Colorectal cancer on the rise: What are the symptoms to watch out for

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SINGAPORE - Film director Desmond Tan found out he had stage 4 colorectal cancer three years ago. The cancer had spread from his colon to his liver and surrounding lymph nodes.

 

He started to feel severe and sharp pain in his lower abdomen, and had blood in his stools a few months before he was diagnosed.

 

He was also unable to pass motion properly despite going to the toilet five to six times a day, says the 47-year-old, who is married and has two sons aged four and six.

 

"The feeling was like knives digging into my intestines: sharp and non-stop. I would often break out in cold sweat and had to stop myself from screaming," he says.

 

Colorectal cancer is the cancer of the colon (large intestine) and the rectum, which is the passageway connecting the colon to the anus.

 

It is the most common cancer among men and the second most common cancer among women in Singapore after breast cancer.

 

The number of people diagnosed with colorectal cancer here has increased over the years, according to figures from the Singapore Cancer Registry Annual Report 2014 and 2019. Cases among men went up from 5,101 over 2010 to 2014 to 6,436 over 2015 to 2019. Among women, cases increased from 4,219 to 5,253 over the same period.

 

Two of three hospitals and clinics that The Straits Times checked with saw a rise in colorectal cancer cases last year.

 

Dr Wong Seng Weng, medical director and consultant medical oncologist at Singapore Medical Group's The Cancer Centre, treated 20 to 30 per cent more colorectal cancer patients last year, compared with 2019.

 

Similarly, Singapore General Hospital (SGH) has seen a 20 per cent rise in cases last year from 2020.

 

Dr Isaac Seow-En, a consultant at its department of colorectal surgery, says many patients chose to reschedule their appointments to avoid the hospital in 2020.

 

He notes that despite national colorectal cancer screening programmes, about 60 per cent of cases are diagnosed at later stages, citing findings from the Singapore Cancer Registry Annual Report 2019.

 

Colorectal cancer usually starts with growths of tissue called polyps on the inner lining of the colon or rectum, which may develop into cancer over time.

 

Polyps, Dr Seow-En explains, often do not cause symptoms, and those with stage 1 or 2 colorectal cancer may feel well.

 

People with stage 3 and 4 cancers are far more likely to have symptoms including blood in the stools, changes to bowel habits, abdominal discomfort or pain, and loss of weight or appetite.

 

In some cases, however, patients with late-stage cancer may not exhibit symptoms.

 

Dr Quah Hak Mien, a consultant colorectal and general surgeon at Gleneagles Hospital, recently saw a businessman in his mid-50s for late-stage colorectal cancer.

 

"He was very shocked when he heard the report because he felt well and had no symptoms," says Dr Quah.

 

Colorectal cancer is preventable, doctors stress. One of the main ways to do so is through screening for those aged 50 and above.

 

The assessment for colorectal cancer starts with a thorough history taking and physical examination by a doctor.

 

Dr Seow-En explains that faecal collection kits look for microscopic blood in the stool, which may suggest colorectal polyps or cancer.

 

"While stool tests are noninvasive and safe for patients, they are not 100 per cent accurate, and if positive, patients are usually referred to a specialist for further confirmatory tests," he says.

 

Of these, the most common test performed is a colonoscopy, which can detect polyps that are potentially pre-cancerous.

 

Dr Seow-En says it may take as long as 10 years for a small polyp to develop into cancer, hence the removal of the polyp during this period can prevent cancer from developing.

 

"As a colorectal surgeon, I have removed several thousand polyps from patients, and I would like to think that many cancers have been prevented in this way," he adds.

 

Early detection is important in increasing the success of treatment. Patients treated at stage 1 or 2 have a greater than 80 or 90 per cent chance of surviving more than five years after their treatment, notes Dr Seow-En.

 

For Mr Tan, who directs commercials, treatment started with four cycles of chemotherapy before surgery to remove 30cm of colon and surrounding lymph nodes, as well as 3.5cm of the tumour. He then went for another four cycles of chemotherapy.

 

Unfortunately, almost nine months after his diagnosis, scans showed that the cancer had progressed and metastasised to the peritoneum, the thin membrane surrounding the abdominal organs.

 

Mr Tan had to undergo chemotherapy and surgery again to treat the cancer.

 

In October 2020, he was declared to be in remission when a check-up showed no evidence of the disease.

 

Mr Tan says his 42-year-old wife has been his main pillar of support: "It was her strength that kept me alive and kicking. Even though she was holding down a full-time job and looking after our two boys, she still had to worry and think about me."

 

He used to eat a lot of fast food and instant noodles, but now stays away from processed food and consumes more vegetables, tofu and beans.

 

Mr Tan has also become an advocate for early cancer screening.

 

He says: "Colorectal cancer does not creep up suddenly. It takes a long time to develop and is a cancer that can be arrested early. I wish that I had gone for a screening much earlier. Who knows, a few months earlier and it might not have been stage 4?"

 

How to prevent colorectal cancer

 

While colorectal cancer can strike at any age, it mostly occurs after the age of 50 and people of Chinese ethnicity have a higher risk of getting the disease.

 

People with a family history of colorectal cancer or polyps, which are non-cancerous growths of tissue, may also be at a higher risk.

 

Although these are factors that cannot be controlled, doctors say there are lifestyle and dietary choices that people can make to help prevent colorectal cancer.

 

This includes maintaining a healthy weight, exercising regularly and avoiding smoking and excessive alcohol consumption, says Dr Quah Hak Mien, a consultant colorectal and general surgeon at Gleneagles Hospital.

 

"We should maintain a balanced diet that has lots of vegetables and fruit and whole grains, and reduce the consumption of red meat and processed meat. Eating meat cooked at very high temperatures, like grilled meat, might also increase one's cancer risk," adds Dr Quah.

 

Many people in Singapore are not doing tests that can help detect colorectal cancer early, doctors say.

 

Citing findings from the Singapore Cancer Registry Annual Report 2019, Dr Isaac Seow-En, a consultant at Singapore General Hospital's department of colorectal surgery, says that despite national colorectal cancer screening programmes, about 60 per cent of cases are diagnosed at later stages of the disease.

 

People aged 50 and above are advised to go for a colonoscopy, where a long flexible tube is inserted into the large intestine to check for tumours. If nothing worrying is found, a subsequent colonoscopy is necessary only 10 years later, says Dr Seow-En.

 

Another way to screen for colorectal cancer is through a stool test called the Faecal Immunochemical Test, which is offered free of charge by the Singapore Cancer Society. It can detect small amounts of blood in the stool which are usually invisible to the naked eye.

 

Those who are above age 50 and have no symptoms of colorectal cancer can do this test once a year as an alternative to a colonoscopy.

 

Says Dr Quah: "Early detection of colorectal cancer improves the chances of successful treatment and long-term cure."

 

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.

 

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