Colorectal Cancer Singapore | Colon Cancer

What is Colorectal Cancer?

Colorectal cancer is the most common cancer in Singapore for both males and females combined. Early detection requires regular screening as well as prompt medical consultation should symptoms occur. Also known as bowel cancer or colon cancer, this type of cancer occurs when cells in the colon or rectum grow abnormally and uncontrollably, developing into tumours.

Most colorectal cancers begin with benign growths (polyps) on the inner lining of the colon or rectum. Over time, these polyps can progress, invade the surrounding tissues; and, in advanced stages, spread to surrounding tissues and organs.

Symptoms of colorectal cancer can be variable and non-specific, but most commonly include:

Change of bowel habits (e.g. increased diarrhoea or constipation, pencil-thin stools, increased urge to pass motion)
Blood in stools
Weight loss, reduced appetite
Abdominal pain
Feeling of lethargy, tiredness or getting breathless with activity may suggest anemia with blood loss that is not obvious to the eye

WHAT ARE THE STAGES OF COLORECTAL CANCER?

The stages of colorectal cancer are determined by the extent of its spread using the tumour, node, and metastasis (TNM) staging system. Staging helps determine the appropriate course of treatment and prognosis for patients.

Stage 0: Also known as carcinoma in situ, the cancer is located within the inner layer of the colon or rectum.
Stage 1: The cancer has progressed beyond the inner layer, but not into the colon or rectum wall.
Stage 2: The cancer has developed within the colon or rectum wall, but has not spread to nearby lymph nodes.
Stage 3: The cancer has metastasised to the surrounding lymph nodes.
Stage 4: Cancerous growths are present in surrounding tissues and organs, such as the liver, lungs, or bones.

WHAT ARE THE RISK FACTORS OF COLORECTAL CANCER?

Several factors can contribute to an increased risk of colorectal cancer. These include:

Being over the age of 50
Personal or family history of colorectal cancer or polyps
Smoking
Heavy alcohol consumption
A diet low in fibre and high in red meat, processed meat, and fats
A sedentary lifestyle
Being obese or overweight

If you have symptoms or risk factors of colorectal cancer, contact us at 6518 4688 or WhatsApp us for a personalized consultation today.

CAN COLORECTAL CANCER BE PREVENTED?

The most effective approach to preventing colorectal cancer is through early detection and preventive screening. For individuals without any risk factors besides age, the recommended age for screening starts at 50. However, those with a family history of the disease, or have other risk factors, should begin screening earlier.

There are a few screening tests available for colorectal cancer in Singapore. The first is a colonoscopy, which allows doctors to examine the lining of the colon and rectum and remove any polyps on the spot. This is the ideal of colorectal cancer screening and prevention; and only need to be done every 10 years (if no polyps are found; and no other risk factor is present).

Another method is the faecal immunochemical test (FIT) which detects blood in the stool, which can be an early indication of colorectal cancer. While it is more affordable than a colonoscopy, it is not as accurate and must be repeated every year.

Besides regular screening, adopting a healthy lifestyle may lower colorectal cancer risk. This includes consuming a healthy and balanced diet, refraining from smoking, reducing alcohol intake, staying active, and ensuring a healthy weight.

HOW IS COLORECTAL CANCER TREATED?

After detailed staging investigations are done, surgery is needed for a definitive cure. Colorectal cancer surgery will remove the affected part of the intestine, lymph nodes around the tumour, and possible surrounding organs if the cancer has invaded or involved these structures.

Dr Chew Min Hoe will tailor a colorectal cancer treatment plan based on the stage and severity of the disease. Surgery techniques can include open surgery or laparoscopic (minimally invasive) surgery. The aims of surgery will be to ensure complete cancer clearance, low complication rates, as well as good and enhanced recovery.

Open surgery for colorectal cancer involves making a long abdominal incision to access the tumour, nearby lymph nodes, and other affected structures. This is more commonly performed for advanced or complex cases of colorectal cancer; and involves a longer hospitalization and recovery.

