Colon Cancer Treatment

Colorectal Cancer is the No. 1 cancer in Singapore

Dr Dennis Koh

Medical Director & Senior Consultant Colorectal Surgeon

MBBS (Nottingham), B Med Sci (Nottingham), MMed (Surgery), FRCS (Edinburgh), FAMS

Dr Sharon Koh

Senior Consultant Colorectal Surgeon

MBBS (Singapore), MMed (Surgery), FRCS (Edinburgh), FAMS

Dr Pauleon Tan

Senior Consultant Colorectal Surgeon

MBBS (Singapore), MMed (Surgery), FRCS (Edinburgh), FAMS

Colorectal Cancer is the
No. 1 cancer in Singapore

Colorectal cancer is cancer of the large intestines and can manifest silently over a period of 5 to 10 years.

Colorectal cancer in Singapore is the most common cancer in men and the second most common cancer in women. Colorectal or colon cancer occurs when cells in the colon or rectum mutate and form a polyp. While most polyps are initially benign, some can gradually transform into cancer through a well-documented process called the adenoma-carcinoma sequence.

Left untreated, polyps may turn cancerous, metastasise, and spread to other parts of the body. Fortunately, screening methods such as colonoscopies can detect and remove precancerous polyps before they develop into cancer. This proactive approach not only facilitates early diagnosis but can also prevent cancer altogether by addressing the risk at its earliest stages.

What are the Different Stages of Colorectal Cancer?

The TNM staging system is used to classify colorectal cancer based on the tumour’s size (T), lymph node involvement (N), and metastasis (M). Understanding these stages helps our colon cancer specialists determine the best treatment plan.

Stage 0 - Cancer is limited to the innermost lining of the colon or rectum.

Stage I - Cancer has grown through the inner lining but not into the deeper.

Stage II - Cancer has spread into or through the outer layers of the colon or rectum but not to lymph nodes.

Stage III - Cancer has spread to nearby lymph nodes but not to distant organs.

Stage IV - Cancer has metastasised to distant organs, such as the liver or lungs.

Colorectal Practice is dedicated to the prevention, early detection and treatment of colorectal cancer in Singapore.

To arrange a detailed assessment with our experienced colorectal surgeons, please contact us at 6262 1226.

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Are You at Risk of Colorectal Cancer?

Individuals aged 50 and above

Although colorectal cancer may manifest at any age, the chances of developing colorectal cancer notably increase after the age of 50.

Individuals with a family history of colorectal cancer

Although colorectal cancer may manifest at any age, the chances of developing colorectal cancer notably increase after the age of 50.

Risk factors of individuals with the following lifestyle and diet

Obesity, cigarette and tobacco use, heavy alcohol intake, sedentary lifestyle, and high consumption of processed and red meats.

Colorectal Polyps

Polyps are abnormal growths in the colon or rectum that can become cancerous if not removed during screening.

Inflammatory Bowel Disease (IBD)

Conditions like Crohn’s disease or ulcerative colitis increase the risk due to chronic inflammation in the colon.

Symptoms of

Colorectal Cancer

Symptoms of

Colorectal Cancer

It is important to note that you may not encounter any obvious signs and symptoms in the early stages of colon cancer.

Common symptoms - particularly in the more advanced stages - include:

Blood in stool - Bright red or dark blood in the stool may indicate bleeding in the colon or rectum.

Changes in Bowel Habits - Persistent diarrhoea, constipation, or a change in stool consistency lasting more than a few weeks.

Unexplained Weight Loss - Cancer cells can consume the body’s energy, triggering an immune response or disrupting how the body processes food. In some cases, a large tumour may also block the colon, altering bowel habits and contributing to further weight loss.

Anaemia - As the tumour grows, bleeding increases, which in turn, reduces both red blood cell (RBC) levels and iron stores in the body, often resulting in iron deficiency anaemia.

