at more advanced stages. This has implications for screening and therapeutic strategic planning. 
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Topics: Adenocarcinoma; Adult; Age Distribution; Aged; Asian People; Colorectal Neoplasms; Female; Humans; Incidence; Indigenous Peoples; Malaysia; Male; Middle Aged; Neoplasm Staging

This study aimed to investigate the clinicopathological patterns and survival outcomes of patients with young-onset colorectal cancer (CRC) in Malaysia.. A total of 206 patients with young-onset CRC (age < 50 years at diagnosis) and 1,715 patients with late-onset CRC (age ≥ 50 years at diagnosis) diagnosed during 2002-2016 were included. The clinicopathological characteristics of patients with young-onset CRC were compared with those of patients with late-onset CRC during 2009-2013. Kaplan-Meier survival analysis was performed to determine the overall survival (OS) and disease-specific survival (DSS) in these patients.. The overall proportion of young-onset CRC was 10.7%. The mean age for young-onset CRC was 39.5 ± 7.4 years, with a male-to-female ratio of 1.2:1. There were more Malay patients with young-onset CRC than late-onset CRC (44.0% vs. 19.9%, p = 0.004). Most CRCs were diagnosed at an advanced stage in both groups. However, young-onset CRC showed more aggressive tumour characteristics, such as poorer differentiation and mucinous subtype. Despite such differences, the OS and DSS in both groups were similar (five-year OS for young-onset CRC vs. late-onset CRC: 44.2% vs. 49.0%, p = 0.40; five-year DSS for young-onset CRC vs. late-onset CRC: 48.8% vs. 57.6%, p = 0.53; mean survival of young-onset CRC vs. late-onset CRC: 4.9 years vs. 5.4 years, p = 0.15). Advanced stage at diagnosis and the treatment modality used were independent prognostic factors.. The unique ethnic and histological differences between patients with young- and late-onset CRC suggest that young-onset CRC may represent a distinct entity. However, despite such differences, both groups were equivalent.

Topics: Adult; Cohort Studies; Colorectal Neoplasms; Female; Humans; Kaplan-Meier Estimate; Malaysia; Male; Middle Aged; Neoplasm Staging; Prognosis; Retrospective Studies; Young Adult

There has been a rapid increase in colorectal cancer (CRC) cases in Asian countries, including Malaysia. CRC is usually diagnosed at a late stage, and early detection of CRC is vital in improving survival. This study was conducted to determine the uptake rate of the immunochemical faecal occult blood test (iFOBT), the response rate to colonoscopy, and the CRC detection rate. We also wanted to identify the association between colorectal neoplasia and the Asia Pacific Colorectal Cancer Screening (APCS) scoring system.. We recruited 2264 individuals from The Malaysian Cohort participants aged 35-65 years who consented to colorectal screening using the iFOBT kit from July 2017 until January 2019.. The response rate and positive iFOBT test rate of this study were 79.6% and 13.1% respectively. Among those with positive results, 125 individuals (52.7%) underwent colonoscopy; CRC was detected in six of them while 45 others (36.0%) had polyps. The overall CRC detection rate was 0.3% while the colorectal neoplasia detection rate (both colorectal cancer and colorectal polyps) was 2.3%. The APCS scoring indicated a significant association with colorectal neoplasia risk, with increasing trend by severity from moderate to high risk (3.46-11.14) compared to low risk. Most of the participants who were positive for iFOBT were those at high risk.. The awareness of CRC risk and iFOBT screening are important strategies for early detection of CRC. We showed a CRC detection rate of 0.3 % among those who volunteered to have the iFOBT screening.

Topics: Adult; Aged; Cohort Studies; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Immunochemistry; Malaysia; Male; Mass Screening; Middle Aged; Occult Blood

Escherichia coli (E. coli) from the B2 phylogenetic group is implicated in colorectal cancer (CRC) as it possesses a genomic island, termed polyketide synthetase (pks), which codes for the synthesis of colibactin, a genotoxin that induces DNA damage, cell cycle arrest, mutations and chromosomal instability in eukaryotic cells. The aim of this study was to detect and compare the prevalence of E. coli expressing pks (pks+ E. coli) in CRC patients and healthy controls followed by investigating the virulence triggered by pks+ E. coli using an in-vitro model. Mucosal colon tissues were collected and processed to determine the presence of pks+ E. coli. Thereafter, primary colon epithelial (PCE) and colorectal carcinoma (HCT116) cell lines were used to detect cytopathic response to the isolated pks+ E. coli strains. Our results showed 16.7% and 4.3% of CRC and healthy controls, respectively were pks+ E. coli. Further, PCE displayed syncytia and cell swelling and HCT116 cells, megalocytosis, in response to treatment with the isolated pks+ E. coli strains. In conclusion, pks+ E. coli was more often isolated from tissue of CRC patients compared to healthy individuals, and our in-vitro assays suggest these isolated strains may be involved in the initiation and development of CRC.

Topics: Academic Medical Centers; Aged; Colorectal Neoplasms; Escherichia coli; Female; Humans; Malaysia; Male; Middle Aged; Polyketide Synthases; Prevalence

Colorectal cancer (CRC) cases are detected late in Malaysia similar to most Asian countries. The Be Cancer Alert Campaign (BCAC) was a culturally adapted mass media campaign designed to improve CRC awareness and reduce late detection in Malaysia. The evaluation of the BCAC-CRC aimed to assess campaign reach, campaign impact and health service use.. Participants aged ≥40 years (n = 730) from randomly selected households in Selangor State Malaysia, completed interview-based assessments. Campaign reach was assessed in terms of responses to an adapted questionnaire that was used in evaluations in other countries. The impact of the campaign was assessed in terms of awareness, confidence to detect symptoms and self-efficacy to discuss symptoms with a doctor as captured by the Cancer Awareness Measure (CAM). CAM was administered before-and-after campaign implementation and responses by BCAC recognisers (i.e. participants who recognised one or more of the BCAC television, radio or print advertisements when prompted) and non-recognisers (i.e. participants who did not recognise any of the BCAC advertisements) were compared analytically. Logistic regression analysed comparative differences in cancer awareness by socio-demographic characteristics and recognition of the BCAC materials.. Over 65% of participants (n = 484) recognised the BCAC-CRC. Campaign-recognisers were significantly more likely to be aware of each CRC symptom at follow-up and were more confident about noticing symptoms (46.9% vs 34.9%, p = 0.018) compared to non-recognisers. There was no difference between groups in terms of self-efficacy to see a doctor about symptoms. Improved symptoms awareness at follow-up was lower for Indians compared to Malays (adjusted odds ratio (OR) 0.53, 95% Confidence Interval (CI): 0.34, 0.83, p = 0.005). Health service use data did not indicate an increase in screening activity during or immediately after the campaign months.. Overall, the findings of the evaluation indicated that the culturally adapted, evidence-based mass media intervention improved CRC symptom awareness among the Malaysian population; and that impact is more likely when a campaign operates a differentiated approach that matches modes of communication to the ethnic and social diversity in a population.

Topics: Adult; Aged; Colorectal Neoplasms; Early Detection of Cancer; Ethnicity; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Malaysia; Male; Mass Media; Middle Aged; Prognosis; Television

While the world witnesses an increasing trend of young-onset colorectal cancer (CRC), the information regarding the impact of age on CRC is limited in Malaysia. This study aimed to compare the incidence, clinic-demographic profiles and survival rates of CRC between patients above and under 50 years of age in northern Malaysia.. This was a registry-based, cross-sectional study. All the CRC cases reported by 18 hospitals to the National Cancer Patient Registry - Colorectal Cancer (NCPR-CC) between January 2007 and December 2017 were included in the analysis. The patients were categorized by age into the above-50 and under-50 groups. The changes in the age-standardized incidence and mortality rates of both the age groups were determined using the time-series analysis, and the impact of age on the mortality risk was assessed using the Cox regression analysis.. Of the 6,172 CRC patients enrolled in the NCPR-CC, 893 (14.5%) were in the under-50 group. As compared with their older counterparts, the patients in the under-50 group were more likely to be female, be of Malay ethnicity, be non-smokers, have a family history of CRC, and present late for treatment. The age-standardized incidence and mortality rates of CRC in the under-50 group remained stable over the years, while a decreasing trend was clearly seen in the mortality rates of CRC in the above-50 group (p=0.003). Nevertheless, the two age groups also did not differ in the mortality risk (adjusted hazards ratio: 1.10; 95% CI: 0.90, 1.36).. Young-onset CRC constituted a considerable proportion of CRC cases in Malaysia. However, in contrast with the findings of most studies, it demonstrated neither an uptrend in age-standardized incidence rates nor a higher mortality risk. Our findings suggest the need to upscale and lower the recommended age for CRC screening in Malaysia.

Topics: Adult; Colorectal Neoplasms; Cross-Sectional Studies; Demography; Early Detection of Cancer; Ethnicity; Female; Follow-Up Studies; Humans; Incidence; Malaysia; Male; Middle Aged; Prognosis; Registries; Risk Factors

Patients with positive immunochemical faecal occult blood test results were found to have poor compliance for a subsequent colonoscopy procedure. This study was conducted to explore patients' perceived deterrence for colonoscopy following a positive stool test.. Using qualitative study method, a phone interview was conducted with 16 patients to elicit their views on the reasons for failure to attend the colonoscopy procedure following a positive stool test. The interviews were audio recorded, transcribed verbatim and translated before proceeded with the data analysis. Content analysis was made on the translated interview, followed by systematic classification of data by major themes.. Reasons for nonattendance were categorized under five main themes; unnecessary test, fear of the procedure, logistic obstacles (subthemes; time constraint, transportation problem), social influences, and having other health priority. Lacking in information about the procedure during the referral process was identified to cause misperception and unnecessary worry towards colonoscopy. Fear of the procedure was commonly cited by female respondents while logistic issues pertaining to time constraint were raised by working respondents.. More effective communication between patients and health care providers are warranted to avoid misconception regarding colonoscopy procedure. Support from primary care doctors, customer-friendly appointment system, use of educational aids and better involvement from family members were among the strategies to increase colonoscopy compliance.

Topics: Aged; Colonoscopy; Colorectal Neoplasms; Diagnostic Tests, Routine; Early Detection of Cancer; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Patient Compliance; Prognosis; Qualitative Research

Colorectal cancer (CRC) is the second most common cancer in Malaysia with 65% detected at stage III and IV. Despite the increasing incidence of cancers including CRC, Malaysia has yet to implement populationbased screening for cancers. The objective of this paper is to review the strategic planning and implementation of the CRC screening program in Malaysia.. A desk review was conducted from August to October in 2018, to examine, review and describe the historical perspective, strategic planning and implementation of the current CRC screening program in Malaysia.. The main policy documents related to CRC screening are the National Strategic Plan for Cancer Control Programme 2016-2020, the Clinical Practice Guideline for Management of Colorectal Carcinoma 2017, and the Implementation Guideline for CRC Screening in Malaysia 2014. Several papers have been published on the epidemiology of CRC in Malaysia. Between 2014 and 2018, 127,957 men and women were screened using immunochemical Faecal Occult Blood Test (iFOBT); 9.3% had positive iFOBT results and were referred for colonoscopy. For those who underwent colonoscopy, CRC detection rate was 4.1% and 13.9% for pre-malignant conditions. Barriers were identified along the continuum of screening process, including patient, provider, and system factors.. Although population-level organised screening programmes are preferable to opportunistic screening, the CRC programme in Malaysia was tailored to meet the needs of the population based on available existing resources. A well-mapped budget for the entire screening programme continuum, a strong partnership between stakeholders and an opportunistic screening strategy is crucial to address the rising incidence of CRC.

Topics: Aged; Colorectal Neoplasms; Databases, Factual; Early Detection of Cancer; Female; Humans; Malaysia; Male; Mass Screening; Middle Aged; Occult Blood

The immunochemical fecal occult blood test (iFOBT) has been widely used for opportunistic colorectal cancer (CRC) screening in average-risk individuals seeking care from public health clinics in Malaysia. This study provides a 5-year outcome evaluation of such a practice.. The findings for a few outcome indicators, ranging from the iFOBT uptake to the CRC and polyp detection rates, were generated from the data contributed by 583 public health clinics between 2014 and 2018. The trends in their changes were also evaluated.. The iFOBT uptake constantly increased over the years (p < 0.001), totaling 2.29 % (n = 127,957) as at 2018. Nearly 10 % (n = 11,872) of the individuals screened had a positive test result. Of those who underwent colonoscopy (n = 6,491), 4.04 % (n = 262) and 13.93 % (n = 904) were found to have CRC and polyps, respectively.. An uptrend in the CRC screening uptake was witnessed following the introduction of the iFOBT in public health clinics.

Topics: Aged; Colorectal Neoplasms; Early Detection of Cancer; Feces; Female; Humans; Malaysia; Male; Middle Aged; Occult Blood; Time Factors

Increasingly, policy and research attention is being directed toward improving global health in low- and middle-income countries. This study investigated the cultural adaptation of a UK-designed and developed evidence-based mass media campaign with the aim of improving colorectal cancer and breast cancer awareness in Malaysia. Guided by the heuristic framework of cultural adaptation, a multidisciplinary team adapted the UK Be Cancer Aware programme for implementation in the Malaysian context. The approach included five steps: (a) information gathering and needs assessment; (b) preliminary design; (c) preliminary testing; (d) refinement; and (e) final trial. Key findings from the information gathering stage related to the need to take into account differences in ethnicity, religion, and beliefs about cancer. Discussions with experts indicated that particular words were not acceptable in Malay culture and that specific aspects were "taboo" (e.g., showing pictures of breasts in relation to breast cancer on TV). Stage 3 of the analysis revealed that the presentation of cancer survivors rather than health professionals on programme materials was preferred by Malaysians and that there was a poor level of awareness about colorectal cancer. The results were used systematically to adapt two culturally suitable cancer awareness mass media campaigns for implementation in Malaysia. The developed materials were in line with government priorities and took into account the local health care system structure. The establishment of a partnership with key stakeholders (e.g., the Ministry of Health and the lead patient advocacy organization) and the application of a systematic approach to address cultural factors and resource constraints contribute to the successful implementation of public health programmes in global health settings.

Topics: Adult; Breast Neoplasms; Cancer Survivors; Colorectal Neoplasms; Cultural Competency; Female; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Implementation Science; Interdisciplinary Research; Malaysia; Male; Mass Media; Program Development; Public Health; United Kingdom

Colorectal cancer (CRC) was the third most commonly diagnosed cancer worldwide in 2008 (1.23 million cases, 9.7%). CRC screening was shown to be effective in reducing 70% of CRC mortality. However, the screening rate for CRC remains poor.. A cross-sectional survey was conducted among primary care physicians (PCPs) in public primary care clinics in Kuala Lumpur, Malaysia. A 30-item self-administered questionnaire was used to assess the knowledge and practice of CRC screening.. The response rate was 86.4% (n = 197/228). Less than half (39.1%) of the respondents answered correctly for all risk stratification scenarios. Mean knowledge score on CRC screening modalities was 48.7% ± 17.7%. The knowledge score was positively associated with having postgraduate educational qualification and usage of screening guidelines. Overall, 69.9% of PCPs reported that they practised screening. However, of these, only 25.9% of PCPs screened over 50% of all eligible patients. PCPs who agreed that screening was cost-effective (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.69‒6.59) and those who agreed that they had adequate resources in their locality (OR 1.92, 95% CI 1.01‒3.68) were more likely to practise screening. Knowledge score was not associated with the practice of screening (p = 0.185).. Knowledge and practice of CRC screening was inadequate among PCPs. Knowledge of screening did not translate into its practice. PCPs' perceptions about cost-effectiveness of screening and adequate resources were important determinants of the practice of screening.

