Colorectal cancer is a cancer that afflicts the large intestine, which consists of the colon and rectum. Its incidence is increasing at an alarming rate in Southeast Asia and it might become the No. 1 cancer afflicting people here over the next 10 to 20 years.

Health education remains the cornerstone in early detection of this cancer, which can be cured.

Looking out for symptoms is important. These include irregular bowel habits, increasing constipation, persistent diarrhea, blood in the stool and abdominal distension and pain. People with these symptoms should seek medical attention as soon as possible, as there are several tests that a doctor may recommend.

The most accurate test is colonoscopy, when a small, flexible fiberoptic camera is introduced into the large intestine with the patient under heavy sedation.

Any abnormality of the intestine can be seen during a colonoscopy and a biopsy can be taken for any suspicious growth.

Less accurate tests, such as like a CT (computerized tomography) colonography or barium enemas are not recommended. A biopsy, for example, cannot be done with these tests if an abnormality is detected, which would require an additional colonoscopy and biopsy if an abnormality is detected.

Many risk factors have been postulated to increase the risk of colorectal cancer, such as a sedentary lifestyle, a diet rich in fatty food or low in fiber, or the over-consumption of alcohol, among other things.

While none of these risk factors has been proven to directly increase the risk of the developing colorectal cancer, small growths in the large intestines called polyps, have been well documented to increase the risk of colorectal cancer.

These colorectal polyps will grow in size and gradually transform into colorectal cancer. It has been shown that some polyps will take about three to five years to become cancerous.

Prevention can be achieved if these polyps are detected early and removed.

While it is recommended that people above the age of 50 should be screened for colon cancer, those with a family history should be tested sooner.

There are several screening tests, such as testing stools for hidden blood or a colonoscopy.

Testing stool for blood is inexpensive and non-invasive, although it must be repeated annually and could result in false positive or false negative results.

Colonoscopies, meanwhile, allow for polyps to be removed as they are detected and need only be repeated every five to ten years. However, the procedure is also more expensive.

It is important to note that screening for colorectal cancer is only for people with no symptoms at all: People with symptoms suggestive of colorectal cancer should see a doctor for colonoscopy.

The mainstay of treatment for colorectal cancer is surgery. However, in more advanced stages of the disease, chemotherapy is done before surgery to shrink the cancer.

The chance of cure is high for early stages of colorectal cancer if patients receive appropriate treatment. Many new and more powerful chemotherapy drugs have been developed over the past two decades. These chemotherapy drugs have greatly improved the survival rate for patients after surgery.

There have also been many advancements in the surgical treatment of colorectal cancer. Keyhole (or laparoscopic) surgery for colorectal cancer has taken center stage over the past ten years, as many studies have shown that it is comparable traditional open surgery in improving survival rate for patients.

At the frontier of this keyhole surgery are single-port surgery and robotics surgery, which offer better cosmetic and functional outcomes for patients.

In single-port surgery, for example, there is only one small scar of about 3 centimeters, compared to more than 15 centimeters in traditional open surgery.

Keyhole surgery also provides the benefits of faster recoveries, shorter hospital stays, saster return to normal life and smaller scars.
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The writer is a colorectal and general surgeon who has published more than 30 scientific papers in peer-reviewed medical journals. For more information, visit khngsurgery.com.sg

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