Colorectal Cancer Screening

November 12, 2020

Should We Start Colorectal Cancer Screening Earlier?


Colorectal Cancer Screening

Colorectal cancer is the most common cancer in Singaporean males and the second most common cancer in Singaporean females.  To understand why colorectal cancer is preventable, it is important to understand how it develops. A colonic polyp is a benign (non-cancerous) growth on the internal lining of the colon. A small proportion of colonic polyps will, in turn, develop into colorectal cancer over 8 to 15 years. If a polyp is detected during a colonoscopy and removed early before the development of cancerous change, then the risk of cancer development is effectively zero.

WHAT IS COLONOSCOPY?
A Colonoscopy is a camera test (endoscopic test) of the colon. It involves intubation of the colon with a flexible endoscope (colonoscope) maneuvered by a trained endoscopist. The colonoscopy allows a comprehensive assessment of the lining of the colon to detect abnormalities such as inflammation, polyps, and cancerous tumors. Other than visualization of the lining of the colon, the colonoscope allows for complete removal of polyps and biopsy sampling of tumors. The ability to remove polyps is what allows a colonoscopy to effectively prevent the development of colorectal cancer.  

WHEN SHOULD I GO FOR A COLONOSCOPY?
The current guidelines from the Singapore Ministry of Health and other major colorectal and gastroenterological societies call for cancer screening of the colon from the age of 50 for individuals with no family history of colorectal cancer.   The above approach will nonetheless miss out on a small but significant population, namely the young population with a cancer diagnosis in their late 30s, and early 40s and those with a cancer diagnosis in their late 40s to early 50s. It is important to note that an approach to prevent cancer development is superior to the early diagnosis of established cancer. An established colorectal cancerous growth will have the potential to spread to other organs and will require a formal colon resection (removal) surgery to ensure cure. In contrast, a colonic polyp is benign (non-cancerous) and has no potential for spread, and can be easily removed during the colonoscopy without needing any colon surgery. The approach to start colorectal cancer screening at age 50 will potentially miss out on individuals who have undiagnosed polyps in their 30s that can further develop into cancer in their early 40s to early 50s.

 

WHO SHOULD GO FOR A COLONOSCOPY?
For individuals with a family history of cancer, particularly in first degree relatives (parents and siblings), the guidelines call for the at-risk individual to undergo early colorectal cancer screening ten years prior to the age of diagnosis of the family member. For example, an individual whose father had colorectal cancer at age 45 years is recommended to have a colonoscopy when he/she is 35 years old.  For individuals with average risk and no family history of colorectal cancer, the decision to perform a colonoscopy before 50 years of age then becomes a personal choice.

HOW DOES COLONOSCOPY WORK?
A colonoscopy is performed as a day procedure with no need for overnight stay. The entire procedure takes about 25-30 minutes with an observation period of 2 hours thereafter. A day prior to the procedure, the patient will have to do a bowel cleansing through medications prescribed by their endoscopist and can expect to go to the washroom about 5-8 times. During the colonoscopy procedure, the patient will be sedated. This ensures the procedure remains comfortable and any removal of polyps will be pain-free.

 

Written By Dr. Aaron Poh 

Alpine Surgical Singapore 

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