Topics: Adult; Colorectal Neoplasms; Community Health Centers; Cross-Sectional Studies; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Physicians, Primary Care; Practice Patterns, Physicians'; Primary Health Care; Regression Analysis; Risk; Surveys and Questionnaires; Urban Population

The most recent version of the European Society for Medical Oncology (ESMO) consensus guidelines for the treatment of patients with metastatic colorectal cancer (mCRC) was published in 2016, identifying both a more strategic approach to the administration of the available systemic therapy choices, and a greater emphasis on the use of ablative techniques, including surgery. At the 2016 ESMO Asia Meeting, in December 2016, it was decided by both ESMO and the Japanese Society of Medical Oncology (JSMO) to convene a special guidelines meeting, endorsed by both ESMO and JSMO, immediately after the JSMO 2017 Annual Meeting. The aim was to adapt the ESMO consensus guidelines to take into account the ethnic differences relating to the toxicity as well as other aspects of certain systemic treatments in patients of Asian ethnicity. These guidelines represent the consensus opinions reached by experts in the treatment of patients with mCRC identified by the Presidents of the oncological societies of Japan (JSMO), China (Chinese Society of Clinical Oncology), Korea (Korean Association for Clinical Oncology), Malaysia (Malaysian Oncological Society), Singapore (Singapore Society of Oncology) and Taiwan (Taiwan Oncology Society). The voting was based on scientific evidence and was independent of both the current treatment practices and the drug availability and reimbursement situations in the individual participating Asian countries.

Topics: Asian People; China; Colorectal Neoplasms; Humans; Malaysia; Neoplasm Metastasis; Republic of Korea; Taiwan

Interleukin (IL)-17A and IL-17F are inflammatory cytokines mainly produced by T helper 17 cells. IL-17A is known to be protumorigenic while IL-17F has a protective role in cancer. A number of studies have been conducted to determine the association between polymorphisms of IL-17AG197A (rs2275913) and IL-17FA7488G (rs763780) and risk of cancers. No studies have yet to be conducted to genotype the IL-17AG197A polymorphism in colorectal cancer (CRC).. To assess the association of IL-17AG197A and IL-17FA7488G polymorphisms with CRC risk.. We performed the genotyping by polymerase chain reaction-restriction fragment length polymorphism method on blood samples from 80 healthy individuals and paraffin-embedded tumor tissues from 70 CRC patients.. Our study showed that IL-17A197AA genotype was significantly associated with an increased CRC risk with odds ratios of 6.08 (95% confidence interval [CI]: 2.25-16.42, P < 0.001) and 2.80 (95% CI: 1.23-6.35, P = 0.014), in comparison with GG and AG genotypes, respectively. However, IL-17FA7488G polymorphism was not significantly associated with CRC risk (P = 0.102). No significant association of IL-17AG197A and IL-17FA7488G polymorphisms with patient and tumor variables was found.. This report from Malaysia shows the relationship of IL-17A197AA genotype with susceptibility to CRC.

Topics: Biomarkers, Tumor; Case-Control Studies; Colorectal Neoplasms; Female; Follow-Up Studies; Genetic Predisposition to Disease; Genotype; Humans; Interleukin-17; Malaysia; Male; Middle Aged; Polymorphism, Single Nucleotide; Prognosis

Breast and colorectal cancer are the two most common cancers in Malaysia. Low awareness coupled with stigma and erroneous beliefs delay help-seeking behaviours, lead to late presentation and contribute to poor detection rates. Promoting cancer awareness through mass media may be effective in improving cancer-related knowledge and uptake in screening tests. However, research is sparse regarding the cultural translation and implementation of mass media campaigns in Malaysia (and Asia) in terms of raising awareness about colorectal and breast cancer.. A collaborative partnership comprising researchers from Malaysia and the UK as well as policy makers, public health experts and non-government organisations from Malaysia was formed to design, deliver and evaluate the Be Cancer Alert Campaign. Each awareness-raising campaign will run for five weeks (Colorectal Cancer in April 2018, followed by Breast Cancer in October 2018). Evaluation of the campaigns will take place in Gombak district (Colorectal Cancer) and Petaling district (Breast Cancer) respectively, in the form of a pre-post randomly selected household survey and collection of service utilisation data. Occupants who are aged 40-years and above and are able to answer questions independently will be selected from each household. A sample of 730 with 80% power will detect a change of 6.09% in knowledge that unexplained lump or swelling is a symptom of breast cancer or changes in bowel habits is a symptom of colorectal cancer.. Malaysia and most South-East Asian countries have a low middle-income economy, with limited resources for cancer control. Late-staged cancers impose a significant economic burden on patients, households, communities, employers, health systems and governments. Our proposed strategy for the implementation of the culturally sensitive mass media cancer awareness-raising campaign will serve as a blueprint for cancer prevention and control policy in South-East Asian countries where the burden of cancer is increasing and there are high cancer death rates.

Topics: Adolescent; Adult; Aged; Breast Neoplasms; Colorectal Neoplasms; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Mass Media; Middle Aged; Population Surveillance; Surveys and Questionnaires; Young Adult

Colorectal cancer is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related death globally. It is the second most common cancer among both males and females in Malaysia. The economic burden of colorectal cancer is likely to increase over time owing to its current trend and aging population. Cancer survival analysis is an essential indicator for early detection and improvement in cancer treatment. However, there was a scarcity of studies concerning survival of colorectal cancer patients as well as its predictors. Therefore, we aimed to determine the 1-, 3- and 5-year survival rates, compare survival rates among ethnic groups and determine the predictors of survival among colorectal cancer patients.. This was an ambidirectional cohort study conducted at the University Malaya Medical Centre (UMMC) in Kuala Lumpur, Malaysia. All Malaysian citizens or permanent residents with histologically confirmed diagnosis of colorectal cancer seen at UMMC from 1 January 2001 to 31 December 2010 were included in the study. Demographic and clinical characteristics were extracted from the medical records. Patients were followed-up until death or censored at the end of the study (31st December 2010). Censored patients' vital status (whether alive or dead) were cross checked with the National Registration Department. Survival analyses at 1-, 3- and 5-year intervals were performed using the Kaplan-Meier method. Log-rank test was used to compare the survival rates, while Cox proportional hazard regression analysis was carried out to determine the predictors of 5-year colorectal cancer survival.. Among 1212 patients, the median survival for colorectal, colon and rectal cancers were 42.0, 42.0 and 41.0 months respectively; while the 1-, 3-, and 5-year relative survival rates ranged from 73.8 to 76.0%, 52.1 to 53.7% and 40.4 to 45.4% respectively. The Chinese patients had the lowest 5-year survival compared to Malay and Indian patients. Based on the 814 patients with data on their Duke's staging, independent predictors of poor colorectal cancer (5-year) survival were male sex (Hazard Ratio [HR]: 1.41; 95% CI: 1.12, 1.76), Chinese ethnicity (HR: 1.41; 95% CI: 1.07,1.85), elevated (≥ 5.1 ng/ml) pre-operative carcino-embryonic antigen (CEA) level (HR: 2.13; 95% CI: 1.60, 2.83), Duke's stage C (HR: 1.68; 95% CI: 1.28, 2.21), Duke's stage D (HR: 4.61; 95% CI: 3.39, 6.28) and emergency surgery (HR: 1.52; 95% CI: 1.07, 2.15).. The survival rates of colorectal cancer among our patients were comparable with those of some Asian countries but lower than those found in more developed countries. Males and patients from the Chinese ethnic group had lower survival rates compared to their counterparts. More advanced staging and late presentation were important predictors of colorectal cancer survival. Health education programs targeting high risk groups and emphasizing the importance of screening and early diagnosis, as well as the recognition of symptoms and risk factors should be implemented. A nationwide colorectal cancer screening program should be designed and implemented to increase early detection and improve survival outcomes.

Topics: Adult; Aged; Colorectal Neoplasms; Female; Humans; Kaplan-Meier Estimate; Malaysia; Male; Middle Aged; Neoplasm Staging; Prognosis; Proportional Hazards Models; Prospective Studies; Retrospective Studies; Risk Factors; Survival Rate; Tertiary Care Centers; Treatment Outcome

This study aimed to estimate potential reductions in case incidence of colorectal cancer attributable to the modifiable risk factors such as alcohol consumption, overweight and physical inactivity amongst the Malaysian population.. Gender specific population-attributable fractions (PAFs) for colorectal cancer in Malaysia were estimated for the three selected risk factors (physical inactivity, overweight, and alcohol consumptions). Exposure prevalence were sourced from a large-scale national representative survey. Risk estimates of the relationship between the exposure of interest and colorectal cancer were obtained from published meta-analyses. The overall PAF was then estimated, using the 2013 national cancer incidence data from the Malaysian Cancer Registry.. Overall, the mean incidence rate for colorectal cancer in Malaysia from 2008 to 2013 was 21.3 per 100,000 population, with the mean age of 61.6 years (±12.7) and the majority were men (56.6%). Amongst 369 colorectal cancer cases in 2013, 40 cases (20 men, 20 women), 10 cases (9 men, 1 woman) or 20 cases (16 men,4 women) would be prevented, if they had done physical exercises, could reduce their body weight to normal level or avoided alcohol consumption, assuming that these factors are causally related to colorectal cancer. It was estimated that 66 (17.8%;66/369) colorectal cancer cases (42 men, 24 women) who had all these three risk factors for the last 10 years would have been prevented, if they could control these three risk factors through effective preventive measures.. Findings suggest that approximately 18% of colorectal cancer cases in Malaysia would be prevented through appropriate preventive measures such as doing regular physical exercises, reducing their body weight to normal level and avoiding alcohol consumption, if these factors are causally related to colorectal cancer. Scaling-up nationwide public health campaigns tailored to increase physical activity, controlling body weight within normal limits and avoid alcohol intake are recommended. Future studies with other site-specific cancers and additional risk factors are needed.

Topics: Aged; Alcohol Drinking; Body Weight; Colorectal Neoplasms; Exercise; Female; Health Promotion; Humans; Incidence; Malaysia; Male; Middle Aged; Overweight; Prevalence; Risk Factors; Social Perception

This study aimed to estimate the cost of colorectal cancer (CRC) management and to explore the prevalence and determinants of catastrophic health expenditure (CHE) among CRC patients and their families arising from the costs of CRC management. Data were collected prospectively from 138 CRC patients. Patients were interviewed by using a structured questionnaire at the time of the diagnosis, then at 6 months and 12 months following diagnosis. Simple descriptive methods and multivariate binary logistic regression were used in the analysis. The mean cost of managing CRC was RM8306.9 (US$2595.9), and 47.8% of patients' families experienced CHE. The main determinants of CHE were the economic status of the family and the likelihood of the patient undergoing surgery. The results of this study strongly suggest that stakeholders and policy makers should provide individuals with financial protection against the consequences of cancer, a costly illness that often requires prolonged treatment.

Topics: Adult; Aged; Catastrophic Illness; Colorectal Neoplasms; Cost of Illness; Family; Female; Health Expenditures; Humans; Malaysia; Male; Middle Aged; Prospective Studies; Social Class; Surveys and Questionnaires

Colorectal cancer (CRC) is one of the most common gastrointestinal cancers in the world. In the Asia- Pacific region, it is the fastest emerging gastrointestinal cancer. Level of awareness on CRC warning signs and risk factors in the rural population of Malaysia is reported of very low. The aim of this study was to assess the level of knowledge of CRC among the public at medical outpatient clinics in Serdang Hospital. The association between sociodemographic factors with level of knowledge among the respondents was further studied.. A study was conducted among the non-CRC patients' relatives accompanying their relatives to the medical outpatient clinics in Serdang Hospital from 1st April to 31st August 2016. The study was carried out with cluster sampling method.. The respondents were assessed using validated and modified Cancer Awareness Measures (CAM) questionnaire consists of three parts which are knowledge on warning signs, knowledge on risk factors and sociodemographic factors. All data were analysed using IBM SPSS Statistics 21.0.. Altogether 308 subjects completed the questionnaires. It was shown high percentage of good knowledge for warning signs and risk factors of CRC among the respondents. A significant association between age groups and level of income with level of knowledge on warning signs was observed.. The level of knowledge of CRC among the general public in Serdang Hospital was sufficient. The respondents with higher income or younger age had higher level of knowledge regarding CRC.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Health Surveys; Humans; Malaysia; Male; Middle Aged; Risk Factors; Rural Population; Young Adult

X-ray repair cross-complementing group 1 (XRCC1) is one of the key components in the base excision repair pathway that repairs erroneous DNA lesions and removes nonbulky base adducts for the maintenance of genome integrity. Studies have revealed that differences in individual DNA repair capacity can impact the interindividual variation in cancer susceptibility, tumour aggressiveness and treatment response. The relationship between XRCC1 and sporadic colorectal cancer (CRC) susceptibility, which is hitherto inconclusive, has been explored in many association studies of different populations. In view of the conflicting findings generated, we aimed to investigate the association between XRCC1 and genetic predisposition to CRC among Malaysians. The present case-control association study was conducted on 130 CRC patients and 212 age-matched healthy controls. The genotyping of XRCC1 Arg194Trp, Arg280His and Arg399Gln single nucleotide polymorphisms was performed with allele-specific real-time PCR approach. This was followed by basic statistical analysis on the single nucleotide polymorphisms and haplotype data obtained. No significant difference in the allele and genotype frequencies was observed between CRC patients and healthy controls (P>0.05). There was also no association observed between XRCC1 haplotypes and CRC (P>0.05). In conclusion, a positive association between XRCC1 gene polymorphisms and CRC risk was not established in our Malaysian population.

Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Colorectal Neoplasms; Female; Genetic Markers; Genetic Predisposition to Disease; Humans; Malaysia; Male; Middle Aged; Polymorphism, Single Nucleotide; X-ray Repair Cross Complementing Protein 1

Canarium odontophyllum Miq. is a plant species widely known as 'dabai' and can be vastly found in Sarawak. The aim of this study was to assess the cytotoxic and genotoxic effect of extracts from stem bark of C. odontophyllum against HCT 116 human colorectal cancer cell line.. The IC50 values of the aqueous, methanol, and acetone extracts against HCT 116 cells as well as the acetone extract against human colon fibroblast cell line CCD-18co were determined using the MTT assay. The concentration of the extracts ranged from 12.5 to 200 μg/ml at treatment time of 24, 48 and 72 h. Annexin V-FITC/PI labelling assay was employed to determine mode of HCT 116 cell death induced by acetone extract at 48 h. The DNA damage induced by the extract in HCT 116 cells was detected using alkaline comet assay at 30 min of IC10 and IC25 treatment.. Acetone extract exhibited the highest cytotoxic effect against HCT 116 cells compared to methanol and aqueous extract at 24, 48 and 72 h. Despite no cytotoxic effect by acetone extract against CCD-18co cells at 24 and 48 h, however at 72 h, CCD-18co cells proliferated. Apoptosis assessment using Annexin V-FITC/PI labelling assay revealed that the primary cell death was via apoptosis after 48 h treatment. Low doses of acetone extract from stem bark of C. odontophyllum showed significant DNA damage in HCT 116 cells with tail moment of 6.187 ± 0.718 A.U and 7.877 ± 0.142 A.U, respectively.. Acetone extract from stem bark of C. odontophyllum has high potential in the development of anticancer agent against HCT 116 cells with no cytotoxic effect against human colon fibroblast cells.

Topics: Antineoplastic Agents, Phytogenic; Burseraceae; Cell Death; Cell Line; Colorectal Neoplasms; HCT116 Cells; Humans; Malaysia; Mutagens; Plant Bark; Plant Extracts

A colorectal cancer screening program was piloted in two districts of Kedah in 2013. There is scarcity of information on colorectal cancer screening in Malaysia.. Thus, this research was conducted to evaluate the colorectal cancer screening program in the districts to provide insights intop its efficacy.. A cross sectional study was conducted using data on the colorectal cancer screening program in 2013 involving Kota Setar and Kuala Muda districts in Malaysia. We determined the response rate of immunochemical fecal occult blood test (iFOBT), colonoscopy compliance, and detection rates of neoplasia and carcinoma. We also compared the response of FOBT by demographic background.. The response rate of FOBT for first iFOBT screening was 94.7% while the second iFOBT screening was 90.7%. Participants from Kuala Muda district were 27 times more likely to default while Indians had a 3 times higher risk of default compared to Malays. The colonoscopy compliance was suboptimal among those with positive iFOBT. The most common finding from colonoscopy was hemorrhoids, followed by tubular adenoma. Detection rate of carcinoma and neoplasia for our program was 1.2%.. In summary, the response rate of iFOBT was encouraging but the colonoscopy compliance was suboptimal which led to a considerably low detection rate.