During laparoscopic surgery, on the other hand, the colorectal cancer surgeon makes several small abdominal incisions (0.5–1 cm) through which a long, thin tube called a laparoscope and other specialized surgical instruments are inserted. It allows the surgeon to visualise the abdominal cavity on a monitor and remove the diseased portions of the colon or rectum. Compared to open surgery, this procedure provides reduced discomfort and a shorter recovery time.

Common types of colorectal cancer surgery include:

Partial Colectomy - Only the cancerous portion of the colon and some surrounding healthy tissues are removed, while the remaining parts of the colon are reattached.
Total Colectomy - This procedure involves the removal of the entire large intestine while the small intestine remains attached to the rectum.
Ileocolectomy - The affected ileum segment will be removed, while the remaining parts of the small intestine will be sutured together.
Abdominoperineal Resection - This procedure removes the rectum, anus, and parts of the sigmoid colon.
Proctosigmoidectomy - This involves the partial or complete removal of the sigmoid colon and rectum.
Total Proctocolectomy - This form of colon cancer surgery removes the entire large intestine and rectum.

Chemotherapy and radiotherapy may be required as part of the treatment; and these will be coordinated with medical and radiation oncologists along with targeted treatment specific to your cancer, in order to achieve the best possible outcomes.

For more information on treatment options, contact our experienced colorectal cancer surgeon at 6518 4688 or WhatsApp us for a detailed consultation.

PREPARATION FOR COLORECTAL CANCER SURGERY?

Prior to surgery, the doctor will perform a physical exam, blood tests, and scans to assess the patient's eligibility for the procedure and discuss any risks involved. They will also provide instructions for bowel preparation, such as dietary restrictions or laxatives. Patients are expected to fast for a specified period to ensure an empty stomach during the surgery. Taking certain medications, such as blood thinners, may be temporarily stopped or adjusted to minimise the risk of complications.

POST-SURGERY CARE FOR COLORECTAL CANCER

DIET

A comprehensive guide will be provided for patients and their caregivers during the recovery phase after colorectal cancer surgery. As an overall guide, patients are advised to consume small and frequent meals, monitor their weight closely, and avoid taking too many supplements at this stage. Do check with your doctor and nurse care coordinator.

EXERCISE AND ACTIVITY

You will be provided with adequate medical leave to rest from surgery. While resting is important, this should be balanced with some daily walks to improve muscle tone, digestion as well as improving mental well-being. Activity is also important to prevent problems such as blood clots in the legs (deep vein thrombosis) and physical deconditioning especially for the elderly which can lead to further complications.

We also advise not to commence high intensity activity too early after colorectal cancer surgery as these may lead to wound problems such as hernias. A good guide is to wait at least 4-6 weeks before commencing such exercises and do check with your doctor and nurse care coordinator.

WOUND CARE

Wound care advice will be provided upon discharge. There may also be a date provided to remove wound sutures or staples with your family physician or by our medical team. In the event of increasing wound pain, redness or some discharge that is unusual, please contact our team for a review.

STOMA CARE

A stoma is needed in some circumstances after surgery and will be advised. Stomas are usually temporary and are created to divert stools to allow healing of the anastomosis after removal of typically a rectal cancer. This stoma will be closed in a 2nd operation usually after a few months once you have fully recovered. If chemotherapy is required, the stoma is closed only after chemotherapy is completed in order to avoid any delays in your curative treatment.

If the cancer is a very low rectal cancer or involves the anus or anal canal muscles, surgery will require the removal of the anus, making the stoma a permanent one.

Stoma care will be advised and provided by our care teams along with supporting expert vendors. Stoma care will involve ensuring correct appliances are sized and the type advised based on each individual, and also guides on stoma skin care products.

There will be counselling on overall nutrition and hydration. It is important to regain normal activities of daily living as best even with a stoma and we can provide guidance on how to cope at studying or at work, and also with intimate moments for couples. We will also provide advise on activities such as sports, diving and travel.

FAQ on Colorectal Cancer

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