Early Screening The Key

COLORECTAL surgeon Dr Tee Shin Shan is optimistic. Despite the increase in incidences of colorectal cancer, he thinks there’s hope for those affected.

“With early detection and treatment of stage one colorectal cancer, the survival rate (on a five-year basis) is up to 90 per cent,” he says in a soft, soothing voice that must greatly reassure his patients as well as inspire their confidence in him.

In conjunction with Assunta Hospital’s March4Blue event which focuses on colorectal cancer, he says this is the most prevalent form of cancer among men in the country. In women, it has overtaken cervical cancer and is now ranked second after breast cancer.

The figures are frightening. The incidence of colorectal cancer in the peninsula has increased with age, with the overall ASR (age-standardised rate) at 18.4 per 100,000 population. Males: 21.6 per 100,000 population, and females: 15.4 per 100,000 population.

The incidence of colorectal cancer is highest among the Chinese (21.4 per 100,000 population), while Indians recorded 11.3 per 100,000 population and Malays recorded the lowest incidence at 9.5 per 100,000 population.

According to the first annual report of the National Cancer Registry — Colorectal Cancer 2007-2008, the incidence was high in the age group of 50-70 years.

Dr Tee says: “The first symptom is usually bleeding from the rectum. Then a patient may feel progressively lethargic and look pale. For instance, he may feel breathless after a short walk or climbing a flight of steps.

“There may also be a change in bowel patterns or altered bowel habits. A patient who goes to the toilet daily may now be going every few days or going many times a day. This will happen over a period of weeks, not just once.”

Is there any pain? “When a patient starts feeling pain, it’s usually in the late stages, so I’d advise taking note of the first two symptoms,” says Dr Tee.

COLONOSCOPY

Often, patients are referred to Dr Tee after they have seen a GP for the above symptoms. “If colorectal cancer is suspected, a colonoscopy will be done,” he says.

For this procedure, a long, thin and flexible telescope, or colonscope, equipped with a tiny camera, is passed through the anus into the rectum and colon to allow the doctor to see the insides clearly. It takes about 10 minutes to complete and is a minimally invasive procedure, though patients may experience cramps as air is blown into the colon.

If anything abnormal is detected, it will be removed for biopsy, a test that will confirm whether the tissue is cancerous.

“If we find polyps, these can be removed on the spot with ease. Polyps can turn malignant, but not all polyps will be cancerous,” says Dr Tee. “A biopsy will indicate if there are cancer cells.”

THOSE AT RISK

He stresses again that people in the high-risk groups should go for colonoscopy. But who are in the high-risk groups?

“Colorectal cancer affects Chinese males more than Indians and Malays,” he says, though other factors must also be taken into account. These include family history, those with inflammatory bowel disease and those genetically at risk.

“If you have a family member, especially immediate family, with polyps or colorectal cancer, you should go for testing if you are aged 40 and above. Those with familial adenomatous polyposis (FAP) run a 100 per cent risk, so even young people, even those in their teens, should get an annual colonoscopy done.”

FAP is an inherited colorectal cancer syndrome and accounts for one per cent of all cases of colorectal cancer.

Are there any risks in colonoscopy? Dr Tee smiles and says:

“Well, there is a 0.5 per cent risk of perforation. And when polyps are removed, this increases to 0.8 per cent and the patient may suffer temporary bleeding.”

NOT ALL BAD NEWS

Having said all that, Dr Tee is reassuring. “Colorectal cancer is one of the ‘better cancers’ as it is more easily treated and can be cured,” he says, adding that the whole colon may even be removed if necessary.