Topics: Adenoma; Colonoscopy; Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Follow-Up Studies; Health Plan Implementation; Hematologic Tests; Humans; Malaysia; Male; Middle Aged; Neoplasm Staging; Occult Blood; Patient Participation; Prognosis

This is the first study that estimates the incidence and mortality rate for colorectal cancer (CRC) patients in Malaysia by sex and ethnicity.. The 4,501 patients were selected from National Cancer Patient Registry-Colorectal Cancer data. Patient survival status was cross-checked with the National Registration Department. The age-standardised rate (ASR) was calculated as the proportion of CRC cases (incidence) and deaths (mortality) from 2008 to 2013, weighted by the age structure of the population, as determined by the Department of Statistics Malaysia and the World Health Organization world standard population distribution.. The overall incidence rate for CRC was 21.32 cases per 100,000. Those of Chinese ethnicity had the highest CRC incidence (27.35), followed by the Malay (18.95), and Indian (17.55) ethnicities. The ASR incidence rate of CRC was 1.33 times higher among males than females (24.16 and 18.14 per 100,000, respectively). The 2011 (44.7%) CRC deaths were recorded. The overall ASR of mortality was 9.79 cases, with 11.85 among the Chinese, followed by 9.56 among the Malays and 7.08 among the Indians. The ASR of mortality was 1.42 times higher among males (11.46) than females (8.05).. CRC incidence and mortality is higher in males than females. Individuals of Chinese ethnicity have the highest incidence of CRC, followed by the Malay and Indian ethnicities. The same trends were observed for the age-standardised mortality rate.

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Colorectal Neoplasms; Ethnicity; Female; Health Surveys; Humans; Incidence; Malaysia; Male; Middle Aged; Mortality; Sex Factors; Young Adult

The aim of this study was to assess the rate of uptake of a customised annual Colorectal Cancer Awareness, Screening and Treatment Project (CCASTP) using faecal immunohistochemical test (FIT) kits in low income communities in Malaysia. The immediate objectives were (1) to evaluate the level of adherence of CRC screening among lowincome groups, (2) to assess the knowledge and awareness of the screened population and (3) to assess the accuracy of FIT kits. A total of 1,581 FIT kits were distributed between years 2010 to 2015 to healthy asymptomatic participants of the annual CCASTP organized by Empowered the Cancer Advocacy Society of Malaysia. Data for sociodemographic characteristics, critical health and lifestyle information of the registered subjects were collected. Findings for use of the FIT kits were collected when they were returned for stool analyses. Those testingd positive were invited to undergo a colonoscopy examination. A total of 1,436 (90.8%) of the subjects retuned the FITkits, showing high compliance. Among the 129 subjects with positive FIT results, 92 (71.3%) underwent colonoscopy. Six cases (6.5%) of CRC were found. Based on the data collected, the level of awareness of stool examination and knowledge about CRC was poor amongst the participants. Gender, age group, ethnicity and risk factors (i.e. smoking, lack of exercise and low consumption of fresh fruits) were associated with positive FITkit results. In conclusion, CRC screening can be performed in the community with a single FITkit. Although CRC knowledge and awareness is poor in lowincome communities, the average return rate of the FIT kits and rate of colonoscopy examination were 91.2% and 70.3%, respectively.

Topics: Aged; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Feces; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Occult Blood; Poverty; Prognosis; Risk Factors

Cancer survival analysis is an essential indicator for effective early detection and improvements in cancer treatment. This study was undertaken to document colorectal cancer survival and associated prognostic factors in Malaysians.. All data were retrieved from the National Cancer Patient Registry Colorectal Cancer. Only cases with confirmed diagnosis through histology between the year 2008 and 2009 were included. Retrieved data include sociodemographic information, pathological features and treatment received. Survival curves were plotted using the KaplanMeier method. Univariate analysis of all variables was then made using the Logrank test. All significant factors that influenced survival of patients were further analysed in a multivariate analysis using Cox' regression.. Total of 1,214 patients were included in the study. The overall 3 and 5year survival rates were 59.1% and 48.7%, respectively. Patients with localized tumours had better prognosis compared to those with advanced stage cancer. In univariate analysis, staging at diagnosis (p<0.001), primary tumour size (p<0.001), involvement of lymph nodes (p<0.001) and treatment modalities (p=0.001) were found to be predictors of survival. None of the sociodemographic characteristics were found to exert any influence. In Cox regression analysis, staging at diagnosis (p<0.001), primary tumour size (p<0.001), involvement of lymph nodes (p<0.001) and treatment modalities (p<0.001) were determined as independent prognostic factors of survival after adjusted for age, gender and ethnicity.. The overall survival rate for colorectal cancer patients in Malaysia is similar to those in other Asian countries, with staging at diagnosis, primary tumor size, involvement of lymph node and treatment modalities having significant effects. More efforts are needed to improve national survival rates in future.

Topics: Adult; Aged; Colorectal Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Malaysia; Male; Middle Aged; Multivariate Analysis; Neoplasm Staging; Prognosis; Regression Analysis; Survival Analysis; Survival Rate

Colorectal cancer (CRC) is the third most common malignancy in Malaysia, where data are limited regarding knowledge and barriers in regard to CRC and screening tests. The aim of the study was to assess these parameters among Malaysians.. The questionnaires were distributed in the Umra Private Hospital in Selangor. The questionnaire had four parts and covered social-demographic questions, respondent knowledge about CRC and colorectal tests, attitude towards CRC and respondentaction regarding CRC. More than half of Malay participants (total n=187) were female (57.2%) and 36.9% of them were working as professionals.. The majority of the participants (93.6%) never had a CRC screening test. The study found that only 10.2% of the study participants did not consider that their chances of getting CRC were high. A high percentage of the participants (43.3%) believed that they would have good chance of survival if the cancer would be found early. About one third of the respondents did not want to do screening because of fear of cancer, and concerns of embarrassment during the procedure adversely affected attitude to CRC screening as well. Age, gender, income, family history of CRC, vegetable intake and physical activity were found to be significant determinants of knowledge on CRC.. The major barriers identified towards CRC screening identified in our study were fear of pain and embarrassment. The findings have implications for understanding of similarities and differences in attitude to CRC amongst elderly patients in other cultural/ geographic regions.

Topics: Attitude to Health; Colorectal Neoplasms; Early Detection of Cancer; Female; Follow-Up Studies; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Patient Acceptance of Health Care; Patient Participation; Prognosis; Surveys and Questionnaires

Loss of E-cadherin, a 120 kDA transmembrane glycoprotein responsible for cell-cell adhesion, is one of the hallmarks of epithelial-mesenchymal-transition (EMT). E-cadherin expression was immunohistochemically studied in 94 histopathologically re-confirmed colorectal carcinomas (CRC) using a monoclonal antibody to E-cadherin (Dako: Clone NCH-38) on a Ventana Benchmark XT automated system. Each case was assessed for E-cadherin immunopositivity at two separate locations viz the tumour centre (TC) as well as the infiltrating front (IF). Expression was semiquantitated for proportion of immunopositive malignant cells as 0 (negative), 1 (1-25% staining), 2 (26-50% staining), 3 (51-75% staining) and 4 (>75% staining) and staining intensity: 0 (negative), 1 (weak), 2 (moderate) and 3 (strong). The final histoscore of E-cadherin immunopositivity was arbitrarily computed as proportion of immunopositivity multiplied by staining intensity of the malignant cells. E-cadherin histoscores were significantly lower at the IF (4.5±2.5) compared with TC (10.7±2.4). Furthermore, the histoscores were significantly reduced at the IF of 49 TNM III+IV tumours (3.6±2.5) compared with 45 II+III CRC (5.4±2.2). Reduction of E-cadherin expression was also noted in the 23 high grade (TC=8.6±3.2; IF=2.6±2.3) compared with 71 low grade tumours (TC=11.4±1.5; IF=5.1±2.3). E-cadherin is downregulated at the infiltrating front of CRC, possibly marking for EMT at this location. The downregulation is further enhanced amongst late stage and high grade tumours compared with earlier stage and low grade tumours; findings which are similar to that noted in CRC of other populations.

Topics: Antigens, CD; Biomarkers, Tumor; Biopsy; Cadherins; Carcinoma; Colorectal Neoplasms; Down-Regulation; Humans; Immunohistochemistry; Malaysia; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Staging; Predictive Value of Tests

Colorectal cancer (CRC) is the most common gastrointestinal cancer and the incidence is increasing. CRC is more common with increasing age, but a proportion occurs in young adults, termed young CRC. This study assessed the incidence and the demographic of young CRC in Brunei Darussalam.. All histologically proven CRC between 1986 and 2014 registered with the Department of Pathology cancer registry were reviewed and data extracted for analyses. Young CRC was defined as cancer in patients aged less than 45 years. The various population groups were categorized into locals (Malays, Chinese and Indigenous) and expatriates.. Over the study period, there were 1,126 histologically proven CRC (mean age 59.1 ± 14.7 years, Male 58.0%, Locals 91.8% and 8.2% expatriates). Young CRC accounted for 15.1% with the proportion declining over the years, from 29% (1986-1990) to 13.2% (2011-2014). The proportion of young CRC was highest among the indigenous (30.8%), followed by the expatriates (29.3%), Malays (14.3%) and lowest among the Chinese (10.8%). The mean age of young CRC was 35.9 ± 6.2; lowest among the indigenous (33.5 ± 6.7), expatriate (34.9 ± 6.0) groupd and the Malays (35.6 ± 6.5) compared to the Chinese (38.6 ± 4.6), a similar trend being observed in the non-young CRC groups. There were no difference between the genders and tumor locations (rectum or colon) between the young and the non-young CRC cases. Female young CRC was significantly younger than male (p<0.05) without any significant variation between the various population groups (p>0.05).. Our study showed that the young CRC accounted for 15.1% of all CRC with declining trend observed over recent years. Young CRC was more common among indigenous, expatriates and Malays and least common among the Chinese. There were no differences in the gender and tumor locations.

Topics: Adenocarcinoma; Adult; Age Distribution; Aged; Brunei; China; Cohort Studies; Colonic Neoplasms; Colorectal Neoplasms; Emigrants and Immigrants; Female; Humans; Incidence; Lymphoma; Malaysia; Male; Middle Aged; Neuroendocrine Tumors; Rectal Neoplasms; Retrospective Studies; Sex Distribution

This study examined the psychometric properties of the Bahasa Malaysia (BM) version of the European Organization for Research and Treatment of Cancer (EORTC) Colorectal Cancer-specific Quality Of Life Questionnaire (QLQ-CR29).. We studied 93 patients recruited from University Malaya and Universiti Kebangsaan Medical Centers, Kuala Lumpur, Malaysia using a self-administered method. Tools included QLQ-C30, QLQ-CR29 and Karnofsky Performance Scales (KPS). Statistical analyses included Cronbach's alpha, test-retest correlations, multi-traits scaling and known-groups comparisons. A p value ≤ 0.05 was considered significant.. The internal consistency coefficients for body image, urinary frequency, blood and mucus and stool frequency scales were acceptable (Cronbach's alpha α ≥ 0.65). However, the coefficients were low for the blood and mucus and stool frequency scales in patients with a stoma bag (α = 0.46). Test-retest correlation coefficients were moderate to high (range: r = 0.51 to 1.00) for most of the scales except anxiety, urinary frequency, buttock pain, hair loss, stoma care related problems, and dyspareunia (r ≤ 0.49). Convergent and discriminant validities were achieved in all scales. Patients with a stoma reported significantly higher symptoms of blood and mucus in the stool, flatulence, faecal incontinence, sore skin, and embarrassment due to the frequent need to change the stoma bag (p < 0.05) compared to patients without stoma. None of the scales distinguished between patients based on the KPS scores. There were no overlaps between scales in the QLQ-C30 and QLQ-CR29 (r < 0.40).. the BM version of the QLQ-CR29 indicated acceptable psychometric properties in most of the scales similar to original validation study. This questionnaire could be used to complement the QLQ-C30 in assessing HRQOL among BM speaking population with colorectal cancer.

Topics: Adult; Aged; Colorectal Neoplasms; Female; Follow-Up Studies; Health Status Indicators; Humans; Karnofsky Performance Status; Malaysia; Male; Middle Aged; Prognosis; Psychometrics; Quality of Life; Sickness Impact Profile; Surveys and Questionnaires

Colorectal cancer is the second most frequent cancer in Malaysia. We aimed to assess the validity and reliability of the Malaysian Chinese version of European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire core (QLQ-C30) in patients with colorectal cancer.. Translated versions of the QLQ-C30 were obtained from the EORTC. A cross sectional study design was used to obtain data from patients receiving treatment at two teaching hospitals in Kuala Lumpur, Malaysia. The Malaysian Chinese version of QLQ-C30 was self-administered in 96 patients while the Karnofsky Performance Scales (KPS) was generated by attending surgeons. Statistical analysis included reliability, convergent, discriminate validity, and known-groups comparisons. Statistical significance was based on p value ≤0.05.. The internal consistencies of the Malaysian Chinese version were acceptable [Cronbach's alpha (α≥ 0.70)] in the global health status/overall quality of life (GHS/QOL), functioning scales except cognitive scale (α≤0.32) in all levels of analysis, and social/family functioning scale (α=0.63) in patients without a stoma. All questionnaire items fulfilled the criteria for convergent and discriminant validity except question number 5, with correlation with role (r = 0.62) and social/family (r = 0.41) functioning higher than with physical functioning scales (r = 0.34). The test-retest coefficients in the GHS/QOL, functioning scales and in most of the symptoms scales were moderate to high (r = 0.58 to 1.00). Patients with a stoma reported statistically significant lower physical functioning (p=0.015), social/family functioning (p=0.013), and higher constipation (p=0.010) and financial difficulty (p=0.037) compared to patients without stoma. There was no significant difference between patients with high and low KPS scores.. Malaysian Chinese version of the QLQ-C30 is a valid and reliable measure of HRQOL in patients with colorectal cancer.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Colorectal Neoplasms; Cross-Sectional Studies; Female; Follow-Up Studies; Health Status Indicators; Humans; Karnofsky Performance Status; Malaysia; Male; Middle Aged; Prognosis; Psychometrics; Quality of Life; Sickness Impact Profile; Surveys and Questionnaires

Although the incidence of colorectal cancer in Malaysia is increasing, awareness of this cancer, including its symptoms, risk factors and screening methods, remains low among Malaysian populations. This survey was conducted with the aim of (i) ascertaining the awareness level regarding colorectal cancer symptoms, risk factors and its screening among the general populations and (ii) assessing the public preference and willingness to pay for colorectal cancer screening.. The questionnaire was distributed in eight major cities in West Malaysia during the World Health Digestive Day (WDHD) campaign. Two thousand four hundred and eight respondents participated in this survey.. Generally, awareness of colorectal cancer was found to be relatively good. Symptoms such as change in bowel habit, blood in the stool, weight loss and abdominal pain were well recognized by 86.6%, 86.9%, 83.4% and 85.6% of the respondents, respectively. However, common risk factors such as positive family history, obesity and old age were acknowledged only by less than 70% of the respondents. Almost 80% of the respondents are willing to take the screening test even without any apparent symptoms. Colonoscopy is the preferred screening method, but only 37.5% were willing to pay from their own pocket to get early colonoscopy.. Continous cancer education should be promoted with more involvement from healthcare providers in order to make future colorectal cancer screening programs successful.

