Colon cancer, sometimes also called bowel cancer, is the second most common cancer in Malaysia. This is according to the National Cancer Society of Malaysia. In Singapore, it is the most common cancer. In fact, based on the latest figures from the Singapore Cancer Registry, there was a 19% increase in new cases. And the figure is expected to rise as the society becomes more affluent (see attached newspaper article). This is because some of the factors that predisposed to colon cancer are usually seen in more developed economies, like rich food, red meat, sedentary lifestyles, diet low in fibre, obesity and smoking. However, it is not all gloom and doom. With advances in medical science, there are some recent good news related to the fight against colon cancer. 3 pieces of good news to be exact

colorectalCancer

 

The first piece of good news is that colon cancer can be prevented through screening.

Traditionally, the public has been encouraged to have their stools check for occult blood annually once they reach 50 years old. This is done through special test kits called the faecal occult blood test (FOBT). More recently, another kit, called the faecal immunochemical test (FIT) has been developed, and it is more sensitive than the FOBT kit. Both test for the presence of blood that is not visible to the naked eye, thereby allowing the detection of cancer. Hopefully this leads to the detection of the cancer at an earlier stage, thereby ensuring better survival following treatment. Early stage cancers usually have no symptoms. By the time symptoms appear, the cancer would likely have spread already.

However such kits are not so sensitive in detecting polyps, which are abnormal small growths on the inner lining of the large intestine. Majority of the colorectal cancers start off as such polyps. Usually non-cancerous in the beginning, but with time, these polyps will turn into cancer. If we can detect such polyps and remove them before they turn cancerous, we can then prevent cancer. Indeed, in the United States, there is a move from cancer detection to cancer prevention, and that is by recommending colonoscopy as the preferred strategy for colorectal cancer screening. Why colonoscopy? Because colonoscopy can detect even small polyps and it also allows the doctor to remove such polyps. According to the guidelines published by the American College of Gastroenterology in 2009, studies have shown that by using colonoscopy as a screening strategy, the incidence of colorectal cancer has been reduced by as much as 80-90%.

Thus the primary aim of screening in colorectal cancer has changed: from reducing death through reducing incidence of advanced disease, to that of preventing colon cancer altogether.

The second piece of good news is that surgeons are now able to use keyhole surgery to remove colon cancer. In the past, surgery to remove colon cancer would entail a long incision, and because of that, patients took a longer time to recover. Not to mention the long ugly scar. Now, for patients whose tumours are not too big, surgeons can perform the same operation using small holes. This translates to less post-operative pain, earlier discharge from hospital, earlier return to normal activities and work, and better cosmetic outcomes. Many studies have been published which showed that such keyhole techniques are safe, and they do not compromise the cancer survival rates of the patients, when compared to the traditional open operation.

The third piece of good news is that for patients with stage IV colorectal cancer, that is cancer which has already spread to other parts of the body, survival rates have improved tremendously over the past 10 to 20 years. In the past, median survival of patients with such advanced disease was usually less than 6 months. Median overall survival is now nearly 30 months. This is mainly due to advances in pharmaceuticals and surgical interventions. Newer generations of chemotherapy drugs can now better control the disease in such patients. Such drugs are better tolerated now than in the past, and there have been additional improvements in supportive medications that reduce the symptoms for patients on chemotherapy.

However, long-term cure is rare just with chemotherapy alone. Usually treatment is combined with surgical removal of the cancer spread, especially if the spread is to the liver or lung or both. For colorectal cancer, the liver and the lung are two of the most common sites where the cancer cells can spread to. With better safety profile of liver surgery and lung surgery, more patients with stage IV disease can now confidently opt for such combined treatment. This also illustrates the point that optimal outcomes can only be achieved when the treatment is coordinated by a multi-disciplinary team, made up of medical oncologists,  cancer surgeons, radiologists, just to name a few. Consequently, more patients can be expected to live longer, and in a select few, even be cured. This was not possible in the past.

In conclusion, although the incidence of colorectal cancer is rising, there is a silver lining. Significant advances have been made in both prevention of disease as well as treatment of disease. Of course, prevention is better than cure. So if you are 50 years old or above, go for your colonoscopy by a certified endoscopist today.

 

Nexus Surgical Associates

(This article was commissioned by the Malaysian Press for consideration of publication in a health supplement)

 

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