Lifestyle changes impact risks of colon cancer

Colorectal cancer patients are becoming increasingly younger, a fact that makes it more important to screen for the disease even when there are no symptoms.

That’s according to Dr Bernard Lim, a consultant general surgeon at Mount Elizabeth Novena Hospital in Singapore who sub-specialises in colorectal surgery.

“Generally, the incidence of colorectal cancer increases with age,” he says. “However, we are seeing increased incidences of patients who are younger, possibly because our diets and lifestyles are approaching those of the West, meaning we are eating more red meat and processed food. These add to the increased risk of getting colorectal cancer.”

To reduce the risk of contracting the disease, which starts in the colon or rectum, people should exercise and ensure a balanced diet that is high in fruits and fibre, while steering clear of food containing carcinogens that cause cancer. Smoking and excessive drinking should also be avoided.

Essential screening

“However, the most important factor that will make a difference in preventing colorectal cancer is screening, so patients should have screening at the right age to detect polyps,” Dr Lim emphasises.

Doctors encourage screening from the age of 50, even for patients who feel healthy, eat well, and have regular bowel movements. But anyone with symptoms, such as rectal bleeding, persistent discomfort, or a change in bowel habits that last longer than four weeks should be screened even if they are under 50. Patients who have a family history of colorectal cancer should similarly be screened earlier as well.

Detection can come from blood tests, stool tests, CT scans, or a fibre-optic endoscopy, also known as a colonoscopy, a procedure that colorectal surgeons see as the gold standard of screening. Not as accurate as a fibre-optic endoscopy, the other tests are merely diagnostic, meaning that the patient will in any event be referred for a colonoscopy if they come up positive.

Polyps in the colon are central to diagnosis since they risk turning cancerous. If polyps are found, they are typically removed during the colonoscopy and their exact cell type determined.

“If we can identify polyps and remove them as they occur, then we will have a chance of preventing cancer. If you have no polyps, then you have less chance of getting colorectal cancer,” Dr Lim says. 

Surgery the norm

If a polyp is found to be malignant, surgery will usually be required for colorectal cancer. This is especially the case if a patient presents at an early stage, enabling surgery to prevent certain forms of the disease from spreading. At later stages, though, surgery is normally followed up with chemo- and radiotherapy.

Surgeons are now able to perform a range of procedures, but the most common are keyhole surgery to remove the tumour and the surrounding lymph nodes. As they are non-invasive and done through tiny incisions, they offer numerous benefits to patients, including smaller scars, faster recovery, and less pain.

In another form of keyhole surgery, surgeons control a robot with small arms that mimic the human hand.

“The advantage of this is having more room to manoeuvre. There’s greater dexterity and increased magnification with a three-dimensional view, allowing for more accurate perception to minimise blood loss and preserve the nerves,” Dr Lim explains.

After major surgery, patients should expect to spend from three to seven days in hospital, depending on the method employed.

Other common complaints

Aside from colorectal cancer, Dr Lim treats patients with other conditions of the perianal (anus) region, including common benign ailments such as haemorrhoids and complex fistula-in-ano.

Also known as piles, haemorrhoids affect almost 35 percent of Singapore’s population. Common symptoms include bleeding, prolapse or protrusion, itching, discomfort, and pain and can be treated in a variety of ways, depending on the stage, degree, and symptoms. It’s important for severe piles sufferers to be screened as the symptoms can mimic those of colorectal cancer.

“If you do have symptoms at the bottom end, do not just assume it’s piles,” Dr Lim advises. “Often there could be something else on the inside. After an assessment, I will generally advise you to go for a colonoscopy as well because, apart from the piles, which is a benign condition, there’s nothing as serious as cancer.”

He also treats fistulas, which are lumps around the anus that are connected to the anal canal. Sometimes these can erupt “like a volcano,” giving rise to a discharge of blood or yellow fluid.

Fistula patients will commonly suffer symptoms such as discomfort, swelling, pain, and itchiness that are often mistaken for piles. Once fistula is identified, it will be treated surgically using new techniques such as VAAFT (visually assisted anal fistula treatment) and LIFT (ligation of internal fistula tract) that require smaller incisions than the traditional fistulectomy and seton procedures that drain the fistula tract.

“VAAFT and LIFT are less invasive, with minimal downtown downtime for the patient. They can go home on the same day,” Dr Lim says. “There’s less pain and less of a big wound to deal with, and we can address complex and recurring fistulas in a more effective manner. They are safe and have low risk of incontinence.”

Dr Bernard Lim Yon Kuei is a general surgeon specialising in colorectal surgery. He sub-specialises in minimally invasive colorectal surgery and is an accredited robotic console surgeon. Dr Lim has been active in clinical practice, teaching, and conducting research in the latest surgical approaches. He has also served as an adjunct assistant professor at the Duke-NUS Medical School.