Gastrointestinal Cancers: Western Medicine & TCM Perspectives

Contributed by: Dr Foo Kian Fong

Last March, as part of a public webinar, Dr Foo Kian Fong (Senior Consultant, Medical Oncology, Parkway Cancer Centre) and Physician Lin Jia Yi (TCM Physician, Eu Yan Sang TCM Clinic) discussed the Western and TCM approaches to the two most common gastrointestinal cancers.

Colorectal cancer is a disease in which normal cells in the lining of the colon or rectum in the large intestine begin to change, grow without control, and no longer die. In Singapore, it is the second-most common cancer and common cause of cancer deaths among males, and third-most common cause of cancer death in females.

StageDescription5-Year Survival Rate
Stage IConfined to the bowel wall90%
Stage IIThrough the bowel wall55–80%
Stage IIISpread to lymph nodes30–60%
Stage IVSpread to other organs5–8%

Fig. 1 Colorectal Cancer - Staging & 5-Year Survival Rates

Non-modifiable risk factors include age, genetic factors, family history, underlying conditions e.g inflammatory bowel disease, and history of colonic polyps/adenomas. Modifiable risk factors include alcohol, obesity, high fat diet, smoking, physical inactivity, and lack of sleep.

Patients with the disease may face symptoms such as:

  • Rectal bleeding
  • Change in bowel habits
  • Unexplained anaemia
  • Unexplained weight loss and appetite changes
  • Abdominal discomfort and pain, especially nocturna 

Diagnosis and treatment – colorectal cancer

Diagnosis is usually done through physical examination for any abdominal or rectal mass, colonoscopy, and a staging investigation.

Surgery is the mainstay of treatment for Stage 1–3 colorectal cancers. For Stage 4, chemotherapy is mainly used with palliative intent. In fact, it has been shown to improve median survival from 9 months to 30 months in recent studies.

Advanced treatment includes targeted therapy and immunotherapy. However, immunotherapy is currently only available for patients with MSI deficient colorectal cancer (5% of all colorectal cancers).

Screening and prevention – colorectal cancer

Screening is done with fecal occult blood test (FOBT) and colonoscopy. Generally, population screening should be done for those starting from age 50, while high-risk screening should be done for patients with family history, previous cancer or polyps, and ulcerative colitis at a younger age.

To reduce possibilities of colorectal cancer, Dr Foo advised regular physical activity, low-fat diet, supplements (e.g. follic acid, calcium, vitamin D), consumption of green tea, drugs (e.g. aspirin), and hormone replacement therapy in women.

Liver cancer

Dr Foo Kian Fong then went on to an overview of liver cancer, of which there are two main types:

  • Secondary: cancer that spread from other cancer sites
  • Primary: cancer that results from cancerous changes in the liver sites. Subtypes depend on the cell of origin.
    • Hepatocellular carcinoma (HCC)
    • Cholangiocarcinoma
    • Angiosarcoma
    • Lymphoma

Liver cancer is the fourth most common cancer and third most cause of cancer death among Singaporean men, and the fourth most cause of cancer death in women.

Prognosis is extremely poor with a 5-year survival rate of 3–5%. Patients with HCC in particular have a generally poor prognosis because they may have an underlying condition called cirrhosis (hardening of the liver) which can cause death.

Risk factors include:

  • Hepatitis B carriers
  • Hepatitis C infection
  • Liver cirrhosis
  • Environmental factors
  • Male
  • Smoking
  • Diabetes mellitus
  • Red meat consumption

Symptoms, diagnosis and prevention - liver cancer

Patients with liver cancer are usually asymptomatic in early stages, and only symptomatic in advanced stages. Symptoms include:

  • Fatigue and general weakness
  • Upper abdominal pain
  • Nausea and vomiting
  • Loss of appetite and weight
  • Abdominal swelling
  • Jaundice
  • Fever

Typically, liver cancer is diagnosed using ultrasound, CT scans and MRI, hepatic angiogram, tumour marker and biopsy.

Treatment modalities for patients diagnosed may include surgery, liver transplant, or PEI/RF (percutaneous ethanol injection/radiofrequency) on the tumour in early stages; chemoembolisation in intermediate stages; immunotherapy or targeted therapy in advanced stages; and symptomatic treatment for patients in their terminal stage.

Generally, screening is recommended for those with confirmed liver cirrhosis from any cause, or inactive hepatitis B carriers for men above 40 and women above 50. Dr Foo also noted that hepatitis B carriers with active disease and high viral loads would require early screening.

He recommended that for the prevention of disease, those at risk should adopt a Mediterranean diet high in vegetables, drink coffee, consume food with Omega 3 fatty acids, stop smoking and drinking, undergo regular physical activity, or take drugs such as Vitamin D, aspirin and metformin.

The role of TCM in cancer management

Dr Foo Kian Fong continued the next part of the webinar with an introduction to complementary and alternative medicines (CAM). He explained that patients may turn to CAM for various reasons, including control over one’s care and reduction of side effects.

Physician Lin Jia Yi explained by outlining the principles of TCM in cancer management: complementary medicine post-treatment; reducing side effects treatment; supporting the immune system and boosting energy to enhance recovery.

She highlighted that an important part of TCM is preventive medicine. TCM believes that the onset of disease is due to a lack of vital Qi, an energy force in your body, and imbalance of Yin and Yang. Hence, a holistic TCM treatment approach involves improving vital Qi and restoring the balance of Yin and Yang.

TCM and preventive measures for gut health

The spleen comprises one of the 5 key organs in TCM. It encompasses the entire digestive system, producing Qi and blood to nourish the body, aiding metabolism, digestion of food, absorption and transportation of nutrients within the body.

A healthy spleen is a sign of good vital Qi, and results in a healthy body and mind. However, a weak spleen (low spleen Qi) can affect digestion, the body and the mind.

Factors for good gut health encompass 6 main pillars: good eating habits, stress management, exercise, TCM superfoods and acupressure. Acupressure for instance promotes a smooth circulation system along the meridians (energy points where Qi flows) and supports vital Qi to strengthen body resistance, while TCM superfoods can strengthen a weak digestive system and improve the absorption of nutrients via the digestive tract.

Generally, such principles offer good results and improve quality of life, says Physician Lin. However, she emphasised the importance of letting the oncologist know when receiving TCM treatment, and verifying information with registered TCM practitioners.

Try It! TCM Superfood Recipe for 四神湯 (淮山、袂苓、艾突、蓮子)
Sishen Soup (chinese yam, poria, gordon euryale seeds, Lotus Seed)

  1. Give the prewashed herbs a gentle final rinse under running water
  2. Blanch 300–500g meat of your choice
  3. Place all the ingredients into the soup pot (approx. 1500ml of water)
  4. Bring soup to a boil before simmering on low heat for 1–2 hours
POSTED IN Cancer Prevention, Cancer Treatments, Traditional Chinese Medicine and Cancer
TAGS cancer screening, cancerous polyps, colonoscopy, FOBT (faecal occult blood test), gastrointestinal cancer, history of cancer, immunotherapy, prevent cancer, stage 4 cancer, targeted therapy, TCM cancer treatment
READ MORE ABOUT Colorectal Cancer, Liver Cancer