Topics: Colonoscopy; Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Health Promotion; Humans; Malaysia; Male; Middle Aged; Patient Preference; Prognosis; Prospective Studies; Surveys and Questionnaires

The aims of the study were (i) to determine the knowledge and perceptions of colorectal cancer (CRC), (ii) to explore the willingness of the study population to take a screening test for CRC, and (iii) to identify factors affecting the willingness to take a screening test for CRC. A cross-sectional survey was carried out in a semiurban town in Malaysia using a pretested structured questionnaire. Descriptive statistics were determined for all important variables. A binary logistic regression model was introduced to identify independent predictors of the willingness to take a screening test. Factors influencing willingness were explored according to the constructs of the health belief model. Of the 256 respondents who had heard about CRC, the majority were aware of altered bowel habits (67.3%) or the presence of blood in stool or rectal bleeding (63.4%) as the warning symptoms. Although 38% of the respondents knew of colonoscopy as the screening test, 22% were not aware of any screening test for CRC. A majority (77.4%) showed willingness to take a screening test for CRC. In the multivariate analysis, 'having family or friends with history of CRC' and 'self-perceived risk' were the two significant variables for predicting the acceptance of CRC screening among the study population. Findings suggested that the respondents' knowledge of the CRC screening test was inadequate, albeit a high proportion expressed their intention to take screening tests. Health education on the CRC addressing available screening tests and the benefits of early screening for CRC should be scaled up.

Topics: Adult; Attitude to Health; Colorectal Neoplasms; Cross-Sectional Studies; Data Collection; Early Detection of Cancer; Female; Humans; Malaysia; Male; Middle Aged; Residence Characteristics; Surveys and Questionnaires; Volition

In Malaysia, data from the Malaysian Health Ministry showed colorectal cancer (CRC) to be the second most common type of cancer in 2007-2009, after breast cancer. The same was apparent after looking at males and females cases separately. In the present study, the Geographic Information System (GIS) was employed to describe the distribution of CRC cases in Kuala Lumpur (KL), Malaysia, according to socio-demographic factors (age, gender, ethnicity and district).. This retrospective review concerned data for patients diagnosed with colorectal cancer in the years 1995 to 2011 collected from the Wilayah Persekutuan Health Office, taken from the cancer notification form (NCR-2), and patient medical records from the Surgical Department, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A total of 146 cases were analyzed. All the data collected were analysed using ArcGIS version 10.0 and SPSS version 19.0.. Patients aged 60 to 69 years accounted for the highest proportion of cases (34.2%) and males slightly predominated 76 (52.1%), Chinese had the highest number of registered cases at 108 (74.0%) and staging revealed most cases in the 3rd and 4th stages. Kernel density analysis showed more cases are concentrated up in the northern area of Petaling and Kuala Lumpur subdistricts. Spatial global pattern analysis by average nearest neighbour resulted in nearest neighbour ratio of 0.75, with Z-score of -5.59, p value of <0.01 and the z-score of -5.59. Spatial autocorrelation (Moran's I) showed clustering significant with p<0.01, Z score 3.14 and Moran's Index of 0.007. When mapping clusters with hotspot analysis (Getis-Ord Gi), hot and cold spots were identified. Hot spot areas fell on the northeast side of KL.. This study demonstrated significant spatial patterns of cancer incidence in KL. Knowledge about these spatial patterns can provide useful information to policymakers in the planning of screening of CRC in the targeted population and improvement of healthcare facilities to provide better treatment for CRC patients.

Topics: Adult; Aged; Aged, 80 and over; Cluster Analysis; Colorectal Neoplasms; Demography; Ethnicity; Female; Humans; Malaysia; Male; Middle Aged; Retrospective Studies; Risk Factors; Young Adult

Colorectal cancer (CRC) is one of the most common types of cancer in both developed and developing countries. This disease is triggered by and progresses via the sequential accumulation of multiple genetic alterations. In addition, the interaction between low-penetrance genes and environmental factors can also increase the risk of developing CRC. Since inflammatory bowel diseases (IBDs) are one of the predisposing factors for CRC, IBD-related genes might, to a certain extent, be associated with cancer initiation. The nucleotide oligomerization domain 2/caspase activating recruitment domain 15 gene (NOD2/CARD15) is the most well-established gene to be associated with increased susceptibility to Crohn's disease. Thus, various studies have been performed to investigate the potential contribution of this gene to CRC risk. In this study, we aimed to determine the frequency of the Arg702Trp, Gly908Arg, 3020insC, Pro268Ser, and JW1 variants of NOD2/CARD15, and to investigate their association with CRC susceptibility. A total of 130 CRC patients and 212 healthy controls were recruited for this study. Subsequently, real-time polymerase chain reaction with TaqMan was performed for the genotyping of these NOD2/ CARD15 variants. None of the NOD2/CARD15 variants was statistically associated to CRC susceptibility in our Malaysian population. Our findings were remarkably similar to those of other Asian cohorts, which indicated that these NOD2/CARD15 variants exhibit genetic heterogeneity between Caucasian and Asian populations.

Topics: Alleles; Asian People; Case-Control Studies; Colorectal Neoplasms; Gene Frequency; Genetic Association Studies; Genetic Heterogeneity; Genetic Predisposition to Disease; Genetic Variation; Genotype; Humans; Malaysia; Nod2 Signaling Adaptor Protein; Odds Ratio; Polymorphism, Single Nucleotide

The interesting preponderance of Chinese with colorectal carcinoma (CRC) amongst the three major ethnic groups in Malaysia prompted a study to determine DNA mismatch repair (MMR) status in our CRC and attempt correlation with patient age, gender and ethnicity as well as location, grade, histological type and stage of tumour. Histologically re-confirmed CRC, diagnosed between 1st January 2005 and 31st December 2007 at the Department of Pathology, University of Malaya Medical Centre, were immunohistochemically stained with monoclonal antibodies to MMR proteins, MLH1, MSH2, MSH6 and PMS2 on the Ventana Benchmark XT autostainer. Of the 142 CRC cases entered into the study, there were 82 males and 60 females (M:F=1.4:1). Ethnically, 81 (57.0%) were Chinese, 32 (22.5%) Malays and 29 (20.4%) Indians. The patient ages ranged between 15-87 years (mean=62.4 years) with 21 cases <50-years and 121 ≥50-years of age. 14 (9.9%) CRC showed deficient MMR (dMMR). Concurrent loss of MLH1 and PMS2 occurred in 10, MSH2 and MSH6 in 2 with isolated loss of MSH6 in 1 and PMS2 in 1. dMMR was noted less frequently amongst the Chinese (6.2%) in comparison with their combined Malay and Indian counterparts (14.8%), and was associated with right sided and poorly differentiated tumours (p<0.05). 3 of the 5 (60.0%) dMMR CRC cases amongst the Chinese and 1 of 9 cases (11.1%) amongst the combined Malay and Indian group were <50-years of age. No significant association of dMMR was noted with patient age and gender, tumour stage or mucinous type.

Topics: Adaptor Proteins, Signal Transducing; Adenosine Triphosphatases; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Biomarkers, Tumor; Colorectal Neoplasms; DNA Mismatch Repair; DNA Repair Enzymes; DNA-Binding Proteins; Female; Humans; Malaysia; Male; Middle Aged; Mismatch Repair Endonuclease PMS2; MutL Protein Homolog 1; MutS Homolog 2 Protein; Nuclear Proteins; Sex Factors; Young Adult

To characterise the mRNA expression patterns of early and advanced stage colorectal adenocarcinomas of Malaysian patients.. Comparative expression analysis.. We performed a combination of annealing control primer (ACP)-based PCR and reverse transcription-quantitative real-time PCR for the identification of differentially expressed genes (DEGs) associated with early and advanced stage primary colorectal tumours. We recruited four paired samples from patients with colorectal cancer (CRC) of Dukes' A and B for the preliminary differential expression study, and a total of 27 paired samples, ranging from CRC stages I to IV, for subsequent confirmatory test. The tumouric samples were obtained from the patients with CRC undergoing curative surgical resection without preoperative chemoradiotherapy. The recruited patients with CRC were newly diagnosed with CRC, and were not associated with any hereditary syndromes, previously diagnosed cancer or positive family history of CRC. The paired non-cancerous tissue specimens were excised from macroscopically normal colonic mucosa distally located from the colorectal tumours.. The differential mRNA expression patterns of early and advanced stage colorectal adenocarcinomas compared with macroscopically normal colonic mucosa were characterised by ACP-based PCR and reverse transcription-quantitative real-time PCR.. The RPL35, RPS23 and TIMP1 genes were found to be overexpressed in both early and advanced stage colorectal adenocarcinomas (p<0.05). However, the ARPC2 gene was significantly underexpressed in early colorectal adenocarcinomas, while the advanced stage primary colorectal tumours exhibited an additional overexpression of the C6orf173 gene (p<0.05).. We characterised two distinctive gene expression patterns to aid in the stratification of primary colorectal neoplasms among Malaysian patients with CRC. Further work can be done to assess and compare the mRNA expression levels of these identified DEGs between each CRC stage group, stages I-IV.

Topics: Adenocarcinoma; Colorectal Neoplasms; Gene Expression; Humans; Malaysia; Neoplasm Staging; Real-Time Polymerase Chain Reaction; RNA, Messenger; Severity of Illness Index

Colorectal cancer (CRC) is second only to breast cancer as the leading cause of cancer-related deaths in Malaysia. In the Asia-Pacific area, it is the highest emerging gastrointestinal cancer. The aim of this study was to identify single nucleotide polymorphisms (SNPs) and environmental factors associated with CRC risk in Malaysia from a panel of cancer associated SNPs.. In this case-control study, 160 Malaysian subjects were recruited, including both with CRC and controls. A total of 768 SNPs were genotyped and analyzed to distinguish risk and protective alleles. Genotyping was carried out using Illumina's BeadArray platform. Information on blood group, occupation, medical history, family history of cancer, intake of red meat and vegetables, exposure to radiation, smoking and drinking habits, etc was collected. Odds ratio (OR), 95% confidence interval (CI) were calculated.. A panel of 23 SNPs significantly associated with colorectal cancer risk was identified (P<0.01). Of these, 12 SNPs increased the risk of CRC and 11 reduced the risk. Among the environmental risk factors investigated, high intake of red meat (more than 50% daily proportion) was found to be significantly associated with increased risk of CRC (OR=6.52, 95% CI :1.93-2.04, P=0.003). Two SNPs including rs2069521 and rs10046 in genes of cytochrome P450 (CYP) superfamily were found significantly associated with CRC risk. For gene-environment analysis, the A allele of rs2069521 showed a significant association with CRC risk when stratified by red meat intake.. In this preliminary study, a panel of SNPs found to be significantly associated with CRC in Malaysian population, was identified. Also, red meat consumption and lack of physical exercise were risk factors for CRC, while consumption of fruits and vegetables served as protective factor.

Topics: Case-Control Studies; Colorectal Neoplasms; Cytochrome P-450 Enzyme System; Diet; Exercise; Female; Genotype; Humans; Malaysia; Male; Odds Ratio; Polymorphism, Single Nucleotide; Risk Factors

Growth factors are polypeptides that are critical for the initiation, progression, and metastasis of cancer. Most tumor cells are capable of synthesizing particular growth factors leading to constitutive pathway activation in these cells through autocrine signaling. Epidermal growth factor (EGF) is a potent mitogenic peptide that exerts direct effects on the proliferation and differentiation of tumor cells in carcinogenesis. By contrast, vascular endothelial growth factor (VEGF) is vital for the invasion and metastasis of neoplasms through the formation of new blood vessels from mature endothelial cells. In this study, we investigated the association between functional polymorphisms of both the EGF and VEGF genes and colorectal cancer (CRC) susceptibility. A total of 130 CRC patients and 212 healthy controls were recruited for this case-control study. Genotyping of genetic variants was conducted via real-time polymerase chain reaction (PCR) amplification with allele-specific TaqMan probes. None of the genotypes of the EGF +61 A>G and VEGF +936 C>T variants was significantly associated with CRC susceptibility among the Malaysian subjects evaluated (P > 0.05). The observed frequency distributions of the EGF +61 A>G polymorphism genotypes showed ethnic heterogeneity, which was not the case for the VEGF +936 C>T genotypes. In conclusion, no positive correlation between these functional polymorphisms and CRC risk was found in this Malaysian population. Studies of the EGF and VEGF genes and CRC susceptibility are scarce, and the results reported thus far differ from one population to another. Hence, more replication studies are warranted before any firm conclusions can be made.

Topics: Alleles; Asian People; Case-Control Studies; Colorectal Neoplasms; Epidermal Growth Factor; Gene Frequency; Genetic Predisposition to Disease; Genotype; Humans; Malaysia; Odds Ratio; Polymorphism, Genetic; Vascular Endothelial Growth Factor A

Colorectal cancer is the second most frequent cancer in Malaysia. Nevertheless, there is little information on treatment and outcomes nationally. We aimed to determine the demographic, clinical and treatment characteristics of colorectal cancer patients treated at the University Malaya Medical Centre (UMMC) as part of a larger project on survival and quality of life outcomes.. Medical records of 1,212 patients undergoing treatment in UMMC between January 2001 and December 2010 were reviewed. A retrospective-prospective cohort study design was used. Research tools included the National Cancer Patient Registration form. Statistical analysis included means, standard deviations (SD), proportions, chi square, t-test/ ANOVA. P-value significance was set at 0.05.. The male: female ratio was 1.2:1. The mean age was 62.1 (SD12.4) years. Patients were predominantly Chinese (67%), then Malays (18%), Indians (13%) and others (2%). Malays were younger than Chinese and Indians (mean age 57 versus 62 versus 62 years, p<0.001). More females (56%) had colon cancers compared to males (44%) (p=0.022). Malays (57%) had more rectal cancer compared to Chinese (45%) and Indians (49%) (p=0.004). Dukes' stage data weres available in 67%, with Dukes' C and D accounting for 64%. Stage was not affected by age, gender, ethnicity or tumor site. Treatment modalities included surgery alone (40%), surgery and chemo/radiotherapy 32%, chemo and radiotherapy (8%) and others (20%).. Significant ethnic differences in age and site distribution, if verified in population-based settings, would support implementation of preventive measures targeting those with the greatest need, at the right age.

Topics: Adult; Aged; Colorectal Neoplasms; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Neoplasm Grading; Prognosis; Prospective Studies; Quality of Life; Retrospective Studies; Time Factors; Universities

Colorectal cancer is one of the most common cancers in many countries, including Malaysia. The accumulation of genomic alterations is an important feature of colorectal carcinogenesis. A better understanding of the molecular events underlying the stages of colorectal carcinogenesis might be helpful in the detection and management of the disease. We used a commercially available single-nucleotide polymorphism genotyping array to detect both copy number abnormalities (CNAs) and copy-neutral loss of heterozygosity (LOH) in sporadic colorectal carcinomas. Matched tumor and normal tissues of 13 colorectal carcinomas (Dukes' stages A-D) were analyzed using a 250K single nucleotide polymorphism array. An additional assay was performed to determine the microsatellite instability status by using the National Cancer Institute-recommended BAT-26 panel. In general, copy number gain (92.3%) was most common, followed by copy number loss (53.8%) and copy-neutral LOH (46.2%). Frequent CNAs of gains and losses were observed on chromosomes 7p, 8, 13q, 17p, 18q, and 20q, and copy-neutral LOH was observed on chromosomes 2, 6, 12, 13q, 14q, 17, 20p, 19q, and 22q. Even though genomic alterations are associated with colorectal cancer progression, our results showed that DNA CNAs and copy-neutral LOH do not reflect disease progression in at least 50% tumors. Copy-neutral LOH was observed in both early and advanced tumors, which favors the involvement of these genomic alterations in the early stages of tumor development.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Chromosome Aberrations; Colorectal Neoplasms; Disease Progression; DNA Copy Number Variations; Female; Genotype; Humans; Loss of Heterozygosity; Malaysia; Male; Microsatellite Instability; Middle Aged; Polymorphism, Single Nucleotide

Changes in dietary practices are known to be associated with changes in the health and disease pattern of a population. This study aimed to qualitatively explore the perception of colorectal cancer patients regarding causes of colorectal cancer and the influence of diet.. Twelve respondents from three major ethnicities in Malaysia were selected from the quantitative study on dietary pattern and colorectal cancer carried out earlier in this study. In-depth interviews (IDI), conducted from April until June 2012, were mainly in the Malay language with additional use of English and continued until the saturation point was reached. All interviews were autorecorded so that verbatim transcriptions could be created.. Causes of colorectal cancer were categorized into internal and external factors. The majority of respondents agreed that there is an association between Western foods and colorectal cancer. Malaysian traditional diet was not related to colorectal cancer as less preservative agents were used. Malaysian diet preparation consisting of taste of cooking (spicy, salty and sour foods) plus type of cooking (fry, grilled and smoked) were considered causes of colorectal cancer. All respondents changed their dietary pattern to healthy food after being diagnosed with colorectal cancer. Advice from doctors regarding suitable food for colorectal cancer was useful in this regard.. Eating outside, use of food flavoring ingredients and preservative agents were considered to be the main factors causing colorectal cancer. All respondents admitted that they changed to a healthy diet after being diagnosed with colorectal cancer.

