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High-tech battle

Technological advancements mean that doctors can now detect and treat colon cancer far more effectively. Dr Mark Wong, Colorectal and General Surgeon at Colorectal Clinic Associates, explains the key improvements.

Colorectal (or colon and rectal) cancer is one of the most common cancers around the world. In Singapore, it is the No.1 cancer in men and No. 2 in women. Yet it is one of the most detectable, preventable and curable forms of cancer.

Doctors today have a wide array of high-tech tools and methods to detect and treat colon cancer, including colonoscopy, laparoscopic surgery, and robot-assisted surgery.

Colonoscopy

This safe, simple procedure to examine the internal surfaces of the colon and rectum makes use of a specialised instrument called a colonoscope. This is a flexible instrument equipped with advanced high-definition optics, including lights and camera systems. It can not only take pictures of the colon and rectum, but also allows the doctor to perform specialised tasks like removing polyps for biopsies.

Colonoscopy is an effective screening tool for colorectal cancer, as it can check for abnormalities in the colon and rectum. A safe and comfortable procedure, it can be done as a day procedure and does not require an overnight stay in the hospital.

During the evening before the colonoscopy or even on the same morning, the patient needs to drink a solution to clear the stools in his bowels. The procedure is then done with the patient under sedation and comfortably asleep. General anaesthesia is not needed, and the entire procedure often does not take more than 30 minutes. The patient can be discharged soon after he wakes up, and receive the results as well.

The risks of colonoscopy are minimal; they include bleeding or perforation of the intestines, but the risk of this happening is just one in 1,000. And this statistic is lower in experienced hands.

Colorectal cancer screening is recommended at the age of 50 or 10 years before the youngest family member had colorectal cancer, whichever is earlier. It is also done for patients who suffer from abdominal pain, loss of weight, loss of appetite, a change in bowel habits, and rectal bleeding. If nothing is found, it can be done once every 10 years.

Laparoscopic surgery

The most common and effective treatment for colorectal cancer is surgery, which removes the affected portion of the colon with the cancerous growth. If the cancer is discovered in the early stages, this can produce an excellent outcome.

Laparoscopic surgery is fast becoming the preferred method of surgery; in fact, it is now recognised as the “gold standard” for colorectal cancer surgery in developed countries such as Singapore. This key-hole technique uses advanced technology (including 3D and high-definition optics) to perform surgery through small cuts on the belly.

Compared with open surgery, the smaller cuts in laparoscopic surgery mean the wounds are smaller and patients experience less pain. The internal organs are also less exposed to the cold operating room environment, reducing the chance of infection, and allowing patients to resume eating faster after surgery. Put together, all these mean a shorter hospital stay and a faster return to normal activities.

As with any major surgery, there are risks such as bleeding and infection. There is also the low risk of leaks from the connected portions of intestine, which may require a conversion to conventional open surgery.

Robot-assisted surgery

Robot-assisted surgery or robotic surgery is the latest advancement in key-hole surgery. It makes use of a robotic console from which the surgeon controls a robotic machine that performs the surgery through small cuts in the belly.

Robotic surgery is an even more precise method of keyhole surgery than laparoscopic surgery, as the robot has more degrees of movement in wielding the instruments, similar to that of the human wrist. It is also more stable, as a robot does not get tired. Other features, including stereoscopic 3D vision and better magnification, enable more precise surgery and also better stitching.

Such features make it very useful and more precise when operating in narrow confined areas like the pelvis, where organs like the rectum are situated. Studies have shown better results in terms of sexual function and continence after robotic surgery compared to laparoscopic surgery.  Robotic surgery is often recommended for cancers involving the lower end of the colon, rectum and anus. It has the same risks as conventional laparoscopic surgery.

COLON CANCER

WHAT IT IS:
A cancer occurring in the large intestine (colon) or rectum

HOW IT IS CAUSED:
From polyps (non-cancerous lumps) that grow and transform over time into malignant tumours or cancer

AROUND THE WORLD
1.8 million new cases of colon cancer in 2018

IN SINGAPORE
No.1 common cancer in men
No.2 cause of cancer deaths in men
No.2 common cancer in women
No.3 cause of cancer deaths in women 

DETECTING COLON CANCER

SCREENING:

• Starting at the age of 50, or 10 years before the youngest family member had colorectal cancer, whichever is earlier
• Once every 10 years

LOOK OUT FOR:

• Change in bowel habits (diarrhoea or constipation or alternating patterns)
• Feeling of bowel not emptied completely
• Blood in the stool
• Stools narrower than usual
• Constant feeling of being full or bloated
• Weight loss with no obvious reason
• Constant feeling of tiredness
• Nausea or vomiting