Year 2018
July 2018
15 July 2018

Colorectal Cancer

What ailment in your field is the most disruptive to a person’s lifestyle? How so?

One of the most serious ailments in the gastroenterology field is definitely colorectal cancer, or more commonly known as colon cancer. Colon cancer is currently the third leading cause of cancer in men worldwide and the number one cancer in Singapore. This necessarily takes a toll on the sufferer’s health. Needless to say, the side effects of colon cancer including fatigue, loss in body mass and general discomfort in digestive system would drastically reduce quality of life. One has a reasonable concern undergoing treatments, side effects and struggling to cope with overwhelming emotions while juggling family commitments, holding their jobs and even engaging in daily activities.

At what age does it usually occur? Is it genetic?

The risk of colorectal cancer increases with age. Colorectal cancer can occur in youths and young adults, but the majority (as high as 90 per cent of these cases) occur in people 50 and above. The average age of a person being diagnosed with this cancer is 64.

Generally, most colorectal cancers (around 95 per cent) are sporadic. This means that genetic mutations which cause cancer occur only after a person is born and there is no risk of inheriting colon cancer. In the less common (5 per cent) of cases, colorectal cancer may run in these families if first-degree relatives or other family members have suffered from colorectal cancer. This is especially so if family members are diagnosed before 60 years old. Furthermore, members of families where rare inherited conditions such as Lynch Syndrome, Familial Adenomatous Polyposis (FAP) and Inflammatory bowel disease (IBD) occur have a significantly increased risk of  contracting colorectal cancer.

Can it be prevented or spotted early? If so, how?

As with other types of cancer, colon cancer is a silent killer. It often goes unnoticed in the early stages, and understandably so, with little or no known symptoms. Thus, it is recommended that people with an average risk should begin screening at age 50. Screening tests such as colonoscopy should be done once every ten years. Colonoscopy involves inserting a flexible tube called colonoscope into the rectum to examine the inner lining of the large intestine. It has high accuracy rate of 95 per cent. During this procedure, the doctor can remove any known colon polyps to greatly reduce risk of cancer development. Other tests include Faecal Immunochemical Test (FIT), Double Contrast Barium Enema (DCBE) and Stool DNA tests which have to be carried out more frequently.

One can take active steps to prevent colon cancer by leading a healthy diet and lifestyle. Eating a variety of fruits and vegetables as well as whole grains would be beneficial as these ‘super foods’ contain fibre, minerals, vitamins and antioxidants that help to prevent colon cancer. Quit smoking and limit alcohol intake to one glass a day for women and two for men. Also, exercise at least half an hour three to five times a week and maintain a healthy BMI.

These serve as preventive measures as an essential and effective safeguard against colon cancer such that no corrective measure is necessary in future.

What are the symptoms?

As previously mentioned, in the early stages of colorectal cancer, there are no visible symptoms. In later stages, common symptoms include a change in bowel habits including constipation and diarrhoea that lasts for more than a few days, blood in the stools, abdominal discomfort such as gas, cramps, and pain. A sense fatigue or weakness, unintended weight loss and anaemia can also signal colon cancer. If one or more of these symptoms persists, do consult your doctor immediately.

What is involved in treating the condition? What’s the recovery time?

In general, surgery is used to treat Stages 0, I, II and III of colorectal cancer. During laparoscopic surgery, the tumour and part of the healthy colon or rectum and nearby lymph nodes will also be removed. Many Stage II and III patients with colorectal cancer also receive chemotherapy and those with rectal cancer receive both chemotherapy and radiotherapy. Chemotherapy is the usage of drugs to destroy cancer cells so they are unable to grow and divide. Radiotherapy involves the use of high energy X-rays to destroy tumour cancer cells. These help to further eliminate cancer after surgery. In Stage IV, colorectal cancer is not curable but treatable. The symptoms can be managed and growth of tumour slowed using a combination of surgery, chemotherapy and radiotherapy.

Surgery takes three to six weeks recovery time. Patients usually undergo a few cycles of chemotherapy where each cycle typically lasts two to four weeks. Radiotherapy lasts for a couple of weeks, depending on the individual.

What is the one thing about this ailment that people don’t know?

A higher stage of colorectal cancer does not necessarily mean a more serious case of cancer and tumour size does not necessarily make a difference. Staging solely serves to match the most optimal treatment to the needs of the patient.

A Specialist’s Point of View – Written by Dr Ganesh Ramalingam

Dr Ganesh Ramalingam
graduated from National University of Singapore in 1997 and he completed his post graduate training and Fellowship with the Royal College of Surgeons, Edinburgh. He is currently a Consultant General Surgeon with PanAsia Surgery at Mt Elizabeth Novena, Mt Elizabeth Orchard and Parkway East Hospitals, specializing in General Surgery, Bariatric and Advanced Laparoscopic Surgery, Endoscopy and Trauma.

He developed the Weight Management Centre and Bariatric Surgery in Alexandra Hospital and Khoo Teck Puat Hospital since 2001 and is currently part of the Centre for Weight Loss and Metabolic Surgery in PanAsia Surgery. During this period, he has performed multiple procedures in Bariatric Surgery which include Laparoscopic Adjustable Gastric Banding, Laparoscopic Sleeve Gastrectomy, Laparoscopic Roux en Y Gastric Bypass, Laparoscopic Biliopancreatic Diversion and Intragastric Balloon inserted Endoscopically. He has performed numerous revisional Bariatric procedures and is actively involved in multiple research projects in Bariatrics. He is a founding committee member of the OMSSS (Obesity and Metabolic Surgical Society of Singapore)

Dr Ganesh was involved in a one year fellowship in Trauma at Beilinson Hospital, Rabin Medical Centre, Petach Tiqva, Israel. He participated in the teaching of paramedics and International students in both prehospital and inhospital Trauma and Critical Care and was in the roster for the Trauma Team during Activations. He organized and presented the monthly Trauma Audit lectures and gave talks at International Conferences representing Beilinson Hospital. He was also heavily involved in Critical Care of patients in the various Intensive Care Units, performing multiple bedside procedures like peritoneal washouts for open abdomen and percutaneous tracheostomy insertion. He also participated in the General Surgery and Bariatric Surgery programs in Beilinson Hospital where he was in the active roster as the senior surgeon on call for 6 months.

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