Topics: Adult; Colorectal Neoplasms; Diet; Eating; Feeding Behavior; Female; Food Preservatives; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Life Style; Malaysia; Male; Middle Aged; Perception; Surveys and Questionnaires

The objective of this study was to determine the knowledge and associated factors regarding colorectal cancer screening among university students in Malaysia. The questionnaire consisted of three parts: socio-demographic characteristics, lifestyle practice and knowledge of colorectal screening. A cross-sectional study was conducted among 300 students (21.3±1.4 years old). The majority of the participants were Malay with a monthly family income of less than 5,000 Ringgit Malaysia (equal to 1,700 USD) (67.0% and 76.0%, respectively). Regarding their lifestyle practices, the majority were non-smokers and had never consumed alcohol (83.7%, and 88.0%, respectively). The majority of the participants had no knowledge of digital rectal examination, colonoscopy, barium enema and fecal occult blood screening (63.3%, 60.7%, 74.0% and 62.3%, respectively). Univariate and multivariate analysis revealed that their age and the discipline which the students were studying significantly influenced their level of knowledge about colorectal screening. The present study results indicate that education campaigns about colorectal cancer should be promoted.

Topics: Adult; Colonoscopy; Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Mass Screening; Occult Blood; Prognosis; Students; Surveys and Questionnaires; Young Adult

To investigate the risk association of xeroderma pigmentosum group C (XPC) Lys939Gln polymorphism alone and in combination with cigarette smoking on colorectal cancer (CRC) predisposition.. Peripheral blood samples of 510 study subjects (255 CRC patients, 255 controls)were collected. DNA was extracted and genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism. The association between polymorphic genotype and CRC predisposition was determined using the OR and 95%CI.. The frequency of the homozygous variant (Gln/Gln) genotype was significantly higher in cases compared with controls (16.0% vs 10.2%, P = 0.049). The Gln/Gln genotype of XPC showed a significantly higher association with the risk of CRC (OR = 1.884; 95%CI: 1.082-3.277; P = 0.025). In the case of allele frequencies, variant allele C was associated with a significantly increased risk of CRC (OR = 1.375; 95%CI: 1.050-1.802; P = 0.020). Moreover, the risk was markedly higher for those who were carriers of the Gln/Gln variant genotype and were also cigarette smokers (OR = 3.409; 95%CI: 1.061-10.949; P = 0.032).. The XPC Gln/Gln genotype alone and in combination with smoking increases the risk of CRC among Malaysians.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Case-Control Studies; Chi-Square Distribution; Colorectal Neoplasms; DNA-Binding Proteins; Female; Gene Frequency; Genetic Predisposition to Disease; Heterozygote; Homozygote; Humans; Logistic Models; Malaysia; Male; Middle Aged; Odds Ratio; Phenotype; Polymorphism, Single Nucleotide; Risk Assessment; Risk Factors; Smoking

To investigate the allele and genotype frequencies of NFKB1 -94 ins/del ATTG (rs28720239) polymorphism and to evaluate the association between the polymorphism and colorectal cancer (CRC) risk in Malaysian population.. Genomic DNA was extracted from the peripheral blood samples of 474 study subjects, which consisted of 237 histopathologically confirmed CRC patients and an equal number of cancer-free controls. The NFKB1 -94 ins/del ATTG (rs28720239) polymorphism was genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and confirmed by DNA sequencing. The association between the polymorphic genotypes and CRC risk was evaluated by deriving odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression analysis.. The frequencies of wildtype (del/del), heterozygous (del/ins) and variant (ins/ins) genotypes in CRC patients were 31.7%, 53.6% and 14.8%, respectively, while those in cancer-free controls were 35.0%, 58.2% and 6.8%, respectively. The frequency of the variant genotype was significantly higher in cases compared to controls (P<0.01). Evaluation of the risk association of the polymorphic genotypes revealed that the variant genotype could contribute to a significantly increased risk of CRC (OR=2.42, 95% CI=1.24-4.73, P<0.01).. The variant allele of NFKB1 -94 ins/del ATTG (rs28362491) polymorphism is associated with higher risk of sporadic CRC in Malaysian population.

Topics: Adult; Aged; Aged, 80 and over; Base Sequence; Case-Control Studies; Colorectal Neoplasms; Female; Gene Frequency; Genetic Predisposition to Disease; Genotype; Humans; INDEL Mutation; Malaysia; Male; Middle Aged; Molecular Sequence Data; NF-kappa B p50 Subunit; Polymerase Chain Reaction; Polymorphism, Genetic; Polymorphism, Restriction Fragment Length; Promoter Regions, Genetic; Young Adult

Malignant transformation from normal colonic mucosa to carcinomas may be accelerated by genetic loss or inactivation of genes of the DNA mismatch repair system. The aim of the study was to determine the local incidence and pattern of immunohistochemical expression of mismatch repair proteins namely: hMLH1, hMSH2 and hMSH6 in a series of colorectal carcinomas (CRCs) and correlate this to their clinical and pathological features. Forty-three out of 298 cases of CRCs (14.4%) showed abnormal staining pattern for mismatch repair proteins with a majority (65.1%) showing single hMLH1 loss. Tumours with mismatch repair defect (MMR-d) were frequently found at the right side of colon (p<0.001), poorly differentiated carcinomas (p<0.001), produced more mucin (p=0.007), exophytic growth (p=0.007) and were bigger (p=0.002) than tumours with no mismatch repair defect. Immunohistochemical stains for mismatch repair proteins could be done in local laboratories on these selected cases before referring for the expensive molecular test.

Topics: Adaptor Proteins, Signal Transducing; Biomarkers, Tumor; Carcinoma; Colorectal Neoplasms; DNA-Binding Proteins; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Malaysia; Male; Middle Aged; MutL Protein Homolog 1; MutS Homolog 2 Protein; Nuclear Proteins

The rapidly increasing of incidence colorectal cancer (CRC) in Malaysia and the introduction of new treatments that prolong survival advocating treatment outcome measures such as patients' quality of life (QOL) are evaluated in this study. The study aims to determine QOL in CRC patients according to cancer stage and age.. A cross-sectional study was performed from June to December 2011 at four public tertiary hospitals. The European Organization for Research and Treatment in Cancer (EORTC) Quality of Life Questionnaire Core-30 (EORTC QLQ C-30) questionnaire was used through face-to-face interview and the medical records of 160 respondents were reviewed.. The mean age of respondents was 58.47 ± 12.04 years with 57.5% of respondents being male and 42.5% female. The majority of respondents were in CRC stages III and IV. Median global health status (GHS) score was 83.33 (IQR 16.67). Sikhs and Indians had a higher median GHS score compared to other ethnicities (Kruskal-Wallis, χ(2)  = 12.12, p = 0.007). Emotional, cognitive and social functions were higher in respondents with earlier stage of disease (Kruskal-Wallis, χ2 = 6.06, 6.36, 10.58, p = 0.048, 0.042, 0.005). Median pain, dyspnea, diarrhea and financial implication scores were significantly higher in advanced stage of disease (Kruskal-Wallis, χ(2)  = 9.31, 6.26,6.77, 7.28, p = 0.010, 0.044,0.034,0.026). Median diarrhea score (p = 0.012) was significantly different between age groups.. Emotional, cognitive and social functions deteriorate with advanced stage of disease. Patients with advanced stage disease experience more pain, dyspnea, diarrhea and financial implications. A systematic screening program to detect cases as early as possible is essential nationwide.

Topics: Adult; Aged; Colorectal Neoplasms; Cross-Sectional Studies; Female; Health Status; Humans; Interviews as Topic; Malaysia; Male; Middle Aged; Quality of Life; Surveys and Questionnaires; Young Adult

This paper presents the level of colorectal cancer awareness among multi-ethnic rural population in Malaysia.. A rural-based cross sectional survey was carried out in Perak state in Peninsular Malaysia in March 2011. The survey recruited a population-representative sample using multistage sampling. Altogether 2379 participants were included in this study. Validated bowel/colorectal cancer awareness measure questionnaire was used to assess the level of colorectal cancer awareness among study population. Analysis of variance (ANOVA) was done to identify socio-demographic variance of knowledge score on warning signs and risk factors of colorectal cancer.. Among respondents, 38% and 32% had zero knowledge score for warning signs and risk factors respectively. Mean knowledge score for warning signs and risk factors were 2.89 (SD 2.96) and 3.49 (SD 3.17) respectively. There was a significant positive correlation between the knowledge score of warning signs and level of confidence in detecting a warning sign. Socio-demographic characteristics and having cancer in family and friends play important role in level of awareness.. Level of awareness on colorectal cancer warning signs and risk factors in the rural population of Malaysia is very low. Therefore, it warrants an extensive health education campaign on colorectal cancer awareness as it is one of the commonest cancer in Malaysia. Health education campaign is urgently needed because respondents would seek medical attention sooner if they are aware of this problem.

Topics: Adult; Aged; Colorectal Neoplasms; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Rural Population; Surveys and Questionnaires

Molecular alterations in KRAS, BRAF, PIK3CA, and PTEN have been implicated in designing targeted therapy for colorectal cancer (CRC). The present study aimed to determine the status of these molecular alterations in Malaysian CRCs as such data are not available in the literature. We investigated the mutations of KRAS, BRAF, and PTEN, the gene amplification of PIK3CA, and the protein expression of PTEN and phosphatidylinositol 3-kinase (PI3K) catalytic subunit (p110α) by direct DNA sequencing, quantitative real-time PCR, and immunohistochemistry, respectively, in 49 CRC samples. The frequency of KRAS (codons 12, 13, and 61), BRAF (V600E), and PTEN mutations, and PIK3CA amplification was 25.0% (11/44), 2.3% (1/43), 0.0% (0/43), and 76.7% (33/43), respectively. Immunohistochemical staining demonstrated loss of PTEN protein in 54.5% (24/44) of CRCs and no significant difference in PI3K p110α expression between CRCs and the adjacent normal colonic mucosa (p = 0.380). PIK3CA amplification was not associated with PI3K p110α expression level, but associated with male cases (100% of male cases vs 56% of female cases harbored amplified PIK3CA, p = 0.002). PI3K p110α expression was significantly higher (p = 0.041) in poorly/moderately differentiated carcinoma compared with well-differentiated carcinoma. KRAS mutation, PIK3CA amplification, PTEN loss, and PI3K p110α expression did not correlate with Akt phosphorylation or Ki-67 expression. KRAS mutation, PIK3CA amplification, and PTEN loss were not mutually exclusive. This is the first report on CRC in Malaysia showing comparable frequency of KRAS mutation and PTEN loss, lower BRAF mutation rate, higher PIK3CA amplification frequency, and rare PTEN mutation, as compared with published reports.

Topics: Aged; Asian People; Carcinoma; Class I Phosphatidylinositol 3-Kinases; Colorectal Neoplasms; Female; Gene Expression Regulation, Neoplastic; Humans; Malaysia; Male; Middle Aged; Mutation; Phosphatidylinositol 3-Kinases; Proto-Oncogene Proteins; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins c-akt; Proto-Oncogene Proteins p21(ras); PTEN Phosphohydrolase; ras Proteins; Sex Factors; Signal Transduction; Tertiary Care Centers

Perceived susceptibility to an illness has been shown to affect Health-risk behavior. The objective of the present study was to determine the risk taking behaviors and the demographic predictors of perceived susceptibility to colorectal cancer in a population-based sample.. A cross-sectional study was carried out among 305 Malaysian adults in six major districts, selected from urban, semi-urban, and rural settings in one state in Malaysia. A self-administered questionnaire was used in this study. It was comprised of socio-demographics, risk-taking behaviors, and validated domains of the Health Belief Model (HBM).. The mean (± SD) age of the respondents was 34.5 (± 9.6) and the majority (59.0%) of them were 30 years or older. Almost 20.7% of the respondents felt they were susceptible to colorectal cancer. Self-reported perceived susceptibility mirrored unsatisfactory screening behaviors owing to the lack of doctors' recommendation, ignorance of screening modalities, procrastination, and the perception that screening was unnecessary. Factors significantly associated with perceived susceptibility to colorectal cancer were gender (OR = 1.8, 95% CI 1.0-3.3), age (OR = 2. 2, 95% CI 1.2-4.0), ethnicity (OR = 0. 3, 95% CI 0.2-0.6), family history of colorectal cancer (OR = 3. 2, 95% CI 1.4-7.4) and alcohol intake (OR = 3.9, 95% CI 2.1-7.5).. The present study revealed that screening behavior among respondents was unsatisfactory. Hence, awareness of the importance of screening to prevent colorectal cancers is imperative.

Topics: Adult; Asian People; Colorectal Neoplasms; Community Health Services; Cross-Sectional Studies; Disease Susceptibility; Female; Humans; Malaysia; Male; Patient Acceptance of Health Care; Risk-Taking; Rural Population; Surveys and Questionnaires; Urban Population

In this study the chemical composition, antioxidant activities and cytotoxic effect of the essential oils of Myristica fragrans (nutmeg) and Morinda citrifolia (mengkudu) were determined.. Thirty-eight compounds in nutmeg oil and six compounds in mengkudu oil were identified by gas chromatography–mass spectrometry. The free radical scavenging activity of nutmeg oil was superior of that mengkudu oil. The MTT assay of nutmeg oil on human colorectal carcinoma (HCT-116) and human breast carcinoma (MCF-7) cell lines showed IC₅₀ values of 78.61 and 66.45 µg mL⁻¹, respectively. The mengkudu oil exhibited IC₅₀ values of 91.46 and 78.15 µg mL⁻¹ for HCT-116 and MCF-7, respectively.. The results showed that nutmeg oil can be developed as potent anti-cancer and antioxidant drugs.

Topics: Antineoplastic Agents, Phytogenic; Antioxidants; Breast Neoplasms; Carcinoma; Cell Proliferation; Colorectal Neoplasms; Drug Discovery; Ethnopharmacology; Female; Fruit; Gas Chromatography-Mass Spectrometry; HCT116 Cells; Humans; Malaysia; Male; MCF-7 Cells; Morinda; Myristica; Oils, Volatile; Osmolar Concentration

Chemotherapy can cause immunosuppression, which may trigger latent intestinal parasitic infections in stools to emerge. This study investigated whether intestinal parasites can emerge as opportunistic infections in breast and colorectal cancer patients (n=46 and n=15, respectively) undergoing chemotherapy treatment. Breast cancer patients were receiving a 5-fluorouracil/epirubicin/cyclophosphamide (FEC) regimen (6 chemotherapy cycles), and colorectal cancer patients were receiving either an oxaliplatin/5-fluorouracil/folinic acid (FOLFOX) regimen (12 cycles) or a 5-fluorouracil/folinic acid (Mayo) regimen (6 cycles). Patients had Blastocystis hominis and microsporidia infections that were only present during the intermediate chemotherapy cycles. Thus, cancer patients undergoing chemotherapy should be screened repeatedly for intestinal parasites, namely B. hominis and microsporidia, as they may reduce the efficacy of chemotherapy treatments.

