Arm yourself against colorectal cancer

There is little doubt that Singaporeans should remain vigilant in the face of colorectal cancer.

The latest data from the Singapore Cancer Registry shows that colorectal cancer is the most frequent type of malignancy in males and the second most common in women. Between 2010 and 2014, 9,320 new patients were diagnosed with colorectal cancer, making it the most frequently diagnosed malignancy in the city-state.

It is not easy to pinpoint the exact cause behind the increased incidence of colorectal cancer, says Dr Dennis Koh, a general surgeon at Mount Elizabeth Hospital in Singapore. “Colorectal cancer is not due to just one factor,” he says. “It is due to interplay between genetic disposition and interaction with the environment.”

He adds that regular screening is the most effective tool available that can help make a dent in colorectal cancer cases.

“The guideline is that people who are 50 or older ought to go for screening, even if they don’t have any symptoms.”

How to screen for colorectal cancer

Although several tests are often recommended to screen patients for colorectal cancer, Dr Koh believes that a colonoscopy is the best tool available. “A colonoscopy is what we call the gold standard for visualising and diagnosing colorectal cancer,” he says.

It involves inserting a small tube, known as an endoscope, through the anus into the colon, while air is pumped inside the colon to expand it. The scope is equipped with a video camera and a tool that can remove tissue, allowing the doctor to spot any lesion, like a polyp, and extract it at once.

“Colonoscopy is useful because it is both diagnostic and therapeutic,” says Dr Koh.

Polyps are quite common cell growths that develop on the lining of the colon. Most of them are harmless, but some can develop into cancer – often in around five to ten years.

“Colorectal cancer grows from polyps,” notes Dr Koh. “So, if we can remove polyps before they become cancer, patients will be spared from the disease.”

It is worthwhile noting that patients with polyps don’t experience any symptoms until these polyps turn into cancer.

Those who are younger than 50, however, are encouraged to get examined if they experience prolonged abdominal pain and an increase in the frequency of passing stools because these are potential telltale signs of colorectal cancer.

“Prevention is the best course,” says Dr Koh. “Regular colonoscopies can reduce the chance of having colorectal cancer by 90 percent.”

Surgery is the mainstay of treatment

“The primary treatment for colorectal cancer is surgery,” according to Dr Koh. “A late-stage malignancy may require chemotherapy and radiotherapy on top of surgery.”

With recent advancement in surgical techniques and surgical instruments, laparoscopic surgery is the method of choice for colorectal cancer. One minimally invasive surgical option is transanal endoscopic operation (TEO), where the tumour is removed through the anus without making any incision. Thus, the surgery is much less invasive and causes fewer damages to the body. This allows patients to recover very quickly.

“My patients can eat the same day of the surgery and go back home the day after,” says Dr Koh.

He adds that TEO is recommended for early-stage cancers that are near the anus or big polyps. Elderly patients and those with multiple medical problems are the most suitable candidates for TEO because they can avoid undergoing a major operation.

Patients fit enough for a more invasive procedure are encouraged to opt for formal curative resection. Dr Koh explains that this procedure allows surgeons to remove the cancer as well as the lymph nodes thus reducing the risk of relapse.

He stresses that good communication between the doctor and the patient is instrumental in achieving positive outcomes.

“Winning the patient’s trust and having good communication between the patient and doctor are half the battle,” says Dr Koh.

He notes that fear of the unknown is what makes patients anxious, so he makes sure that patients understand not only the risks and the benefits associated with surgery, but also their condition.“Patients are responsible for their own body, so they deserve the chance to make an informed choice.”

Dr Dennis Koh is a general surgeon at Mount Elizabeth Hospital in Singapore. His field of expertise is in proctology and colorectal surgery, and he has performed several minimally invasive and open surgeries to treat various colorectal conditions. Dr Koh graduated from the University of Nottingham Medical School in the UK in 1998. He obtained his Master of Medicine in Surgery from the National University of Singapore in 2005 and Fellowship of the Royal College of Surgeons of Edinburgh  (FRCS) in 2009.

Mount Elizabeth Hospital
3 Mount Elizabeth, Singapore 228510
Tel: (+65) 6735 5000
www.mountelizabeth.com.sg           

Colorectal Practice
Mount Elizabeth Medical Centre, #13-05
3 Mount Elizabeth, Singapore 228510
Tel: (+65) 6262 1226