January – April 2013 MICA (P) 035/05/2012 COLORECTAL CANCER Article contributed by second-most common in women (2012 data from National Dr Mark Wong Registry of Diseases Office). Consultant Surgeon Dept of Colorectal Surgery, Singapore General Hospital Colorectal cancer is formed from cells lining the colon and Director, SGH Anorectal Ultrasound & Physiology Laboratory rectum, often arising from smaller growths known as polyps. Director, SGH Pelvic Floor Disorder Service Polyps are benign growths in the colon and rectum which Adjunct Asst-Professor, Duke-NUS Graduate Medical School may enlarge and develop into cancer over a period of Clinical Senior Lecturer, YLL School of Medicine, NUS Visiting Consultant, National Cancer Centre Singapore time. As it is difficult to predict which polyps will eventually become cancerous, polyps should be removed whenever they are detected. What is colorectal cancer? Colorectal cancer is cancer of the colon (the main part of Causes and risk factors for colorectal cancer the large intestine) or rectum (the final portion of the intestine The majority of colorectal cancers arises from benign connecting the colon to the anus). The colon comprises the colorectal polyps. It is believed that the interaction of one’s caecum, ascending colon, transverse colon, descending genes with the environment triggers mutations (irreversible colon and sigmoid colon. It is the most common cancer in and harmful changes) that result in polyps growing out of Singapore, being the most common cancer in men and control and becoming cancerous growths. Over the years, several factors have been identified that could make one be at a higher risk of developing colorectal cancer, some of which can be modified while others cannot. These risk factors include: • Age — More than 90% of colorectal cancers occur in people aged 50 and above. • Family history — Personal or family history of colorectal cancer or polyps in the colon increases the risk • Inflammatory bowel disease — People suffering from ulcerative colitis and Crohn’s disease have a higher chance of developing colorectal cancer, especially when the disease is very extensive (involving much of the colon and rectum) or long-standing (up to 10 years or more) CONTENTS • COLORECTAL CANCER 01 • SWEET HOME PROJECTS SUPPORTED 05 • BREAST CANCER AWARENESS 09 BY WEE GUAN GROUP OF COMPANIES PINK RIBBON FORMATION • COLORECTAL CANCER (Continue) 02 • THE “JOY OF GIVING” SUPPORTED BY 05 • TERRY FOX RUN 2013 10 • CAREGIVING FOR FAMILY MEMBERS 03 KEPPEL REIT MANAGEMENT DIAGNOSED WITH CANCER • THOMAS LEONG SOLO PHOTOGRAPHY 10 • WORLD CANCER DAY 2013 06 – 07 EXHIBITION • MINIMISING THE IMPACT OF CANCER 04 UPON FAMILY LIFE • A MOVING TRIBUTE TO ROSALIND LEE 08 • COLORECTAL CANCER AWARENESS 11 FOUNDING MEMBER OF REACH TO CAMPAIGN (CCAM) 2013 • SCS LUNAR NEW YEAR LUNCHEON 04 RECOVERY • FREE FAECAL OCCULT BLOOD TEST 11 • SCS ‘STAR’ VOLUNTEERS APPRECIATION 05 • MOVEMBER 2012 09 (FOBT) KIT DISTRIBUTION DINNER 2012 • WHAT’S NEW! 12 COLORECTAL CANCER You are encouraged to be screened on a yearly basis. (continued from page 1) The Singapore Cancer Society distributes the FOBT kits all year round and is freely available to all Singaporeans and Permanent Residents aged 50 and above at various • Diet — Although no direct causal link can be established distribution points across the island. Please refer to page between food and colorectal cancer, some studies 12 for more information. have shown that people on a low fibre and high fat diet are more likely to develop colorectal cancer. There Double-contrast barium enema is also some data to suggest that an increase in fibre This is an X-ray examination of the large intestine using intake reduces risk. Certain food are linked to a higher a special liquid and air to provide good images of the risk of developing colorectal cancer, e.g, meat cooked colon and rectum. Polyps and other growths can be at higher temperatures, animal fat, tobacco and alcohol. detected but they cannot be removed if present. • Sedentary lifestyle and obesity — Studies also suggest CT-Colonoscopy that these two related factors can increase the risk This is a more recent X-ray examination of the large intestine of colorectal cancer. using 3D CT images that provide more accurate images of the colon and rectum. As in the case of barium enema, Symptoms of colorectal cancer growths that are detected cannot be removed. Although Colorectal cancer often has no symptoms, Colonoscopy warning signs that you should look out for include: In this procedure, a longer, flexible lighted tube is used to • Blood in your stools view the internal lining of the entire length of colon up • Small Calibre (narrowed) stools to the caecum. This technique has the advantage of • Change in bowel habits (ie. alterations in your regular being both diagnostic and therapeutic as polyps and patterns) other