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There is a lot we can now do to prevent and treat colorectal cancer. At a recent webinar organised by Parkway Cancer Centre, a panel of experts shared the latest treatment advances for one of the world’s most common malignancies.

Colorectal cancer, often referred to as bowel or colon cancer, is the most common cancer among Singaporean men, said Dr Foo Kian Fong. Though the condition is one of the leading causes of death in Singapore, many patients with the disease have improved chances of survival given the advances in treatment and preventative tools at our disposal, shared Dr Chew Min Hoe.

In fact, a significant 60 percent of Singaporean patients survive for five years after diagnosis—a good indicator that the disease has been cured in these patients.

The lower survival rate for the remaining 40 percent is largely attributed to late diagnosis, as many individuals present with advanced cancers due to the asymptomatic nature of symptoms in the early stages of the disease.

This is where early screening comes in.

Screening for colorectal cancer

Early screening can go a long way in improving survival rates for colorectal cancer.

The main screening options for the disease include an annual Faecal Immunochemical Test (FIT) and a colonoscopy every 5–10 years.

FIT is an inexpensive and non-invasive approach to detecting hidden blood in the stool, by collecting a sample to test with an at-home kit.

Positive results, however, do not necessarily indicate cancer as blood in the stool can be caused by benign conditions like piles or diverticula. To confirm the diagnosis of cancer, patients need to undergo a colonoscopy, an invasive procedure where a small tube with a camera is inserted through the anus to check the bowels for signs of disease.

A colonoscopy is the current standard for colorectal cancer screening because it provides an accurate diagnosis while allowing doctors to identify and remove bowel polyps, which are small benign growths in the intestine that can become cancerous over time. According to Dr Chew, “Regular screening and the removal of polyps by colonoscopy reduces the risk of colorectal cancer by up to 90 percent”.

Another tool to reduce the risk of colorectal cancer is adopting a healthy lifestyle. A diet rich in fruits, vegetables, and fish, while limiting alcohol and red or processed meat, can lower risk of the disease. Individuals should also avoid smoking and get regular sleep and exercise.

Managing colorectal cancer

For patients with colorectal cancer, there is an array of well-established and advanced treatments available to manage and even cure the disease.

“Treatment strategy depends on cancer stage,” explained Dr Ng Chee Yung, who believes surgery has come a long way in the treatment of this disease.

Surgery is usually recommended for Stage 1–3 disease (when the tumour is confined to the bowel or spread to nearby lymph nodes) with the aim of removing the cancerous mass while keeping the bowel connected and functional. Most surgical procedures are minimally invasive, using a ‘keyhole’ technique where surgeons make small key-sized holes in the belly to insert surgical instruments and remove the tumour, allowing the patient to recover quickly.

Surgery can achieve a very high cure rate of 90 to 95 percent in patients at Stage 1 and 2, without the need for further treatment.

Some patients at Stage 2, however, may require chemotherapy or other drugs after surgery to prevent the cancer cells from dividing or to kill off any residual bits of cancer, explained Dr Zee Ying Kiat, who adds that survival rates for these patients hover around 60–80 percent.

Chemotherapeutic drugs are usually recommended after surgery to maximise the chances of cure for patients at Stage 3, where the malignancy has spread to nearby lymph nodes and is more likely to recur. In this scenario, survival rates drop further to 30–60 percent.

While prospects are usually bleaker for patients with advanced cancers where the malignancy has spread to faraway organs like the liver, they can still benefit from palliative chemotherapy, radiation, and advanced drugs like targeted therapy and immunotherapy. The key takeaway is that the disease is highly preventable and treatable at an early stage, thanks to treatment advances.