In this article, we will cover colorectal cancer prevalence in Singapore, risk factors, symptoms and treatment options, including palliative care options for colorectal cancer.
Overview – Colorectal Cancer in Singapore
Colorectal cancer is a common type of malignant tumor that affects the colon and the rectum. Generally, the cells of the gastrointestinal tract die off when they endure excessive physiological stress or when their lifespan has passed. This process gets regulated by a dozen of biological checkpoints. In cancer, however, cells undergo a genetic mutation that drives its growth exponentially. As a result, the cancerous cells multiply and develop into a small collection of cells that grows over time.
During the early stages, newly-formed cancer has not yet spread to other tissues, which facilitates the treatment plan. Unfortunately, when cancer grows large enough to spread through the bloodstream to other tissues, the therapeutic success rate drops significantly.
In this article, we will cover the prevalence of colorectal cancer in Singapore, as well as the common symptoms and treatments of this condition.
The Prevalence of Colorectal Cancer in Singapore
According to reports, colorectal cancer is the most common type of cancer in Singapore, together with lung cancer and breast cancer. By itself, colorectal cancer accounts for:
- 1 in 6 cancer diagnoses among males
- 1 in 7 cancer diagnoses among females
Worldwide, numbers are not looking better, with colorectal cancer being the second most deadly cancer. In 2018, this cancer caused 881,000 deaths.
The Risk Factors of Colorectal Cancer
Over the years, researchers identified several risk factors of colorectal cancer, including:
- Advanced age (most cases are diagnosed after the age of 50)
- Sedentary lifestyle (no physical activity)
- A diet rich in animal protein and saturated fats
- Low fiber diet
- Excessive alcohol consumption
- Having a medical history of other types of cancer (e.g., breast, ovarian, uterine)
- Having a family history of colorectal cancer or colorectal polyps
- Long-time diagnosis of inflammatory bowel diseases (IBD) such as ulcerative colitis or Crohn’s disease
- The presence of polyps in the colon or rectum. A number of colorectal cancer cases are found to start within polyps, which develop inside the bowel wall and are confirmed through colonoscopy.
Signs and Symptoms of Colorectal Cancer
The signs and symptoms of colorectal cancer vary from one individual to another. Here are the common symptoms:
- Changes in bowel habits, such as constipation, diarrhea
- Reporting a sensation that the bowel is not empty despite bowel movement
- Melena, which is the presence of blood in the feces that turn the stools black
- Rectal bleeding, or incidents of bright, red blood coming from the rectum
- Pain and cramping in the abdomen
- Unexplained weight loss
- Severe fatigue
- Iron deficiency anemia in men
- Iron deficiency anemia in women after menopause
As you may notice, the symptoms of colorectal cancer are highly non-specific, which explains the difficulty of diagnosing this condition during the early stages. If you or your loved ones experience any of these symptoms for more than a few weeks, it might be a good idea to visit your doctor for further evaluation.
The Staging of Colorectal Cancer
The staging of colorectal cancer is important for several reasons. It helps with predicting the prognosis (i.e., outcome) of patients and determining the best treatment approach to follow. The stages of colorectal cancer are:
Stage 0 – this is the earliest stage when cancer has not yet penetrated the basal membrane of the tissue. Doctors refer to this stage as carcinoma in situ.
Stage 1 – cancer penetrates the basal membrane of the bowel; however, it does not spread beyond the wall of the rectum or colon.
Stage 2 – cancer reaches and grows through the wall of the colon or rectum. It does not reach nearby lymph nodes.
Stage 3 – cancer invades nearby lymph nodes but does not affect other organs.
Stage 4 – cancer reaches other organs (e.g., liver, lungs, ovaries, peritoneum).
Unfortunately, 40% of colorectal cancer cases get diagnosed in an advanced stage.
The Treatment Options of Colorectal Cancer
Colorectal cancer is one of the most treatable cancers if detected at an early stage. The available treatment options include:
Surgery for colorectal cancer
Surgery is an indispensable tool in treating colorectal cancer. The surgeon will remove the malignant tumor and the nearby lymph nodes to reduce the risk of metastasis (i.e., cancer spreading to other tissues). In some cases, the rectum is completely removed, with a colostomy bag attached for drainage. The purpose of the colostomy bag is to collect stool, which is a temporary solution in many cases.
If the diagnosis of colorectal cancer is early, surgery is the most effective way to treat it. It may also benefit some cases of advanced stages as part of palliative care.
Chemotherapy for colorectal cancer
Chemotherapy revolves around using pharmacological drugs to destroy cancerous cells. When the tumor is large enough, your doctor may recommend chemotherapy before the surgery to shrink it. Recently, scientists developed new treatments that target specific proteins, which are responsible for promoting cancer growth. These drugs have fewer side effects relative to conventional chemotherapy. Such drugs include:
- Bevacizumab (Avastin)
- Ramucirumab (Cyramza)
Radiation therapy for colorectal cancer
Radiation therapy uses high-energy radiation beams to disintegrate the tumor. Similar to chemotherapy, radiation therapy may be beneficial before surgery to shrink the tumor.
Palliative Treatment for Colorectal Cancer
Palliative care refers to measures that alleviate the suffering of the patient. Palliative care becomes an option when the patient has an advanced case of colorectal cancer that does not improve with the treatments listed above. In the case of colorectal cancer, symptoms such as nausea, vomiting, pain and constipation may be managed at home together with support from Ninkatec’s care teams.
Colorectal cancer is a very common condition that affects millions of people every year. It is the second-leading cause of death worldwide and the first in Singapore. We hope that this article sheds some light on the primary aspects of colorectal cancer, and the treatment and care options.
Early detection helps to improve treatment effectiveness and save lives. Singaporeans above 50 years old and those younger with high risk factors are recommended to participate in regular screening to combat the disease. Eligible Singaporeans can participate in the Screen For Life programme to enjoy subsidised or free of charge screening for colorectal cancer and other common cancers.