At Colorectal Practice, we want to help clear things up so that our patients and their families can make the most well-informed choices when it comes to the heart of the matter – treatment.
What Is Colorectal Cancer?
Colorectal cancer begins in the colon or rectum and is the most common cancer in Singapore, affecting both men and women. It often develops from benign polyps that can become cancerous over time if left untreated. While this process typically takes years, factors such as genetic mutations, inflammatory bowel disease (IBD), and unhealthy lifestyle habits can accelerate progression.
What Are the Stages of Colorectal Cancer?
Colorectal cancer is staged to describe the extent of tumour growth and spread. Each stage determines treatment options and prognosis.
- Stage 0 – The cancer is confined to the inner lining of the colon or rectum and has yet to invade deeper layers or spread to other areas. Treatment typically involves removing the polyp or affected tissue.
- Stage I – The cancer has grown beyond the inner layers of the colon or rectum. However, it has not spread to nearby lymph nodes or other organs. Surgery to remove the entire cancerous area is often the main treatment.
- Stage II – The cancer has spread through the colon or rectum wall including the nearby tissues. Nevertheless, the lymph nodes and distant organs remain unaffected. Surgery may be recommended for treatment then followed by chemotherapy to reduce the risk of recurrence.
- Stage III – The cancer has already reached the nearby lymph nodes. While it has not spread to distant organs yet, it indicates an advanced progression of the disease. Tumours and affected lymph nodes must be removed through surgery. Treatment also includes chemotherapy and radiation therapy.
- Stage IV – This is the most advanced stage of colorectal cancer. The cancer has spread to distant organs in the body such as the liver and lungs. Treatment at this stage focuses on controlling the growth of the cancer and managing symptoms. Options may include surgery (in select cases), chemotherapy, targeted therapy, and immunotherapy.
What Are the Symptoms of Colorectal Cancer?
Colorectal cancer often presents with subtle or no symptoms in the early stages. When symptoms do occur, they vary depending on the location and stage of the disease. Common symptoms include:
- Blood in Stool
- Changes in Bowel Habits
- Abdominal Pain
- Constant Gas or Bloating.
- Unexplained Weight Loss
- Anaemia
- Fatigue
What Causes Colorectal Cancer?
Colorectal cancer develops due to a combination of factors, which can increase an individual's risk of developing this disease, including:
- Age – The risk of colorectal cancer increases with age, making it especially common for people over 50.
- Family History – Having a first-degree relative (parent, sibling, child) with colorectal cancer significantly increases the risk of developing the disease.
- History of Colon Polyps – Those who have had colon polyps are at greater risk of developing colorectal cancer.
- Chronic Inflammation – Conditions like inflammatory bowel disease (IBD) can cause long-term inflammation in the colon, increasing cancer risk.
What Does Colorectal Cancer Surgery Actually Entail?
While there are different types of colorectal surgery available in Singapore (depending on the stage and extent of the cancer), the main goal of colorectal cancer surgery remains the same – to remove the cancerous sections of the colon and/or rectum, as well as its surrounding tissues and lymph nodes, before stitching the remaining two ends back together.
What Are the Colorectal Cancer Treatments Available?
At our Colorectal Surgery Clinic, we are skilled in both open and laparoscopic methods of surgery, including the use of advanced robotic surgery which offers high levels of precision, speed and safety. We also offer non-surgical therapies like chemotherapy and radiation therapy so as to provide personalised, all-rounded care.
There are three main types of surgery for colorectal cancer. These include:
Open Surgery
- This traditional method involves making a larger incision in the abdomen to access the colon or rectum. It is typically used for complex cases where a good view of the surgical area is necessary.Laparoscopic Surgery
- This is a minimally invasive procedure that only needs small incisions and a tiny camera to remove the tumour. This method often results in less pain, smaller scars and faster recovery compared to open surgery.Robotic Surgery
- This is an advanced form of minimally invasive surgery. The surgeon sits at a console and controls robotic arms to perform the surgery precisely and accurately.