Topics: Animals; Antineoplastic Combined Chemotherapy Protocols; Blastocystis hominis; Breast Neoplasms; Colorectal Neoplasms; Cyclophosphamide; Epirubicin; Feces; Female; Fluorouracil; Humans; Leucovorin; Life Style; Malaysia; Male; Microsporidia; Middle Aged; Opportunistic Infections; Organoplatinum Compounds; Oxaliplatin; Surveys and Questionnaires

To investigate the protein expression profile of mismatch repair (MMR) genes in suspected cases of Lynch syndrome and to characterize the associated germline mutations.. Immunohistochemical analysis of tumor samples was performed to determine the protein expression profile of MMR protein. Germline mutation screening was carried out on peripheral blood samples. The entire exon regions of MLH1 and MSH2 genes were amplified by polymerase chain reaction, screened by denaturing high performance liquid chromatography (dHPLC) and analyzed by DNA sequencing to characterize the germline mutations.. Three out of 34 tissue samples (8.8%) and four out of 34 tissue samples (11.8%) showed loss of nuclear staining by immunohistochemistry, indicating the absence of MLH1 and MSH2 protein expression in carcinoma cells, respectively. dHPLC analysis followed by DNA sequencing showed these samples to have germline mutations of MSH2 gene. However, no deleterious mutations were identified in any of the 19 exons or coding regions of MLH1 gene, but we were able to identify MLH1 promoter polymorphism, -93G > A (rs1800734), in 21 out of 34 patients (61.8%). We identified one novel mutation, transversion mutation c.2005G > C, which resulted in a missense mutation (Gly669Arg), a transversion mutation in exon 1, c.142G > T, which resulted in a nonsense mutation (Glu48Stop) and splice-site mutation, c.2006-6T > C, which was adjacent to exon 13 of MSH2 gene.. Germline mutations were identified in four Malaysian Lynch syndrome patients. Immunohistochemical analysis of tumor tissue proved to be a good pre-screening test before proceeding to germline mutation analysis of DNA MMR genes.

Topics: Adaptor Proteins, Signal Transducing; Base Sequence; Colorectal Neoplasms; Colorectal Neoplasms, Hereditary Nonpolyposis; DNA Mismatch Repair; DNA Mutational Analysis; Genetic Predisposition to Disease; Germ-Line Mutation; Humans; Malaysia; MutL Protein Homolog 1; MutS Homolog 2 Protein; Nuclear Proteins; Polymorphism, Genetic; Promoter Regions, Genetic

Rapidly increasing colorectal cancer (CRC) incidence in Malaysia and the introduction of cutting edge new treatments, which prolong survival, mean that treatment outcome measures meed to be evaluated, including consideration of patient's quality of life (QoL) assessment. There are limited data on QoL in CRC patients, especially in Malaysia. Therefore, this study was performed focusing on cancer stages and age groups.. The cross sectional study was conducted from June to September 2011 at three public tertiary hospitals with the EORTC QLQ C-30 questionnaire in addition to face to face interview and review of medical records of 100 respondents.. The mean age was 57.3 (SD 11.9) years with 56.0% are males and 44.0% females, 62% of Malay ethnicity, 30% Chinese, 7% Indian and 1% Sikh. Majority were educated up to secondary level (42%) and 90% respondents had CRC stages III and IV. Mean global health status (GHS) score was 79.1 (SD 21.4). Mean scores for functional status (physical, emotional, role, cognitive, social) rangeds between 79.5 (SD 26.6) to 92.2 (SD 13.7). Mean symptom scores (fatigue, pain, nausea/vomiting, constipation, diarrhea, insomnia, dyspnoea, loss of appetite) ranged between 4.00 (SD 8.58) to 20.7 (SD 30.6). Respondents role function significantly deteriorates with increasing stage of the disease (p=0.044). Females had worse symptoms of pain (p=0.022), fatigue (p=0.031) and dyspnoea (p=0.031). Mean insomnia (p=0.006) and diarrhea (p=0.024) demonstrated significant differences between age groups.. QOL in CRC patients in this study was comparable to that in other studies done in developed countries. Pain, fatigue and dyspnoea are worse among female CRC patients. Given that functions deteriorates with advanced stage of the disease at diagnosis, a systematic screening programme to detect cases as early as possible is essential nationwide.

Topics: Adult; Aged; Colorectal Neoplasms; Cross-Sectional Studies; Female; Health Status; Humans; Malaysia; Male; Middle Aged; Neoplasm Staging; Quality of Life; Surveys and Questionnaires; Treatment Outcome; Young Adult

Colorectal cancer (CRC) is the third most common cancer worldwide with approximately 1 million cases diagnosed annually. In Malaysia, CRC is the second most common cancer in women and ranked first in men. The underlying cause of CRC remains unknown.. The aim of this study was to analyze the mutations in genes involved in CRC including MLH1, MSH2, KRAS, and APC genes.. A total of 76 patients were recruited. We used the polymerase chain reaction-denaturing high-performance liquid chromatography for the detection of mutations in the mismatch repair (MMR) and APC genes and the PCR single-strand conformation polymorphism for screening of the KRAS gene mutations.. We identified 17 types of missense mutations in 38 out of 76 patients in our patients. Nine mutations were identified in the APC gene, five mutations were detected in the KRAS gene, and two mutations were identified in the MSH2 gene. Only one mutation was identified in MLH1. Out of these 17 mutations, eight mutations (47 %) were predicted to be pathogenic. Seven patients were identified with multiple mutations (3: MSH2 and KRAS, 1: KRAS and APC, 1: MLH1 and APC, 2: APC and APC).. We have established the PCR-DHPLC and PCR-SSCP for screening of mutations in CRC patients. This study has given a snapshot of the spectrum of mutations in the four genes that were analyzed. Mutation screening in patients and their family members will help in the early detection of CRC and hence will reduce mortality due to CRC.

Topics: Adaptor Proteins, Signal Transducing; Aged; Chromatography, High Pressure Liquid; Colorectal Neoplasms; Female; Genes, APC; Humans; Loss of Heterozygosity; Malaysia; Male; Middle Aged; Mutation, Missense; MutL Protein Homolog 1; MutS Homolog 2 Protein; Nuclear Proteins; Polymerase Chain Reaction; Proto-Oncogene Proteins; Proto-Oncogene Proteins p21(ras); ras Proteins

To investigate the allele and genotype frequencies and associated risk of interleukin (IL)-8 -251T>A polymorphism on colorectal cancer (CRC) susceptibility risk.. Peripheral blood samples of 255 normal controls and 255 clinically and histopathologically confirmed CRC patients were genotyped for IL-8 -251T>A polymorphism employing allele-specific polymerase chain reaction. The relative association of variant allele and genotypes with CRC susceptibility risk was determined by calculating the odds ratios (ORs). Corresponding χ² tests on the CRC patients and controls were carried out and 95% confidence intervals (CIs) were determined using Fisher's exact test. The allele frequencies and its risk association were calculated using FAMHAP, haplotype association analysis software.. On comparing the frequencies of genotypes of patients and controls, the homozygous variant AA was significantly higher in CRC patients (P = 0.002) compared to controls. Investigation on the association of the polymorphic genotypes with CRC susceptibility risk, showed that the homozygous variant IL-8 -251AA had a significantly increased risk with OR 3.600 (95% CI: 1.550-8.481, P = 0.001). In the case of allele frequencies, variant allele A of IL-8 -251 showed a significantly increased risk of CRC predisposition with OR 1.32 (95% CI: 1.03-1.69, P = 0.003).. Variant allele and genotype of IL-8 (-251T>A) was significantly associated with CRC susceptibility risk and could be considered as a high-risk variant for CRC predisposition.

Topics: Adult; Aged; Alleles; Case-Control Studies; Colorectal Neoplasms; Female; Gene Frequency; Genetic Predisposition to Disease; Genetic Variation; Genotype; Haplotypes; Humans; Interleukin-8; Malaysia; Male; Middle Aged; Models, Statistical; Odds Ratio; Polymorphism, Genetic; Risk; Software

To assess the diagnostic potential of tumor-associated high molecular weight DNA in stool samples of 32 colorectal cancer (CRC) patients compared to 32 healthy Malaysian volunteers by means of polymerase chain reaction (PCR).. Stool DNA was isolated and tumor-associated high molecular weight DNA (1.476 kb fragment including exons 6-9 of the p53 gene) was amplified using PCR and visualized on ethidium bromide-stained agarose gels.. Out of 32 CRC patients, 18 were positive for the presence of high molecular weight DNA as compared to none of the healthy individuals, resulting in an overall sensitivity of 56.3% with 100% specificity. Out of 32 patients, 23 had tumor on the left side and 9 on the right side, 16 and 2 being respectively positive. This showed that high molecular weight DNA was significantly (p=0.022) more detectable in patients with left side tumor (69.6% vs 22.2%). Out of 32 patients, 22 had tumors larger than 1.0 cm, 18 of these (81.8%) being positive for long DNA as compared to not a single patient with tumor size smaller than 1.0 cm (p<0.001).. We detected CRC-related high molecular weight p53 DNA in stool samples of CRC patients with an overall sensitivity of 56.3% with 100% specificity, with a strong tumor size dependence.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Colorectal Neoplasms; DNA, Neoplasm; Feces; Female; Genetic Testing; Humans; Malaysia; Male; Middle Aged; Neoplasm Staging; Pilot Projects; Polymerase Chain Reaction; Prognosis; Sensitivity and Specificity

Colorectal cancer is a major public health problem in Malaysia. However, it is also one of the most treatable cancers, resulting in significant numbers of survivors. Therefore, the impact of surviving treatment for colorectal cancer on health related quality of life is important for the patients, clinicians and policy makers, and may differ in different cultures and populations. The aim of this study was to validate the Malaysian versions of the European Organization for Research and Treatment of Cancer quality of life instruments among colorectal cancers patients.. This is a cross sectional multi centre study. Three hospitals were included, the University of Malaya Medical Centre, the Universiti Kebangsaan Malaysia Medical Centre and Hospital Tuanku Jaafar Seremban. Malaysian citizens and permanent residence were studied and demographic and clinical information obtained from hospital records. The European Organization for Research and Treatment of Cancer Quality of life Core 30, colorectal cancer CR29, and the colorectal cancer liver metastasis LMC 21 were used and an observer assessment of performance obtained with the Karnofsky Performance Scale. Questionnaires were translated into three most commonly spoken languages in Malaysia (Bahasa Malaysia, Chinese and Tamil), then administered, scored and analyzed following the developers' guidelines. Ethical approval was obtained from the participating centres. Tests of reliability and validity were performed to examine the validity of these instruments.. The result of pilot testing shows that the use of the Malaysian versions of EORTC QLQ C30, CR29 instruments is feasible in our sample of colorectal cancer patients. Instructions for completion as well as questions were well understood except the questions on the overall quality of life, overall health status and sexual activity. Thus we anticipate obtaining good psychometric properties for the instruments at the end of the study.

Topics: Aged; Clinical Protocols; Colorectal Neoplasms; Cross-Sectional Studies; Female; Health Status; Humans; Malaysia; Male; Middle Aged; Quality of Life; Surveys and Questionnaires

Colorectal cancer (CRC) and the metabolic syndrome (MetS) are both on the rise in Malaysia. A multi-centric case-control study was conducted from December 2009 to January 2011 to determine any relationship between the two.. Patients with confirmed CRC based on colonoscopy findings and cancer free controls from five local hospitals were assessed for MetS according to the International Diabetes Federation (IDF) definition. Each index case was matched for age, gender and ethnicity with two controls (140: 280).. MetS among cases was highly prevalent (70.7%), especially among women (68.7%). MetS as an entity increased CRC risk by almost three fold independently (OR=2.61, 95%CI=1.53-4.47). In men MetS increased the risk of CRC by two fold (OR=2.01, 95%CI, 1.43-4.56), demonstrating an increasing trend in risk with the number of Mets components observed.. This study provides evidence for a positive association between the metabolic syndrome and colorectal cancer. A prospective study on the Malaysian population is a high priority to confirm these findings.

Topics: Adult; Aged; Case-Control Studies; Colonoscopy; Colorectal Neoplasms; Female; Humans; Malaysia; Male; Metabolic Syndrome; Middle Aged; Prevalence; Prognosis; Risk Factors

In Malaysia, colorectal cancer is the most common cancer in males and the third most common in females. Mortality due to colorectal cancer can be effectively reduced with early diagnosis. This study was designed to look into colorectal cancer screening participation and its barriers among average risk individuals in Malaysia. A cross sectional study was conducted from August 2009 till April 2010 involving average risk individuals from 44 primary care clinics in West Malaysia. Each individual was asked whether they have performed any of the colorectal cancer screening methods in the past five years. The barrier questions had three domains: patient factors, test factors and health care provider factors. Descriptive analysis was achieved using Statistical Program for Social Sciences (SPSS) version 12.0. A total of 1,905 average risk individuals responded making a response rate of 93.8%. Only 13 (0.7%) respondents had undergone any of the colorectal cancer screening methods in the past five years. The main patient and test factors for not participating were embarrassment (35.2%) and feeling uncomfortable (30.0%), respectively. There were 11.2% of respondents who never received any advice to do screening. The main reason for them to undergo screening was being advised by health care providers (84.6%). The study showed that participation in colorectal cancer screening in Malaysia is extremely low and multiple factors contribute to this situation. Given the importance of the disease, efforts should be made to increase colorectal cancer screening activities in Malaysia.

Topics: Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Patient Participation; Prognosis; Surveys and Questionnaires

DNA mismatch repair gene (MMR) abnormalities are seen in 95 per cent of hereditary nonpolyposis colorectal cancer (HNPCC) and 10-15 per cent of sporadic colorectal cancers. There are no data on MMR abnormalities in Malaysian colorectal cancer patients. This study was aimed to determine the frequency of abnormal MMR gene protein expression in colorectal carcinoma in Northern Peninsular Malaysia using immunohistochemistry.. Clinicopathological information was obtained from 148 patients' records who underwent bowel resection for colorectal cancer (CRC) at the three hospitals in Malaysia. Immunohistochemistry for MLH1, MSH2, MSH6 and PMS2 proteins were performed on paraffin embedded tissue containing carcinoma.. A total of 148 subjects and 150 colorectal carcinomas of sporadic and hereditary types were assessed. Three patients had synchronous tumours. Twenty eight cancers (18.6%) from 26 subjects (17.6%) had absent immunohistochemical expression of any one of the MMR gene proteins. This comprised absent MLH1 only - 3 cancers, absent MSH2 only - 3, absent MSH6 only - 2, absent PMS2 only - 3, absent MLH1 and PMS2 - 14, absent MSH2 and MSH6 - 2 and absent MLH1, MSH6 and PMS2 - 1. There was significant association between abnormal MMR gene protein expression and proximal colon cancers, mucinous, signet ring and poorly differentiated morphology.. Cancers with abnormal MMR gene expression were associated with microsatellite instability-high (MSI-H) phenotype. About 15 per cent demonstrated absent MSH2, MSH6 and PMS2 protein expression in isolation or in combination with other MMR genes, which often predicts a germline mutation, synonymous with a diagnosis of HNPCC. This appears to be high frequency compared to reported data.

Topics: Adaptor Proteins, Signal Transducing; Adenosine Triphosphatases; Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Colorectal Neoplasms, Hereditary Nonpolyposis; DNA Mismatch Repair; DNA Repair Enzymes; DNA-Binding Proteins; Female; Gene Expression; Germ-Line Mutation; Humans; Immunohistochemistry; Malaysia; Male; Microsatellite Instability; Middle Aged; Mismatch Repair Endonuclease PMS2; MutL Protein Homolog 1; MutS DNA Mismatch-Binding Protein; MutS Homolog 2 Protein; Nuclear Proteins; Retrospective Studies

Colorectal cancer is the commonest cancer among males and the third commonest cancer among women in Malaysia. However, almost 80% of patients sought treatment for cancer only when they were already in late stage due to lack of awareness. Hence, the objectives of this study were to determine the knowledge and attitude of colorectal cancer screening among moderate risk patients. A cross-sectional study was conducted between August 2009 till April 2010 in 44 health clinics with Family Medicine Specialists in West Malaysia. Stratified multistage random sampling was applied and a validated Malay version of the questionnaire with the Cronbach' alpha of 0.65 to 0.82 was used. Data were entered using SPSS 12.0 and analysed with STATA 8.0. A total of 1,905 (93.8%) patients responded. The mean (SD) knowledge and attitude score among moderate risk patients were 69.5 (6.11%) and 66.5 (7.07%), whereas, the percentages for good knowledge and attitude were 4.1% and 3.3% respectively. Less than 1% had undergone colorectal cancer screening and the main reasons were not bothered, busy and embarrassment. The majority of patients who had moderate risk for colorectal cancer had extremely low knowledge and attitude towards colorectal cancer screening. As a result, the majority did not undergo any form of colorectal cancer screening.

