The single most important risk factor in the development of colorectal cancer is age, with the risk increasing substantially after the age of 50. Although young patients can also develop colorectal cancer, approximately 75-80% of patients diagnosed are over the age of 55.
Individuals with a family history of colorectal cancer are also at increased risk,
particularly if there are multiple family members affected, the family members are
first degree relatives, or if one or more were less than 50 years old at diagnosis.
It is important to note, however, that more than 80% of patients have sporadic
colorectal cancer, which means that most patients with colorectal cancer do not have
a family history.
Early stage colorectal cancer usually does not manifest any symptoms. Hence by the time there
are symptoms, it is likely that intermediate or late stage cancer may be diagnosed.
Some symptoms of colorectal cancer include:
Regardless of age, having these symptoms does not mean that you definitely have colorectal cancer. Rather, it means that you should consult a colorectal surgeon, so that tests can be performed to assess if you have cancer.
Yes! Colorectal cancer almost always develops from precancerous polyps. Hence regular screening
with
colonoscopy is the key to preventing colorectal cancer.
In Singapore, the Ministry of Health recommends screening for an average risk individual to
begin at age 50.
Individuals with a family history of colorectal cancer may need to start screening at an earlier
age. For
example, to start screening at age 40 or 10 years prior to the youngest case in the family
(whichever is
younger) if there is one 1st degree relative with colorectal cancer below the age of 60.
The American Cancer Society, in 2018, suggested to consider lowering the screening age to 45
years old. There
is clear evidence of the benefit of this recommendation but this has not been adopted in
Singapore likely
because of the lack of cost effectiveness.
Faecal occult blood test (FOBT)
Yearly FOBT is a common population screening method. This detects the presence of blood in the
stool. FOBT
enables detection of cancers but is not meant to detect polyps as polyps, unless very large, do
not usually
bleed. Those with a positive FOBT will have to undergo a colonoscopy to rule out colorectal
cancer.
Colonoscopy
Colonoscopy, which examines the inner lining of the colon and rectum, is a more robust screening
method as it allows detection and removal of polyps before they turn into cancer. Removal of
these polyps
during colonoscopy is a proven effective way of preventing the progression to cancer. If a
cancer has already
developed, it is also more likely to be discovered at an earlier stage on a screening
colonoscopy, when
treatment has a higher chance of cure.
Other options for colorectal cancer screening
However the evidence for the use of these 2 options for colorectal cancer screening is less strong, and a colonoscopy is still required to confirm any diagnosis if an abnormality is found on barium enema or CT colonography.
Colorectal cancer is a highly curable form of cancer, especially if detected in the early stages.
The mainstay of treatment is colorectal cancer surgery, by removing the segment of affected bowel. While this
appears daunting,
most patients are able to have their bowel continuity restored during the surgery, allowing them
to continue
to move their bowels through the anus, as they did prior to surgery. A small number of patients
may require a
stoma, but usually only temporarily.
In addition, most patients can have their surgery performed with minimally invasive techniques,
either
laparoscopically or robotically using the da Vinci robot.
Advantages of Miminally Invasive Colorectal Cancer Surgery:
Patients with more advanced disease may require treatment with radiotherapy and/or chemotherapy in addition to surgery.
With better understanding of the disease, improved surgical techniques and better chemotherapy drugs, selected cases of Stage IV cancer or locally advanced cancers where the tumour has involved surrounding organs may also potentially be cured.
Mount Elizabeth Medical Centre
#08-07, 3 Mount Elizabeth, Singapore 228510
Tel: 6454 0054
|
Fax: 6764 0054
|
Email: ask@surgicalassociates.sg
Gleneagles Medical Centre
#05-01, 6 Napier Road, Singapore 258499
Tel: 6471 0054
|
Fax: 6271 0054
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