Medical Care ,  Oncology (Cancer)

Colorectal cancer can be beaten

March 29, 2022

Early screening can save many patients with the common malignancy, while advanced treatments are readily available


Colorectal cancer can be beaten

There’s a lot we can now do to prevent and cure colorectal cancer, beginning with healthy lifestyles and regular screening. And for those with the disease, an array of therapies developed over the years continues to provide patients with better chances of survival.

That’s the takeaway message from a recent webinar organised by the Parkway Cancer Centre (PCC) in Singapore, where a range of experts offered up the latest treatment advances for one of the world’s most widespread and deadly malignancies.

Colorectal cancer, often referred to as bowel or colon cancer, is the most common cancer among Singaporean men, said Dr Foo Kian Fong, Senior Consultant in Medical Oncology at PCC. But Singapore is not alone. The International Agency for Research on Cancer estimates that in 2020 there were roughly two million new cases and almost one million deaths from the disease worldwide.

Though the condition has long been a top killer in Singapore, many deaths could be avoided and survival rates much higher given the preventative tools at our disposal, stressed Dr Chew Min Hoe, General and Colorectal Surgeon at The Surgeons. Just about 60 percent of Singaporean patients survive for five years after diagnosis, a good indicator the disease has been cured in those patients. The main culprit for not achieving higher rates is late diagnosis as many people present with advanced cancers.

Therefore, early screening is key to improving survival since colorectal cancers are often asymptomatic in the initial stages.

The main screening options include an annual faecal immunochemical test (FIT) and a colonoscopy every five to 10 years. People at average risk should start them when turning 50, while those at greater risk, like

first-degree relatives of colorectal cancer patients, should get screened much sooner and more regularly. Those experiencing recurring symptoms, like changes in bowel habits (including constipation and diarrhoea), bloating, stomach pain, especially at night, paleness, a lump in the tummy, unexplained fatigue, and weight loss, should also undergo yearly screening.

FIT is an inexpensive and non-invasive approach to detecting hidden blood in the stool, a potential sign of colorectal cancer, and is done by collecting a sample to test with an at-home kit. Positive results, however, don’t necessarily indicate cancer since blood in the stool can result from benign conditions like piles or diverticula. To confirm a final diagnosis, patients need to undergo a colonoscopy, an invasive procedure where a small tube with a camera is inserted through the anus to check the bowels for signs of disease.

Carrying out a colonoscopy is the gold standard for colorectal cancer screening because it can provide the most accurate diagnosis while allowing doctors to see and remove bowel polyps, small benign growths in the intestine that over time can become cancerous. “Regular screening and removal of polyps by colonoscopy reduces the risk of colorectal cancer by up to 90 percent,” explained Dr Chew.

Another tool to reduce the risk of colorectal cancer is adopting a healthy lifestyle.

A diet rich in fruits, vegetables, and fish, while limiting alcohol and red or processed meat, can contribute to risk reduction. People should also avoid smoking, sleep at least seven hours at night, and do moderate exercise like brisk walking for about 150 minutes per week or more vigorous physical activities like weightlifting for 75 minutes weekly.

 

How to deal with colorectal cancer

For those who get colorectal cancer, a formidable set of well-established treatments is available that can control and even cure the majority of cases.

“Treatment strategy depends on cancer stage,” explained Dr Ng Chee Yung, Colorectal Surgeon at One Surgical Clinic & Surgery, who believes surgery has come a long way in the treatment of these malignances.

An operation is usually needed for cancers in stages one to three where the tumour is confined to the bowel or spread to nearby lymph nodes and aims to remove the cancerous mass while keeping the bowel connected and functional. Most procedures can be done in a minimally invasive way, where surgeons make small key size holes in the belly to insert surgical instruments and take the tumour out, allowing the patient to recover quickly.

Surgery can achieve a very high cure rate of 90 to 95 percent in patients with stage one and two cancers, without the need for further treatment.

Some patients with stage two cancers, however, may also need post-op chemotherapy, or drugs that stop cancer cells from dividing, to kill off any residual bits of cancer, explained Dr Zee Ying Kiat, Senior Consultant in Medical Oncology at PCC, adding that survival rates hover around 60 to 80 percent.

Chemotherapeutic drugs are usually recommended post-surgically for stage three cancers to maximise the chances of cure because the malignancy has spread to lymph nodes and is more likely to recur. In this scenario, survival rates drop further to 30 to 60 percent.

The prospects are usually bleaker for patients with advanced cancers or in the fourth stage because the malignancy has spread to several faraway organs like the liver, with the five-year survival rate being less than five percent. But patients can still benefit from palliative chemotherapy, radiation, and advanced drugs like targeted therapy and immunotherapy.

Doctors

Dr. Foo Kian Fong
Oncology
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Dr. Zee Ying Kiat
Oncology
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