Topics: Attitude to Health; Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Mass Screening; Middle Aged; Patient Acceptance of Health Care; Risk; Surveys and Questionnaires

Knowledge is believed to be a driving factor for patients' early presentation for healthcare. This study was conducted to assess knowledge of colorectal cancer among subjects presenting with rectal bleeding and to determine its association with late presentation.. A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The research instruments used in this study was a self-administered questionnaire including data on duration of rectal bleeding, first medical consultation and knowledge of colorectal cancer.. Sixty percent of subjects with rectal bleeding delayed seeking medical advice. Subjects were more aware of symptoms of non-colorectal cancers compared to symptoms of colorectal cancer. The majority of subjects (63.8%) correctly identified rectal bleeding as a symptom but were not aware of the best screening method to detect colorectal cancer. Half of the subjects knew increasing age and genetic background to be risk factors for colorectal carcinoma. However, knowledge of colorectal cancer was not found to be significantly associated with delay in seeking help.. Findings indicate poor awareness of colorectal cancer among the subjects. Although public education of colorectal cancer is important for early presentation on rectal bleeding, further studies are advocated to evaluate other factors influencing patients' help seeking behavior other than knowledge.

Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Cross-Sectional Studies; Delayed Diagnosis; Delivery of Health Care; Female; Gastrointestinal Hemorrhage; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Patient Acceptance of Health Care; Rectum; Referral and Consultation; Risk Factors; Surveys and Questionnaires

Colorectal cancer (CRC) results from the interaction between environmental exposures and genetic predisposition factors.. A case control study was designed and to investigate the genotype frequencies of P53Arg72Pro polymorphism in Malaysian CRC patients and healthy controls and to determine the associated risk of this polymorphism with CRC predisposition.. In this case-control study, peripheral blood samples of 202 sporadic CRC patients and 201 normal controls were collected, DNA extracted and genotyped using the polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) technique.. Genotype analysis showed the frequency of homozygous variant (Pro/Pro) genotype (21%) to be significantly higher in cases compared to controls (13%), (p=0.013). On examining the association between variant genotypes and CRC risk, the Pro/Pro homozygous variant genotype showed significantly higher risk association with CRC susceptibility (OR: 2.047, CI: 1.063-4.044, p=0.033). When stratified according to age, we observed that, individuals aged above 50 years and carriers of pro/pro genotype had significantly higher risk with OR: 3.642, CI: 1.166-11.378, p=0.026.. Our results suggest that the codon 72 SNP which results in amino acid substitution of Arginine to Proline in cell cycle regulatory gene P53, is associated with sporadic CRC risk and carriers of Pro/Pro genotype and more than 50 years old may have high susceptibility.

Topics: Adult; Age Factors; Aged; Amino Acid Substitution; Case-Control Studies; Colorectal Neoplasms; Female; Gene Frequency; Genes, p53; Genetic Predisposition to Disease; Genotype; Humans; Malaysia; Male; Middle Aged; Polymorphism, Single Nucleotide; Risk Factors; Tumor Suppressor Protein p53

Colorectal cancer (CRC) screening is key to CRC prevention and mortality reduction, but patient compliance with CRC screening is low. We previously reported a blood-based test for CRC that utilizes a seven-gene panel of biomarkers. The test is currently utilized clinically in North America for CRC risk stratification in the average-risk North American population in order to improve screening compliance and to enhance clinical decision making.. In this study, conducted in Malaysia, we evaluated the seven-gene biomarker panel validated in a North American population using blood samples collected from local patients. The panel employs quantitative RT-PCR (qRT-PCR) to analyze gene expression of the seven biomarkers (ANXA3, CLEC4D, TNFAIP6, LMNB1, PRRG4, VNN1 and IL2RB) that are differentially expressed in CRC patients as compared with controls. Blood samples from 210 patients (99 CRC and 111 controls) were collected, and total blood RNA was isolated and subjected to quantitative RT-PCR and data analysis.. The logistic regression analysis of seven-gene panel has an area under the curve (AUC) of 0.76 (95% confidence interval: 0.70 to 0.82), 77% specificity, 61% sensitivity and 70% accuracy, comparable to the data obtained from the North American investigation of the same biomarker panel.. Our results independently confirm the results of the study conducted in North America and demonstrate the ability of the seven biomarker panel to discriminate CRC from controls in blood samples drawn from a Malaysian population.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Colorectal Neoplasms; Female; Gene Expression Regulation, Neoplastic; Genetic Testing; Humans; Logistic Models; Malaysia; Male; Mass Screening; Middle Aged; Predictive Value of Tests; Reproducibility of Results; Reverse Transcriptase Polymerase Chain Reaction; Risk Assessment; Risk Factors; RNA; ROC Curve; Sensitivity and Specificity

Colorectal carcinoma (CRC) is the second commonest malignancy in Malaysia, with the highest incidence seen in the Chinese. The aim of this study is to examine the knowledge of CRC and to identify potential barriers for screening, which has yet to be carried out on a nationwide scale.. Subjects were recruited consecutively from friends and relatives accompanying patients to the general medical clinic in a tertiary hospital in Kuala Lumpur. Interviews were carried out using a standardized questionnaire for the Asia Pacific CRC working group based on the Health Belief Model (HBM).. 991 subjects were interviewed. From our study, 414 (41.8%), 500 (50.5%) and 646 (65.2%) could not identify any of the symptoms, risk factors and screening methods for CRC respectively. Only 384 (38.7%) were agreeable to undergo screening. Independent factors associated with willingness to undergo screening were as follows; Malay and Indian race compared to the Chinese [aOR 2.73 (1.87, 3.98) and 3.04 (2.02, 4.59) respectively], perceived susceptibility, perceived barriers to screening, doctor's recommendation and personal contact with CRC.. Knowledge of CRC and CRC screening is low among the Malaysian population. The majority are not willing to undergo screening, the Chinese paradoxically being the least willing despite being at greatest risk.

Topics: Attitude to Health; Colorectal Neoplasms; Early Detection of Cancer; Family; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Perception; Prognosis; Prospective Studies; Risk Factors; Surveys and Questionnaires; Urban Population

Research over the past several decades has indicated that low socioeconomic class has a direct effect on health outcomes. In Malaysia, class distribution may differ with the region. The objective of this study was to compare the presentation and survival of colorectal cancer patients in two dissimilar cities, Kuala Lumpur and Kuching, Sarawak.. All patients diagnosed with a malignancy of the colon or rectum in Sarawak General Hospital and University of Malaya Medical Center from 1st Jan 2000-31st Dec 2006 were recruited. Data on presentation, socio-economic class and survival were obtained. The survival duration was categorized into more than three years or three years and less. Testing for significance was performed using the chi-square test, with p values less than 0.05 considered statistically significant.. A total of 565 patients in UMMC and 642 patients in SGH had a new diagnosis of colorectal carcinoma. Patients in Kuching had a longer duration of symptoms and more advanced stage at presentation, but this was not statistically significant. Lower socio-economic class was a significant factor for late and more advanced stage at diagnosis, as well as poorer three and five year survival rates. However, survival was lower for patients in Kuching compared to Kuala Lumpur, even after matching for socio-economic class.. There is near-zero awareness of colorectal cancer screening in Malaysia. These findings support reaching out to communities of lower socioeconomic backgrounds to improve the colorectal cancer survival rates.

Topics: Chi-Square Distribution; Colorectal Neoplasms; Early Detection of Cancer; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Practice Guidelines as Topic; Practice Patterns, Physicians'; Social Class; Survival Analysis

To determine the 5-year survival rate and prognostic factors for survival in patients with colorectal cancer treated at the Surgical Unit, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia.. We retrospectively reviewed the records of 115 patients treated in HUSM from 1996 to 2005. Data of variables considered as prognostic factors were obtained from the records. Simple and multiple Cox proportional hazard regression using the stepwise method were used to model the prognostic factors for survival.. We found that the significant prognostic factors were liver metastases [adjusted hazard ratio (HR): 3.75; 95% confidence interval (CI): 1.95-7.22], Dukes C stage (adjusted HR: 4.65; 95% CI: 2.37-9.11), Dukes D stage (adjusted HR: 6.71; 95% CI: 2.92-15.48) and non-surgical treatment (adjusted HR: 3.75; 95% CI: 1.26-11.21).. Colorectal patients treated at HUSM with Dukes C staging, presence of liver metastases and received treatment with both chemotherapy and radiotherapy are at the greatest risk of death from colorectal cancer.

Topics: Adolescent; Adult; Cohort Studies; Colorectal Neoplasms; Female; Hospitals, University; Humans; Malaysia; Male; Middle Aged; Prognosis; Retrospective Studies; Survival Rate; Young Adult

Patients' delay in the presentation with rectal bleeding had been identified as a factor for late diagnosis of colorectal cancer. This study was conducted to determine the prevalence of delay in consulting a medical practitioner and identifying associated factors.. A cross-sectional study of 80 patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 in the endoscopy unit, University Kebangsaan Malaysia Medical Centre. The self-administered questionnaire included data on sociodemographic, concern of rectal bleeding, whether patients sought initial advice, any self treatment prior to medical consultation and patients' opinion on causes of their own rectal bleeding.. The prevalence of delay in the presentation of rectal bleeding was 60%. Patients who were less worried (OR 9.6; 95% CI 3.3-27.5), who did not seek anyoneandapos;s advice (OR 11.8; 95% CI 3.8-36.8) and took some treatment before seeking medical consultation (OR 5.0; 95% CI 1.0-24.1) were significantly more likely to delay. Multiple logistic regression revealed that less worry of rectal bleeding and not seeking anyoneandapos;s advice were important predictors (p<0.05). The majority of patients attributed their bleeding to benign causes.. A high proportion of patients with rectal bleeding in the high risk group delayed in seeking medical advice. Public education needs to focus on interventions to reduce the delay in presenting and diagnosis of colorectal carcinoma.

Topics: Academic Medical Centers; Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Cross-Sectional Studies; Delayed Diagnosis; Female; Gastrointestinal Hemorrhage; Humans; Malaysia; Male; Middle Aged; Patient Acceptance of Health Care; Surveys and Questionnaires

Colorectal cancer (CRC) is the second most common cause of cancer mortality among men and women worldwide; the risk of its occurrence has been shown to be increased by chronic bacterial infections. A case control study was therefore carried out at Hospital Universiti Sains Malaysia (HUSM) to determine the incidence of colorectal cancer associated with S. bovis infection. A total of 166 stool specimens were collected from diseased patients and healthy individuals and S. bovis isolates were identified. Suspected colon tumor and cancer cases were diagnosed and confirmed. It was found that overall prevalence of S. bovis was 41 (24.7%) out of 166 cases studied. Some 41(48.6%) of these S. bovis isolates was found in patients with colonic polyps, adenocarcinomas, inflammatory bowel disease (IBD) and chronic gastrointestinal tract (GIT). It was also found that colorectal cancer incidence was 24.7%, adenocarinomas accounting for 51% with the highest incidence in the sigmoid part of the colon. Among the IBD and chronic GIT cases, ulcerative colitis featured in the majority of cases (41.4%). In conclusion, there is a high incidence of colorectal cancer associated with S. bovis.

Topics: Adenocarcinoma; Adult; Case-Control Studies; Chronic Disease; Colorectal Neoplasms; Female; Gastrointestinal Diseases; Humans; Incidence; Inflammatory Bowel Diseases; Malaysia; Male; Prevalence; Prognosis; Risk Factors; Streptococcal Infections; Streptococcus bovis

It is well established that almost all colorectal cancers arise from benign, neoplastic adenomatous polyps. In previous studies, intake of fruits, vegetables and legumes were found to decrease the risk for colorectal adenomas (CRA) and colorectal cancer. This case-control study aimed to evaluate the roles of a variety of foods in contributing to the risk of CRA in Malaysian subjects. One hundred and eighteen subjects were recruited into case (n=59) and control (n=59) groups at Hospital Kuala Lumpur (HKL). A pre-tested quantitative food frequency questionnaire (FFQ) was used to record the types of food items and frequency consumed. Logistic regression was used to determine the crude and adjusted odds ratios of the independent variables. Soy bean and soy products were associated with a reduced risk for CRA (OR = 0.38, 95% CI = 0.15-0.98), while tubers were associated with increase in risk four-fold (OR = 4.14, 95% CI = 1.60-10.70) and red meat intake was found to increase the risk two and a half-fold (OR = 2.51, 95% CI = 1.02-6.28). Higher servings of fruits and vegetables were found to significantly decrease the risk (OR fruits = 0.47, 95% CI = 0.30-0.74; OR vegetables = 0.49, 95% = 0.29-0.80). In conclusion, our data support protective roles for soy, fruits and vegetables in the aetiology of colorectal adenomas and increase in risk in those with high intakes of red meat and tubers. Food intake of an individual may have an influence on one's risk for developing CRA. This finding warrants further investigation before the protective effect of these food items is to be accepted. New studies should explore the possibility of these associations among individuals in the general population especially with regard to different ethnic or other groups in Malaysia with low fruit and vegetable consumption.

Topics: Adenoma; Adult; Aged; Case-Control Studies; Colorectal Neoplasms; Diet; Eating; Female; Fruit; Humans; Malaysia; Male; Meat; Middle Aged; Risk Factors; Surveys and Questionnaires; Survival Rate; Vegetables

Colorectal cancer (CRC) is one of the major malignancies in the world. In Malaysia, CRC is fast becoming the commonest cause of cancer death. Its etiology is complex, involving both environmental and genetic factors. This study looked at the profile and outcome of five-year follow-up of patients with CRC.. Retrospective case review study done on CRC patients at University Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia. Patientsandapos; socio-demographic characteristics, modalities of treatment, cancer characteristics and outcome at 5-year follow up were extracted from the case records.. A total of 107 case records of patients were analyzed. Peak age of CRC presentation was 40-69 years (71.1%). Male to female ratio was 1.2:1 with Chinese predominance (52.3%). Anaemia and its related symptoms including per rectal bleeding was the commonest clinical presentation. The median duration of clinical presentation was 13 weeks (IQR 21.8). More than two-thirds presented as non-emergency cases (69.2%). Most patients presented with Dukes C stage (40.2%). The overall 5-year survival rate was 40% with local recurrence rate of 19.6%. Metastasis after curative-intend treatment (surgery with adjuvant therapy) developed in 26% of patients. Lower recurrence (p = 0.016, OR = 0.205) and metastatic disease (p = 0.02, OR = 0.24) found among the Chinese patients. Almost half of the patients defaulted follow up care (43%), most often within the first year of treatment (22.4%) and the Chinese were the least likely to default (p= 0.04, OR = 0.45).. Socio-demographic profile of CRC patients in UKMMC is comparable to Asia pacific region. Apparent delay in seeking treatment gives rise to poor overall survival and local recurrence rates.