Abdominal Pain or Bloating - Characterised by discomfort, cramping, or bloating that persists without an obvious cause.

Persistent Tiredness - Ongoing fatigue that does not improve with rest, often linked to advanced cancer or anaemia.

If you notice any of these symptoms, please seek medical attention as soon as possible.

Call us at 6262 1226

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How Is Colorectal Cancer Detected Through Screening?

Colorectal cancer is diagnosed using screening tests to detect abnormalities early. They include the following:

Colonoscopy

The ideal method of screening is via a colonoscopy, a specialised procedure where a thin, flexible tube with a camera is inserted through the anus and through the rectum into the colon.

During this process, we will look for polyps - abnormal growths on the lining of the colon. These polyps can grow and develop without any obvious symptoms. Polyps that are detected during a colonoscopy will be removed on the spot and tested for the presence of cancer.

More about colonoscopy

CT Colonography (Virtual Colonoscopy)

A CT-based imaging test used to screen for abnormalities in the colon without inserting a scope.

Sigmoidoscopy

A procedure that uses a flexible tube to examine the rectum and lower colon. It is quick and requires minimal preparation but only checks part of the colon.

Stool Tests

FIT (Faecal Immunochemical Test) and FOBT (Faecal Occult Blood Test) are used to detect hidden blood, which may signal colorectal cancer or polyps. They are simple and non-invasive, but a positive result usually requires a colonoscopy for further investigation.

Preparation for Colon Cancer Treatment

Following a colon cancer diagnosis, cancer staging is a crucial step in guiding your treatment plan. This process often involves imaging scans of the abdomen, pelvis, and chest to precisely locate the tumour and determine its size. However, the definitive stage is usually confirmed only after surgery.

Preparation for colon cancer surgery generally begins weeks in advance. At least a week before your procedure, it is essential to discuss all current medications with your surgeon, as you may be advised to temporarily stop them to reduce the risk of complications.

As the surgery date nears, typically 24 hours prior, you will switch to a clear liquid diet and may be instructed to fast after midnight. Your surgeon will also provide specific bowel preparation instructions to ensure your colon is completely empty for the procedure.

How is Colon Cancer Treated?

Treatment for colorectal cancer depends on the stage and severity of the disease. Our colorectal cancer specialists use advanced techniques to provide effective care with minimal downtime.

Surgical Colon Cancer Treatments

Colorectal Surgery

It is used to remove the affected part of the colon (be it partial or total) to curb the spread of the disease, and is the only treatment that can provide a definite cure to colon cancer. While there are other treatment options, such as chemotherapy, these are best used as supporting treatments and not as standalone treatments.

Polypectomy

Polypectomy involves the removal of polyps during a colonoscopy, often performed for early-stage cancer or precancerous growths.

Colostomy

This is not a direct treatment for colon cancer but may be needed after surgery. It creates an opening (stoma) in the abdomen to divert waste while the bowel heals. It can be temporary or permanent.

Non-Surgical Colon Cancer Treatments

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells or inhibit their growth. It is commonly used after surgery or for advanced-stage cancers.

Targeted Therapy

Targeted therapy uses drugs to target specific cancer cells to block their ability to grow and spread. It is often used for advanced colon cancer and may cause fewer side effects than chemotherapy.

Immunotherapy

Immunotherapy helps your body’s immune system recognise and fight cancer cells. It is usually used for advanced colon cancer with certain genetic traits and may not be suitable for all patients.

Post-Surgery Care After Colorectal Cancer Treatment

Recovery from colon cancer surgery in Singapore involves careful post-surgery care to promote healing and prevent complications.

Diet - Follow a balanced, fibre-rich diet and avoid greasy or processed foods to help your digestive system recover smoothly.
Exercise - Light activities like walking, as recommended by your doctor, can aid blood circulation, prevent stiffness, and gradually restore strength.
Wound Care - Keep your surgical wounds clean and dry, and look out for redness, swelling, or unusual discharge. Follow your care team's instructions closely.
Stoma Care - If you have a colostomy, our team will guide you on how to clean, care for, and manage your stoma.