Non-surgical therapy treatments are often used in combination with surgery for advanced cases of colorectal cancer. These include:
Chemotherapy
– This treatment uses powerful drugs to slow or stop tumour growth. It is often recommended after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence.Radiation Therapy
– This treatment uses high-energy radiation to destroy cancer cells. It can be given to relieve symptoms of advanced colorectal cancer.Immunotherapy
– This treatment uses the body's immune system to target and destroy cancer cells. It can be given to help control advanced colorectal cancer and improve long-term outcomes.
How to Prepare for Colorectal Surgery
Preparing for colorectal surgery is crucial for a smooth procedure and optimal recovery.
- Bowel Cleanse – Patients need to undergo a liquid diet for a few days before surgery. Laxatives may also be prescribed. This ensures that their bowels are empty and thoroughly cleansed.
- Lifestyle Changes – Smoking and drinking alcohol should be avoided in the weeks leading up to surgery as they can impair wound healing and increase the risk of complications.
- Medication Adjustments – Some medications, such as blood thinners, may need to be adjusted or stopped before surgery to reduce the risk of excessive bleeding during and after the procedure.
- Fasting – Patients must not eat or drink anything for a certain period before surgery. This is essential to ensure the procedure is safe and effective.
What to Expect After Colorectal Surgery?
Recovery after colorectal surgery depends on the procedure and individual factors. Many colorectal cancer cases are curable, and minimally invasive techniques like laparoscopy and robotic surgery can promote faster recovery, reduce infection risk, and minimise scarring.
Generally, here is what you can expect after the procedure:
- Following colorectal surgery, patients typically remain in the hospital for a few days while their vital signs are closely monitored. Pain medication will be prescribed to manage post-operative discomfort.
- Initially, patients will receive clear liquids intravenously to allow their digestive system to adjust. This will gradually transition to soft foods and then a balanced, high-fibre diet.
- Temporary changes in bowel habits are common during the recovery period. These usually resolve with dietary adjustments or medication.
- Strenuous activities and heavy lifting should be avoided for several weeks as advised by your surgeon.
- Follow-up appointments with your surgeon are crucial to monitor healing, assess bowel function, and address any concerns, including signs of infection or complications.
FAQs on Colorectal Cancer Surgery
I’m not keen on colon cancer surgery. Are there non-surgical treatments available?
Am I going to end up with a stoma after colon cancer surgery?
Does having colorectal cancer mean that I am likely to die?
If my cancer has metastasised (spread), does that mean I have a short life expectancy?
Our Colorectal Surgeons
Dr Dennis Koh
Medical Director & Senior Consultant Surgeon
B Med Sci (Nottingham), MBBS (Nottingham)
MMed (Surgery), FRCS (Edinburgh), FAMS
Dr Dennis Koh is a MOH-accredited and experienced colorectal surgeon; and currently the Medical Director at Colorectal Practice.
Dr Koh strives to provide a customized treatment plan for each patient, which allows for better outcomes. He also honed his skills in proctology abRd in Geneva, bringing a more diverse touch to his practice.
Dr Sharon Koh Zhiling
Senior Consultant Surgeon
MBBS (Singapore), MMed (Surgery),
FRCS (Edinburgh), FAMS
Dr Sharon Koh is an experienced colorectal surgeon and the former Director of Endoscopy at Alexandra Health.
Dr Koh completed her fellowship at Cedars-Sinai Medical Centre in the US after being awarded the Academic Medicine Development Award by the National University Hospital.
Dr Pauleon Tan Enjiu
Senior Consultant Surgeon
MBBS (Singapore), MMed (Surgery),
FRCS (Edinburgh), FACS
Dr Pauleon Tan has served in public hospitals for over 15 years and is experienced in minimally invasive surgery and endoscopy.
Dr Tan undertook advanced colorectal surgical training at Japan’s Saitama International Medical Center after being awarded the Ministry of Health – Health Manpower Development Plan (HMDP) Award.