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colon & Rectal Cancer

Colon and rectal cancer is the cancer of the large intestine. It is currently the most common cancer in Singapore and the incidence is still increasing at alarming rate. There are approximately 1500 new cases of colon and rectal cancer in Singapore every year, affecting mainly people more than 50 years of age. Screening for colorectal cancer is the most effective way of prevention of this disease. Though the exact cause of colon and rectal cancer is still unknown, it can be attributed to the appearance of small growths in the lining of the large intestine called polyps. These colon and rectal polyps take more than 3 to 5 years to become cancerous. Prevention of colon and rectal cancer can be achieved if these polyps are detected early and removed.

Screening and prevention of colon and rectal cancer

Who should go for screening for colon and rectal cancer?

  • Anyone with no symptoms and more than 50 years of age
  • Anyone who has a family history of colon and rectal cancer

What are the recommended screening tests for colon and rectal cancer?

  • Testing stool for hidden blood
  • Colonoscopy
  • Barium enema
  • CT scan

What are the advantages and disadvantages of testing stool for hidden blood?

  • Advantages: cheap, non-invasive
  • Disadvantages: need to repeat test every year, false negativity and false positivity

What are the advantages and disadvantages of colonoscopy?

  • Advantages: can remove polyps at the same time, only need to repeat colonoscopy after 5 to 10 years
  • Disadvantages: more expensive and invasive than stool test

Screening of colorectal cancer is only for people with no symptoms at all. People with symptoms suggestive of colon and rectal cancer should see a Singapore colorectal surgeon for colonoscopy.

What are the symptoms of colorectal cancer?

  • Irregular bowel habit
  • Increasing constipation
  • Frequent diarrhea
  • Change in bowel habit
  • Rectal bleeding
  • Sensation of incomplete bowel motion
  • Abdominal pain

What are the treatment options for Colon and Rectal cancer?

Surgery

Surgery is the first line of treatment for early stages of colon and rectal cancer. Cure can be achieved with surgery in early stages of colon and rectal cancer. Various surgical options are available for the cancer of the colon and rectum.

Chemotherapy

Chemotherapy can be given before surgery for late stages of colon and rectal cancer. Chemotherapy helps to reduce the size and severity of the cancer. As a result, the surgery for colon and rectal cancer can be performed with less complications and more thoroughly.

Radiotherapy

Radiotherapy is usually performed before surgery for very late stage of rectal cancer. Radiotherapy is given together with chemotherapy in this situation to reduce the size and severity of the cancer.

References

1. KH Ng et al. Surgical treatment of colorectal cancer. SURGERY 2005.

2. KH Ng et al. Improved survival in an Asian cohort of young colorectal cancer patients: an analysis of 523 patients from a single institution. Int J Colorectal Disease. 2009 Sep.

3. KH Ng et al. Critical analysis of mucin and signet ring cell as prognostic factors in an Asian population of 2,764 sporadic colorectal cancers. 2010 Oct; 25(10):1221-9. Int J Colorectal Dis.

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