Topics: Adult; Aged; Colorectal Neoplasms; Female; Follow-Up Studies; Humans; Malaysia; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Retrospective Studies; Survival Rate

Somatic mutations of phosphoinositide-3-kinase, catalytic, alpha; PIK3CA gene have been reported in several types of human cancers. The majority of the PIK3CA mutations map to the three "hot spots" - E542 K and E545 K in the helical (exon 9) and H1047R in the kinase (exon 20) domains of the p110alpha. These hot spot mutations lead to a gain of function in PI3 K signaling. We aimed to determine the frequency of PIK3CA mutations in the three most common Malaysian cancers. In this study, we assessed the genetic alterations in the PIK3CA gene in a series of 20 breast carcinomas, 24 colorectal carcinomas, 27 nasopharyngeal carcinomas (NPC), and 5 NPC cell lines. We performed mutation analysis of the PIK3CA gene by genomic polymerase chain reaction (PCR) and followed by DNA direct sequencing in exons 9 and 20. No mutations were detected in any of the 24 colorectal and 27 NPC samples, but one hot spot mutation located at exon 20 was found in a NPC cell line, SUNE1. Interestingly, PIK3CA somatic mutations were present in 6/20 (30%) breast carcinomas. Two of the six mutations, H1047R, have been reported previously as a hot spot mutation. Only one out of three hot spot mutations were identified in breast tumor samples. The remaining four mutations were novel. Our data showed that a higher incidence rate of PIK3CA mutations was present in Malaysian breast cancers as compared to colorectal and nasopharyngeal tumor tissues. Our findings also indicate that PIK3CA mutations play a pivotal role in activation of the PI3 K signaling pathway in breast cancer, and specific inhibitors of PIK3CA could be useful for breast cancer treatment in Malaysia.

Topics: Breast Neoplasms; Cell Line, Tumor; Class I Phosphatidylinositol 3-Kinases; Colorectal Neoplasms; DNA Mutational Analysis; Humans; Malaysia; Mutation; Nasopharyngeal Neoplasms; Phosphatidylinositol 3-Kinases; Signal Transduction

The objectives of the present study were (i) to study the pharmacogenetics of UGT1A1*6, UGT1A1*28 and ABCG2 c.421C>A in three distinct healthy Asian populations (Chinese, Malays and Indians), and (ii) to investigate the polygenic influence of these polymorphic variants in irinotecan-induced neutropenia in Asian cancer patients. Pharmacokinetic and pharmacogenetic analyses were done after administration of irinotecan as a 90-min intravenous infusion of 375 mg/m(2) once every 3 weeks (n = 45). Genotypic-phenotypic correlates showed a non-significant influence of UGT1A1*28 and ABCG2 c.421C>A polymorphisms on the pharmacokinetics of SN-38 (P > 0.05), as well as severity of neutropenia (P > 0.05). Significantly higher exposure levels to SN-38 (P = 0.018), lower relative extent of glucuronidation (REG; P = 0.006) and higher biliary index (BI; P = 0.003) were found in cancer patients homozygous for the UGT1A1*6 allele compared with patients harboring the reference genotype. The mean absolute neutrophil count (ANC) was 85% lower and the prevalence of grade 4 neutropenia (ANC < or = 500/microL) was 27% in patients homozygous for UGT1A1*6 compared with the reference group. Furthermore, the presence of the UGT1A1*6 allele was associated with an approximately 3-fold increased risk of developing severe grade 4 neutropenia compared with patients harboring the reference genotype. These exploratory findings suggest that homozygosity for UGT1A1*6 allele may be associated with altered SN-38 disposition and may increase the risk of severe neutropenia in Asian cancer patients, particularly in the Chinese cancer patients who comprised 80% (n = 36) of the patient population in the present study.

Topics: Adult; Aged; Alleles; ATP Binding Cassette Transporter, Subfamily G, Member 2; ATP-Binding Cassette Transporters; Camptothecin; Carcinoma, Non-Small-Cell Lung; Colorectal Neoplasms; Female; Genetic Predisposition to Disease; Glucuronosyltransferase; Humans; India; Irinotecan; Lung Neoplasms; Malaysia; Male; Middle Aged; Neoplasm Proteins; Neutropenia; Polymorphism, Genetic; Singapore; Urogenital Neoplasms

The is currently a heavy burden on endoscopy services worldwide and although guidelines for the appropriate use of esophagogastroduodenoscopy (EGD) have been well studied, there are few such studies with respect to colonoscopy and none for the Asia-Pacific region. This study aimed, firstly, to determine the 'appropriateness of colonoscopy' for procedures performed in the endoscopy unit of a large Asian hospital using the American Society of Gastrointestinal Endoscopy (ASGE) 2000 guidelines, and secondly, to determine predictive factors including 'appropriateness of colonoscopy' for positive findings and colorectal cancer (CRC).. A prospective cross-sectional study was carried out on consecutive colonoscopies performed in the University of Malaya Medical Center. The unit has an open-access endoscopy policy for doctors who work in the hospital. Referrals were from endoscopists (gastroenterologists and surgeon-endoscopists), primary care physicians and other specialists. The indication of a procedure referral was recorded and judged 'appropriate' or 'inappropriate' using the ASGE criteria. The colonoscopic findings were recorded and classified as positive (endoscopies showing any pathology that had direct therapeutic or prognostic consequences) or negative findings (endoscopies showing no pathology or minor pathologies). Predictive factors for positive findings and CRC were determined using multivariate analysis.. Of 380 patients referred for colonoscopy, 220 (57.9%) were classified as appropriate according to the ASGE guidelines, and 49 (12.9%) as inappropriate. The remaining 111 patients (29.2%) presented with complaints and conditions that could not be categorized. The rate of appropriate referral was similar for all three categories of physician (endoscopists: 59.8%, primary care physicians: 48.1%, others: 51.1%). When referrals by endoscopists were substratified according to gastroenterologists and surgeon-endoscopists, the rate of appropriate referral among gastroenterologists (78.4%) was significantly higher than that of surgeon-endoscopists (56.1%) (P = 0.049), primary care physicians (P = 0.013) and 'others' (P = 0.009). The most common appropriate indications were unexplained Rectalbleeding (79 cases, 20.8%) followed by CRC surveillance (45 cases, 11.8%). The most common inappropriate indication was inappropriately timed colonic cancer surveillance (32 cases, 8.4%). Chronic constipation in 36 cases (9.5%) was the most common 'unlisted' indication. A positive colonoscopic finding was detected in 131 (34.5%) examinations and CRC was found in 36 patients (9.5%). Appropriateness of indication was not a predictive factor for positive findings or CRC and there was no difference in the proportion of cases with positive findings or CRC in the three 'appropriateness categories'. Multivariate analysis revealed that only Rectalbleeding and smoking were significant independent positive predictive factors for positive findings and CRC.. The appropriateness of colonoscopy was not high among the different sources of referrals except for the subgroup of 'gastroenterologist'. Furthermore, the rates of positive findings and CRC among the cases with appropriate, inappropriate and unlisted indications did not differ. The ASGE guidelines will need to be modified for Asia to be of practical use.

Topics: Adult; Aged; Aged, 80 and over; Colonoscopy; Colorectal Neoplasms; Cross-Sectional Studies; Female; Hospitals, University; Humans; Malaysia; Male; Middle Aged; Practice Guidelines as Topic; Prospective Studies; Risk Factors; Unnecessary Procedures; Utilization Review

To report 2 cases of hypersensitivity reactions associated with oxaliplatin treatment in Asian patients.. A 33-year-old Chinese woman received adjuvant oxaliplatin in combination with fluorouracil and leucovorin. Shortly during her sixth infusion, she developed a severe hypersensitivity reaction. Despite prophylactic measures, she developed another reaction of similar severity during her subsequent infusion and was not further rechallenged with oxaliplatin. The second case involved a 45-year-old Malay woman who received oxaliplatin, fluorouracil, and leucovorin for metastatic colorectal cancer. Shortly during her ninth infusion, she developed a mild hypersensitivity reaction. With prophylactic measures, she developed less marked reactions with her subsequent 3 infusions.. Hypersensitivity reactions to oxaliplatin have been reported to be between 12% and 16% in the Western population. As of April 20, 2005, there are only 2 previously published reports of hypersensitivity reactions to oxaliplatin in 6 Asian patients. The incidence rates of such reactions in different Asian ethnic groups could vary. The cumulative dose, time of exposure to oxaliplatin, and clinical features were variable and unpredictable in all of the reported Asian patients who developed hypersensitivity reactions. An objective causality assessment using the Naranjo probability scale revealed that oxaliplatin was the highly probable cause of hypersensitivity in the 2 Asian patients reported by our center.. Patients who develop mild to moderate reactions can be rechallenged with the drug administered as a slow infusion with prophylactic measures. Desensitization may allow patients who experience severe hypersensitivity reactions to oxaliplatin to further receive effective therapy for their colorectal cancer.

Topics: Adult; Anti-Allergic Agents; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; China; Chlorpheniramine; Colorectal Neoplasms; Drug Hypersensitivity; Female; Fluorouracil; Humans; Hydrocortisone; Infusions, Intravenous; Leucovorin; Malaysia; Organoplatinum Compounds; Oxaliplatin; Pregnancy; Treatment Outcome

Traditionally, diverticular disease of the colon has been attributed to ageing, low dietary fibre and a high intraluminal pressure. Recently, genetic and racial factors have also been implicated.. Four-hundred and ten consecutive multiracial Asian patients undergoing colonoscopy for a variety of bowel symptoms in a private endoscopy unit were studied for differing frequencies (if any) in colonic diverticular disease and concomitant abnormalities.. Forty-one patients (10%) had diverticular disease. Diverticula were present in 22/147 Chinese (15%), 14/153 Indians (9%) and 5/110 Malays (4.5%). The mean age of patients with diverticular disease was 55 years as compared with 51.3 years in those without (P = 0.12) and there was no gender difference. Thirty-six patients (88%) had diverticula in the right colon only, four patients (10%) exclusively in the left hemicolon, and one patient (2%) had bilateral involvement. Using regression analysis, Chinese ethnicity [odds ratio (OR)=2.11; 95% confidence interval (CI), 1.09-4.09; P = 0.027), constipation (OR = 2.65; 95% CI, 1.23-5.42; P = 0.007) and colorectal adenomas (OR = 2.65; 95% CI, 1.08-6.46; P = 0.033) were independently associated with diverticular disease.. Colonic diverticular disease in a multiracial Asian patient population has an ethnic predilection and is predominantly right-sided.

Topics: Adenoma; Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; China; Colonoscopy; Colorectal Neoplasms; Diverticulosis, Colonic; Epidemiologic Methods; Female; Humans; India; Infant; Malaysia; Male; Middle Aged

Colorectal cancer is one of the most common forms of gastrointestinal cancer in the world today. In the Asia-Pacific area, it is the fastest emerging gastrointestinal cancer.. To determine the basic demographic features of patients with colorectal cancer and the anatomic distribution and characteristics of the tumour in a local Asian population.. We conducted a review of consecutive patients who had undergone colonoscopy from 1999 to 2003 at the University of Malaya Medical Center, Kuala Lumpur, Malaysia.. Analysis was carried out on 3404 patients who underwent colonoscopy. A total of 228 patients (7%) were diagnosed with carcinoma. The mean age of diagnosis (+/-s.d.) was 64.4 +/- 13.1 years. The male to female ratio was 1.15. Polyps were noted in 470 patients (14%). Polyps detected concomitantly with a colorectal cancer were noted in 55 patients (2%). Four patients (0.1%) were diagnosed to have familial adenomatous polyposis coli. Of the 228 patients 209 (92%) had tumours at only one site whereas 19 (8%) had synchronous lesions. Tumours were mainly left sided [198 of 248 patients (80%)] with the majority located in the recto-sigmoid region. Detailed records of treatment were available only in 176 patients. A total of 147 of 176 patients (84%) underwent surgery and 50 (28%) also received adjuvant or palliative chemotherapy (28%). Seven of 154 patients (5%) were diagnosed to have stage A cancers, 64 (42%), stage B, 23 (15%), stage C and 60 (39%), stage D. Multivariate analysis using multiple logistic regression analysis showed that age > or =65 years (OR = 1.78; 95% CI: 1.35- 2.36) and Malay (OR = 2.09; 95% CI: 1.30-3.35) and Chinese (OR = 1.77; 95% CI: 1.77-2.69) race were significant independent predictive factors for colorectal cancer.. The demography of colorectal cancer is different from western patients. Tumours were mainly left sided in our patients. However, no differences in anatomic location were found between races, men and women and younger and older age groups. Colorectal cancer presented in an advanced stage in the majority of patients.

Topics: Aged; Cecal Neoplasms; China; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Family Health; Female; Humans; India; Malaysia; Male; Middle Aged; Neoplasm Staging; Neoplasms, Multiple Primary; Population Surveillance; Rectal Neoplasms; Sex Distribution; Sigmoid Neoplasms

This is a retrospective study evaluating the risk factors for clinical anastomotic leakage after anterior resection in 64 patients with rectal cancer operated from November 2001 till August 2003. The percentage of anastomosis leakage was higher in those patients with diabetic, low albumin level, neoadjuvant radiotherapy, higher staging, and poorly differentiated tumour. However, these differences were statistically not significant. There was a significant difference (p=0.03) of anastomosis leakage in those patients with very distal tumour of < 4cm from anal verge (42%), when compare to those patients with proximal tumor of > 15cm from anal verge (4.3%). The mortality associated with this complication was 30%. Hence, a surgeon may consider a covering stoma or be more vigilant in operating patients with multiple risk factors.

Topics: Adenocarcinoma; Anastomosis, Surgical; Colorectal Neoplasms; Humans; Malaysia; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors

Promising new pharmacological agents and gene therapy targeting cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) could modulate treatment of colorectal cancer in the future. The aim of this study was to elucidate the expression fo beta-catenin and teh presence of COX-2 and iNOS in colorectal cancer specimens in Malaysia. This is a useful prelude to future studies investigating interventions directed towards COX-2 adn iNOS.. A cross-section study using retrospective data over a 2-year period (1999-2000) involved 101 archival, formalin-fixed, paraffin-embedded tissue samples of colorectal cancers that were surgically resected in a tertiary referral.. COX-2 production was detected in adjacent normal tissue in 34 sample (33.7%) and in tumour tissue in 60 samples (59.4%). More tumours expressed iNOS (82/101, 81.2%) than COX-2. No iNOS expression was detected in adjacent normal tissue. Intense beta-catenin immunoreactivity at the cell-to-cell border. Poorly differentiated tumours had significantly lower total beta-catenin (p = 0.009) and COX-2 scores (p = 0.031). No significant relationships were established between pathological stage and beta-catenin, COX-2 and iNOS scores.. the accumulation of beta-catenin does not seem to be sufficient to activate pathways that lead to increased COX-2 and iNOS expression. A high proportion of colorectal cancers were found to express COX-2 and a significant number produced iNOS, suggesting that their inhibitors may be potentially useful as chemotherapeutic agents in the management of colorectal cancer.

Topics: Adult; Aged; Aged, 80 and over; beta Catenin; Colorectal Neoplasms; Cross-Sectional Studies; Cyclooxygenase 2; Cyclooxygenase 2 Inhibitors; Cyclooxygenase Inhibitors; Cytoskeletal Proteins; Female; Gene Expression Regulation, Enzymologic; Gene Expression Regulation, Neoplastic; Humans; Immunohistochemistry; Isoenzymes; Malaysia; Male; Membrane Proteins; Middle Aged; Nitric Oxide Synthase; Nitric Oxide Synthase Type II; Prostaglandin-Endoperoxide Synthases; Retrospective Studies; Statistics, Nonparametric; Trans-Activators

Loss of P53 function is regarded as one of the critical steps in colorectal carcinogenesis. This study determines the P53 expression pattern of colorectal carcinoma in a cohort of 116 local patients. There was no significant relationship between overexpression of P53 with tumour stage (p=-0.209, chi square test) and grade (p=0.877, chi square test). Survival analysis using Kaplan-Meier procedure did not show significant relationship between P53 positivity with overall recurrence-free and survival outcome (p=0.3322 and 0.921 respectively; log rank test). Long-term follow-up may give a better evaluation on the prognostic value of P53 overexpression in colorectal carcinoma.

Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Disease-Free Survival; Female; Gene Expression Regulation, Neoplastic; Humans; Malaysia; Male; Middle Aged; Prognosis; Tumor Suppressor Protein p53