suspicious growths can be removed or biopsies • Abdominal pain or discomfort taken at the time of the procedure. • Presence of a lump in the abdomen • Anaemia (low blood count) Treatment options for colorectal cancer As colorectal cancer has no symptoms in the early stages, Surgery it is best to come for screening even if you do not have This is the mainstay of treatment for colorectal cancer. any of the above symptoms. This will increase the chances During the surgery, the cancer, the adjacent normal intestine of detecting polyps that can be removed or detecting on either side of the cancer as well as surrounding lymph cancers at an earlier stage. The severity of colorectal glands and blood vessels are removed together. The 2 cancer is measured by the stage of the disease and cut ends of the colon are then reconnected using surgical indicates how far the cancer has spread from the colon staples or by stitching them together. A stoma (opening or rectum. This directly affects the overall survival of the in the intestine brought to the skin to allow faeces to pass affected individual. out into a bag rather than via the anus) might be required if the connection is very close to the anus. Depending on Spread to other organs the nature of the cancer and fitness of the patient, the stoma may be temporary (in a majority) or permanent. Stage 5 Years However, with improvements in surgical techniques, the Survival Rate Stage I need for a stoma is increasingly reduced. The “laparoscopic” Stage II I More than 95% or keyhole surgery now allows the operation to be performed Stage III safely and also avoids long scars after surgery. This new II 70% Stage IV method reduces post-operative pain and thereby reduces III 50% recovery time. In recent years, even robotic-surgery has IV Less than 5% been used to perform colorectal cancer surgery safely. Chemotherapy Screening for Colorectal Cancer It is used after surgery to reduce the risk of recurrence Regular screening can detect colorectal polyps or colorectal and to improve survival chances if there is evidence of cancer early. Several different tests can be used. spread to the lymph glands adjacent to the cancer (Stage Faecal occult blood test 3). This is indicated for patients with advanced colorectal The Faecal Occult Blood Test (FOBT) is a quick and cancer which cannot be cured by surgery where there is evidence of cancer spreading to distant organs like the convenient screening test to detect colorectal cancer. liver and lungs (Stage 4). By itself, chemotherapy cannot Blood that is hidden in the stool may not appear red cure colorectal cancer. and may only be detected through this screening test. It is a simple test conducted on a person’s stool to Radiotherapy detect invisible traces of blood. There are many conditions This is used after surgical removal of the cancer to kill that can cause blood in the stool. This includes piles, any residual cancer cells around the original tumour site. peptic ulcer, colonic polyps (benign growth from the When given together with chemotherapy, it can also be lining of the colon) which are pre-cancerous, and colorectal used to shrink a large colorectal cancer before surgery cancer. to make surgery easier and more complete. P2 CAREGIVING FOR FAMILY MEMBERS IN & AROUND SCS DIAGNOSED WITH CANCER Article contributed by Jamie Choon Life changes when a person is told they have cancer. For An active person before his diagnosis, Mr Loh enjoyed many patients, the lives of their family and friends will also physical activity and always wanted to move about. When change, especially for those who love and care for the Agnes and Mandy were not at home, Mr Loh would walk patient. For Mr Loh Buck Hee’s family, becoming his care- about in the corridor outside their flat. Mr Loh was prone giver meant pulling together as a family, working together to falls but Ms Tan was able to come up with a solution to overcome challenges and cherishing the time spent to the problem of not being able to lift him up. Ms Tan with Mr Loh as he went on his final journey through cancer. would walk behind Mr Loh and would bring over a stool whenever he fell. Determined, Mr Loh would lift himself Mr Loh Buck Hee was referred to the Singapore Cancer back up using the stool as support. They laugh when Society (SCS) Hospice Home Care for palliative care of they recall his favourite saying, “the more I fall, the wiser cancer of the ear canal. He had previously been diagnosed I get.” with Chronic Obstructive Lung Disease, and the news of his cancer came as a shock to his family. Despite the challenges they faced, the Loh family worked things out together. They were also supported by the After Mr Loh’s wife, Ms Tan Pheck Choo, and their two SCS Hospice Home Care Team, who would give them daughters, Agnes and Mandy Loh, came to terms with his advice whenever they faced problems.