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.
Symptoms 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
Feeling of lethargy, tiredness or getting breathless with activity may suggest anemia with blood loss that is not obvious to the eye
HOW IS COLORECTAL CANCER TREATED?
After detailed staging investigations are done, surgery is needed for a definitive cure. 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 determine treatment strategies 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.
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.
A comprehensive guide will be provided for patients and their caregivers during the recovery phase after 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 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 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.
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.
Chew MH; Ng KH; Fook-Chong M C Stephanie; Eu KW
Redefining conversion in laparoscopic colectomy and its influence on outcomes: analysis of 418 cases from a single institution.
World journal of surgery 2011; 35(1):178-185
Tan WS; Chew MH; Ooi BS; Ng KH; Lim JF; Ho KS; Tang CL; Eu KW
Laparoscopic versus open right hemicolectomy: a comparison of short-term outcomes.
International journal of colorectal disease 2009; 24(11):1333-9
Chew MH; Wong M TC; Lim B YK; Ng KH; Eu KW
Evaluation of current devices in single-incision laparoscopic colorectal surgery: a preliminary experience in 32 consecutive cases.
World journal of surgery 2011; 35(4):873-880
Lim J WM; Chew MH; Lim KH; Tang CL
Close distal margins do not increase rectal cancer recurrence after sphincter-saving surgery without neoadjuvant therapy.
International journal of colorectal disease 2012; 27(10):1285-1949
Chew MH; Chang MH; Tan WS; Wong M TC; Tang CL
Conventional laparoscopic versus single-incision laparoscopic right hemicolectomy: a case cohort comparison of short-term outcomes in 144 consecutive cases.
Surgical Endoscopy 2013; 27(2):471-477
Tan WJ, Chew MH, Dharmawan AR, Singh M,Acharyya, Loi TT, Tang CL
Critical appraisal of laparoscopic vs open rectal cancer surgery.
World J Gastrointest Surg. 2016 Jun 27;8(6):452-60.
Chew MH, Yeh YT, Lim E, Seow-Choen F.
Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades.