The Enemy Inside

Colorectal cancer (also know as colon cancer) is  cancer of the large intestines, which is made up of the colon and rectum. According to the Singapore Cancer Registry report, it is the most common form of cancer in Singapore. It affects both males and females. Dr Ho said: “Most of the time, the people who are aware that colorectal cancer is the most common cancer in Singapore are those who have friends or relatives who were diagnosed with it, have done some research on it because they have some symptoms, and who have been diagnosed with it.”

Dr Ho clarifies the misconceptions behind this disease.

• Colorectal cancer is predominantly a man’s disease.
  Although women are at a slightly lower risk of contracting colorectal cancer (the ratio of men to women with the disease is about 10 men to 8 or 9 women), it is the second-most common cancer in women after breast cancer. Thus, women should not write it off as a men’s disease.
  
• Chinese are more prone to contracting colorectal cancer.
  Studies have shown that Chinese have a higher risk than Indians and Malays, possibly due to their genetic make-up and diet.
  
• Colorectal cancer afflicts older people only.
  Although a majority of patients that are diagnosed with colorectal cancer are in their 50s or older, there is a fair percentage of patients in 30s or 40s too, and a smaller number in their 20s. If you have a family history of this disease, you are at higher risk of getting cancer at a younger age.
  
• Colorectal cancer cannot be prevented.
  It is actually one of the more preventable cancers. Most colorectal cancer develops from colon or rectum polyps. these are small growths in the wall of the large intestines which can increase in size over the years before eventually turning cancerous. A colonoscopy is the best form of prevention as it can detect and remove these polyps.
  
• There is no point in getting tested as colorectal cancer is incurable.
  Testing with colonoscopy — detecting a polyp and removing it actually prevents the cancer from happening. Detecting and treating the cancer at an early stage markedly improves the chance of cure. Colon cancer is quite curable. the earlier the stage, the better the cure rate. the cure rate for first-stage colon cancer is as high as 98 per cent.
  
• Colonoscopy is painful and very unpleasant.
  Most people who have had colonoscopy complained more about the bowel preparation (where one has to take medication that causes diarrhoea to clear the bowel) than the actual procedure itself. this is because most people opt to have sedation during the procedure and hence do not feel any discomfort at all.
  
• I have no symptoms so there is no way that I have cancer.
  Most cancer in its early stages have no symptoms. Colon polyps, the precursor to cancer, also have no symptoms. only in the mid to advance stages do the symptoms appear.
  
• I lead a healthy lifestyle and my diet consists of a lot of fruit and vegetables, and very little meat. Therefore, I would not get colorectal cancer.
  There is no conclusive link between having a healthy lifestyle and diet and colorectal cancer.
  
• Any surgery to treat colorectal cancer will result in a long and painful recovery process.
  You can opt for keyhole surgery, also known as minimally invasive surgery. Keyhole surgery is one of the best advancements in recent years as it only requires a few small sub-centimetre cuts. Compared to a traditional operation, the pain is usually much less after the procedure. Some patients can even be up and walking the next day. Most of them can be discharged from hospital within five days of the operation, and may even be back at work within two weeks.
  
• Having surgery will expose the cancer and make it spread.
  Many people who have this misconception tend to delay seeking treatment. only when the symptoms become too serious to ignore do they then undergo surgery. But time is actually the main contributing factor to having the cancer spread. thus, seeking treatment and undergoing surgery early is key to containing the spread of cancer cells.
  
• If I have surgery for colon cancer, I can no longer pass motion through the anus but have to do it through a bag instead (via a stoma).
  Most colon cancer surgeries do not require patients to have a stoma. In fact, less than 3 per cent of patients require a permanent stoma — which only happens when the anal muscles have to be removed because the cancer has spread to the anus.
  
• Colorectal cancer can easily be spread to the surrounding organs such as the bladder, uterus and bone.
  The cancer can spread to the bladder and uterus (it is rarer for it to spread to the bone), when patients delay seeking diagnosis and treatment. Cancer cells that are given time to grow and spread will invade the surrounding organs. Early detection and treatments crucial because the more advance the stage of the cancer, the higher the risk of it spreading.