A renowned Japanese mystery novelist died recently of colorectal cancer, at 68. For many readers the news felt sudden — one of the world’s best-known storytellers, gone to a disease people rarely talk about.
And here is the part that is hard to sit with. Colorectal cancer is one of the most screenable cancers there is. Caught early, it is often curable. So how does anyone still reach a late stage?
The answer is almost never the disease moving fast. It is the screening happening late, or not at all.
In Malaysia, this is not someone else’s disease
It is easy to file cancer news under “tragic, but far away.” The Malaysian numbers make that harder.
Colorectal cancer is now the second most common cancer in Malaysia. In 2024 there were an estimated 7,693 new cases — about 14% of all cancers diagnosed that year (GLOBOCAN 2024, WHO/IARC).
The lifetime risk has been climbing. A Malaysian man now has roughly a 1-in-44 chance of developing colorectal cancer in his life; a woman, about 1-in-62. A decade ago those odds were 1-in-56 and 1-in-76. The trend is going the wrong way.
One more detail that matters for a lot of readers here: incidence is highest among the Chinese population, followed by Malay and Indian communities.
And the hardest fact of all — in Malaysia, most colorectal cancers are found late. Public awareness is low, screening participation is low, and survival by stage sits below that of wealthier Asian countries. Not because the treatment is worse, but because people arrive later.
Why the timing decides everything
Colorectal cancer is not one fixed outcome. What happens to you depends enormously on when it is found. The numbers are stark:
| Stage at diagnosis | What it means | 5-year survival |
| Localized | Still inside the colon or rectum | about 91% |
| Regional | Spread to nearby lymph nodes | about 75% |
| Distant | Spread to other organs | about 17% |
(Stage-based figures here are from US SEER data, which tracks this more completely than most registries. The pattern holds everywhere.)
Read that table again. Found early, more than nine in ten people are alive five years on. Found after it has spread to distant organs, fewer than one in five.
Same cancer. The only thing that changed was the calendar.
Now the number that ties it all together: only about 39% of colorectal cancers are caught at that early, localized stage — largely because too few people get screened. The tool that moves someone from the bottom row of that table to the top row already exists. Most people just do not use it in time.
The good news: this cancer usually gives you years
Here is what makes the late diagnoses so frustrating, and also so preventable.
Most colorectal cancers do not appear overnight. They grow slowly from a small clump of tissue on the bowel wall called a polyp. Most polyps are harmless. But certain types — adenomas in particular — are the seeds a cancer can grow from.
That transformation, from polyp to cancer, usually takes many years. Often more than ten.
That long, silent window is the whole opportunity. For a decade or more, the thing that could one day kill you is sitting there as a small growth that has not yet turned dangerous — and that can be removed in minutes.
The catch is the silence. This process rarely causes symptoms. By the time there is obvious discomfort, bleeding, or a change in bowel habits, the disease has often already advanced. Waiting for symptoms is waiting too long.
So when should you have your first screening?
For people at average risk, the widely used guidance for colorectal cancer screening in Malaysia is to begin at 45. That is the starting age recommended by the US Preventive Services Task Force, and Malaysian colorectal specialists point to the same age for the general population.
You should start earlier, and screen more often, if:
- A parent, sibling or child has had colorectal cancer or advanced polyps
- You have inflammatory bowel disease, such as Crohn’s or ulcerative colitis
- You have a known genetic syndrome that raises bowel cancer risk
- You are of Chinese descent — the group with the highest incidence in Malaysia — and want to be cautious
If you already have symptoms — bleeding, persistent change in bowel habits, unexplained weight loss, ongoing abdominal pain — screening age is beside the point. That is a reason to see a doctor now, not at 45.
Why a colonoscopy is the one test that finds and fixes
There are several ways to screen for colorectal cancer — stool tests among them — and they all have a place. But a colonoscopy does something none of the others can.
It does not just detect a polyp. It removes it, in the same session.
A thin, flexible camera travels the length of the bowel. When it finds a suspicious growth, the doctor loops it, snips it out, and sends it for testing — right then. A polyp that might have become cancer over the next decade is gone before you leave. If the idea of the procedure itself is what puts you off, that part is more manageable than most people expect — we walk through exactly what a colonoscopy feels like in this separate guide.
For anyone weighing where to have it done, including same-day upper and lower endoscopy in one sedated session, you can see how that is arranged here.
The one thing worth remembering
You cannot control whether you are the 1-in-44. You can control when you look.
A novelist’s death makes headlines. The thousands of quieter cases every year do not — but most of them share the same story, which is not that the cancer was unbeatable. It is that it was found too late. Screening is how you change which row of that table you end up in.