Colorectal Cancer in Singapore

Based on the 4th Colorectal Cancer Symposium March 7, 2005, organized by Singapore Cancer Society at the Meritus Mandarin Hotel. The below a personal notes taken during the seminar I hope will be help for your colorectal research.

You will learn:

• 1. What is colorectal cancer?
• 2. Learn How to get Free screening if you are over this age?
• 3. Who can get colorectal cancer?
• 4. Based on today’s statistics what are your chances of survival should you be diagnose with this disease?
• 5. How bad is the situation in Singapore?
• 6. What are the signs and symptoms to show that you may have colorectal cancer? -
• 7. How the medical doctors diagnose and treat this disease?
• 8. What are your chances of survival with colorectal cancer?
• 9. Questions myself and other participants asked the doctors and their reply. You may be surprised.

Singapore Colo-rectal Cancer Facts

• 1. Colorectal cancer is the most common cancer in Singapore.
• 2. We are the Number 2 incidence rate in the world.
• 3. 1 in 20 Singaporeans will get this cancer in the lifetime.
• 4. New cases are rising each year.
• 5. Half of those diagnose die of the disease since most are usually in the advanced stages.
• 6. Early detection results in 80-90 % chances of survival.
• 7. Over 50% of colon cancer occurs in the distal part of the colon and the rectum.

It can occur in any part of the colon, but the most common >50%of cases, the location is in the distal part of the colon and the rectum near the anus, thus the name “colo-rectal cancer.”Who is at risk of colorectal cancer?

Any one, at any age, but you risks is highest if you are are a 50 years and above. As a Singaporean or Permanent Resident you get FREE screening. Call 6221-9578 or visit http://www.singaporecancersociety.org.sg

What are some symptoms I can observe to know I may have colorectal cancer?

• -Blood in the stools
• -Change in bowel habits not due to food poisoning.
• -Unexplained anemia or lack of blood
• -Abdominal pain
• -Sometime no symptoms

How do medical doctors diagnose for this cancer?

They asked about your family history, physical examination of masses of cancer cells, colonoscopy, and biopsy or barium enema.

What is colorectal cancer?

Most developed from polyps. A polyp is basically uncontrolled growth of cells in your colon area resulting in a mass of cells called a polyp. Polyps are usually, benign or non-cancerous.These polyps could then continue growing and invade through the mucosa or the intestinal walls. In stage 3 of the disease, it spreads to the lymph nodes and in the final stage number 4 it spreads to the other organs of the body. In general, once the cancer spread to the lymph nodes, you are considered to have advanced cancer.Where does colorectal cancers occur?

What Medical doctors say causes colon cancer?

• -No one really knows and say the about 15% is genetic.
• -Low fiber intake
• -90% due to environment
• -Obesity
• -High caloric intake
• -Processed or preserved meat such as hot dogs, sausages, luncheon meat, cured ham and bacon.
• -Some saturated fat may be responsible.
• -Refine sugar and starch raising the insulin levels.

What medical doctors believe may prevent colorectal cancer?

• -Natural antioxidants from food
• -Fish and lean meat seem to be protective
• -Surgery to remove the polyps from the colon upon detection followed by annual check up.
• -Sometimes removal of entire colon, if necessary.

What drugs can help prevent colorectal cancer?

Aspirin seems to show some properties of lowering polyp formation.

What is the best prevention according to the medical doctors?

First go for the screening if you are over 50 yrs of age. It’s FREE in Singapore. Or if you have a close relative who has this cancer say at age 45 yrs, you should go for the test 10yrs earlier or when you are 35yrs of age for early detection. (Our comments: Note that our medical community see preventive measures as better detection. Is that how you see prevention?)What are my chances of survival from this dreaded disease?

Your cure rate is highest if you are at stage 1 of the disease. After surgery, if you do not get a relapse after 5 years, your chances of survival are very high. How do medical doctors diagnose for this cancer?

They asked about your family history, physical examination of masses of cancer cells, colonoscopy, and biopsy or barium enema.

What is FOBT?

It is called the “Fecal Occult Blood Test.” It’s the most common screening test that is now available free to Singaporeans over the age of 50. It is simple and non-invasive. It works by detecting blood in the stools than may not been observed with the naked eye, hence, the term “occult” or “hidden.”This screening method is thought to reduced death rates by 15-30 % and reduced the chance of getting the cancer of 17-20%. What is means here is that, if you are detected with polyps then removal via surgery can prevent further cancer growth.What are the major diagnosis methods or test for colorectal cancer?They are Flexible Sigmoidoscopy, Colonoscopy, combination of the first two test and the Double contract Barium Enema.

Are there any new tests for detection?

The medical community is exploring Virtual Colonoscopy and Stool Based Molecular Screening. In other words they test for DNA marker of cancer genes in your sh**.

What is Flexible Sigmoidoscopy?

It is a 60-cm scope used to insert into the distal end or last half of the colon performed after 1 to 2 saline enemas. This detection has decreased death rates by up to 59%. Recommended to be test with this method every 5 years. Below is the picture, you imagine how it gets in.

What is Colonoscopy?

This is the Gold Standard for colorectal cancer diagnosis, meaning that it is the most accurate test available today, reducing death rates by from 76-90%. Combined with Flexible Sigmoidoscopy, death rates reduction can be as good as over 90%. Incidentally, it’s also the most expensive test.

It is a longer scope 160-cm in length that reaches to the entire colon. You will require a lot of laxatives to clean the bowel and you will go to the toilet about 10 to 15 times!

Disadvantages are that inaccuracy is about 6 to 27 % rate. From the patient point of view, it required undesirable bowel preparation to clearly see the polyps, very expansive (4 figure $$), high chances of colon perforation. In other words, that is a good chance they damage your colon by creating holes in it!

What is Double Contrast Barium Enema Test?

It entails similar bowel prep to colonoscopy. Then barium is pumped through your colon. You will then be examined in different positions anywhere between 30 to 60 min.

It is the most inaccurate diagnosis test available.

According to medical experts in Singapore what are the best cures available?

• -Surgery is the main treatment (about 50% of the time).
• -Minimally invasive surgery (recover faster)
• -Colonic Stent. It is similar to heart stent to allow blood flow, colonic stent allows feces to flow since many cancer patient have constipation.

What drugs can help prevent colorectal cancer?

• Aspirin seems to show some properties of lowering polyp formation.

How much fiber should one take per day?

• Recommended to take 30 grams per day. An apple gives about 5 grams.

Does piles or hemorrhoids cause colorectal cancer?

• Hemorrhoids are closely related to colorectal cancer.

Are there any studies that correlate bowel movements or constipation with incidence of colorectal cancer?

• No direct answer was given. We did our homework and found research information on bowel movement frequency and colorectal cancer correlation

How can I differentiate colorectal cancer with other similar bowel disease?

Colorectal Cancer usually presents with blood in the stools and abdominal pain, but may not be seen with the naked eye. Blood is darker red mixed with stools, if observable.  In contrast, if you have hemorrhoids, blood is found in the stools  but since bleeding occur near anus and the blood is bright red in color.  It is usually not mixed with stools and not accompanied by abdominal pain. With Irritable Bowel Syndrome, you can have abdominal pain but there is no blood in the stools.