Colorectal Cancer
Incidence
Colorectal cancer (CRC) or cancer of the large intestine is the leading cause of cancer death in developed countries. In Singapore, it is the most common cancer and number one cause of death. The risk of CRC in the general population is 1 in 20 Singaporean.
The age-standardised rates for men from 2003-2007 was 40.5 per 100,000 per year and for women it was 29.0 per 100,000 per year. However, it is largely preventable and highly curable if detected early. Most CRC develop from adenomatous polyps. Therefore, removal of adenomas by colonoscopy reduces the risk of CRC.
Early screening and polypectomy is the key to prevention and may improve survival significantly. Colonoscopy is the most effective way to reduce risk of CRC and mortality.
Causes & Risk Factors
While the majority of CRC are sporadic, genetic causes or predispositions are more commonly cited as risk factors.These are risk factors:
- Age > 50
- Race: Chinese>Malay>Indian
- Male show a slight predominance over female
- Family history of polyps or cancer
- Personal history of polyps or cancer
- Inflammatory Bowel Disease ( ulcerative colitis & Crohn's disease)
- Tobacco consumption
- Alcohol consumption
- Physical inactivity/Obesity
- Diet high in red meats & animal fats
- Low fibre diet
- Inheritable genetic conditions:
- Familial Adenomatous Polyposis (FAP)
- Hereditary NonPolyposis Coolorectal Cancer (HNPCC)
Symptoms & Signs
Usually, colorectal polyps and early cancers do not cause any symptoms until they have become quite large or advanced. The common symptoms are bleeding, change in bowel habit, alternating constipation and diarrhoea. Late symptoms include loss of weight and appetite and abdominal bloating and pain.
Screening and Prevention
Primary prevention of CRC includes lifestyle changes as well as medical intervention. Since most cases of colorectal cancer are sporadic in nature, changes in diet and lifestyle may contribute to a diminished risk. In the low risk individuals, moderate physical activity and a diet high in fibre and low in red meat and animal fat may be protective.
There are multiple screening tools available. Faecal occult blood test (FOBT) is the easiet and simplest screening method. But this test has some limitations eg: false positive and false negative results. The combination of flexible sigmoidoscopy and FOBT is felt to be a better approach to improve the result of detection of polyps or cancers. However, recent data has shown that a single FOBT and flexible sigmoidoscopy may miss up to 30-40% of all significant tumour proximal to the splenic flexure. Therefore, currently, colonoscopy is still considered the best option, especially for high risk individuals.
Who Should Go for Colonoscopy?
Individuals who are or has:
Above 50 years old.
Family history of Colorectal Cancer or Polyp
Personal history of Colorectal Cancer or Polyp
Change in bowel habit
History of Inflammatory Bowel Disease
How is Colonoscopy performed?
Cleansing of colon, by drinking diluted Oral Fleet 2 bottles.
Intravenous sedation will be given, so there is no pain during the procedure.
Procedure takes about 10-15 minutes.
Result is instant.
No hospitalization is needed.
Some examples of growth within the colon:
Colonic Polyp
Colon Cancer
You may speak to our friendly doctors at CentralClinic to enquire more about a colonscopy. Click here to use
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