Can Colorectal Cancer Be Prevented?

While not all cases of colorectal cancer can be prevented, adopting healthy habits reduces risk:

Quit smoking
Moderate alcohol consumption
Focus on consuming fruits, vegetables, whole grains, and lean proteins while limiting red and processed meats
Schedule regular colorectal cancer screening starting at age 50 (or earlier if at high risk)

FAQs on Colorectal Cancer

When should you see a colorectal cancer specialist?

Consult a specialist if you experience persistent symptoms such as rectal bleeding, unexplained weight loss, changes in bowel habits, or abdominal discomfort. Early consultation can lead to timely colorectal cancer diagnosis and more effective treatment.

Is colorectal cancer treatable?

Yes, colorectal cancer is treatable, especially when detected early. Treatment options include surgery, chemotherapy, radiation therapy, and targeted therapies. The choice of treatment depends on the cancer's stage and location, and the patient's overall health.

Are there any side effects from colorectal cancer treatments?

Treatment side effects vary based on the type and intensity of therapy. Common side effects include fatigue, nausea, neuropathy (nerve damage causing tingling or numbness), and skin reactions. These side effects are often manageable and temporary.

What is life like after colon removal?

Life after colon removal involves significant adjustments, primarily to new digestive processes and altered bowel habits, which vary based on the surgery's extent. Generally, it requires careful dietary management and routine medical follow-ups to ensure comfort and optimal health.

Is colon cancer fast or slow growing?

Colon cancer typically develops slowly over about a decade, often originating as benign polyps that can become malignant over time. This gradual progression underscores the critical importance of regular screening for early detection.

What happens if a screening test is positive?

A positive screening test does not confirm cancer but indicates the need for further evaluation. Your doctor may recommend additional diagnostic tests, such as a biopsy, to determine the presence and type of abnormal cells.

Dr Dennis Koh

Medical Director & Senior Consultant Colorectal Surgeon

MBBS (Nottingham), B Med Sci (Nottingham), MMed (Surgery), FRCS (Edinburgh), FAMS

Dr Dennis Koh is a colorectal surgeon specialising in minimally invasive and advanced endoscopic techniques. He trained in Singapore and Switzerland, where he focused on proctology and pelvic floor disorders. A Fellow of the Royal College of Surgeons of Edinburgh and the Academy of Medicine, Singapore, Dr Koh is also passionate about teaching, having served as Assistant Professor at Duke-NUS and Clinical Senior Lecturer at NUS.

About Dr Dennis Koh

Dr Sharon Koh

Senior Consultant Colorectal Surgeon

MBBS (Singapore), MMed (Surgery), FRCS (Edinburgh), FAMS

Dr Sharon Koh is a fellowship-trained colorectal surgeon with expertise in minimally invasive surgery, advanced endoscopy, and inflammatory bowel disease. She trained in advanced colorectal surgery at Cedars-Sinai Medical Center (USA) and Japan. Formerly Director of Endoscopy at Alexandra Health, she also lectures at NUS and is an active member of local and international colorectal societies like the European Society of Coloproctology.

About Dr Sharon Koh

Dr Pauleon Tan

Senior Consultant Colorectal Surgeon

MBBS (Singapore), MMed (Surgery), FRCS (Edinburgh), FAMS

Dr Pauleon Tan is an experienced colorectal surgeon focusing on minimally invasive surgery, advanced endoscopy and cancer care. After receiving the MOH Health Manpower Development Plan award, he trained in Japan, where he mastered advanced techniques to improve cancer outcomes. Dr Tan has held key roles such as Clinical Director of the Colorectal Cancer Screening Programme at KTPH and is dedicated to delivering patient-centred care.

About Dr Pauleon Tan