From a young age, surgery has always been a passion of mine with Dad being a general surgeon and my greatest inspiration. Seeing my relative afflicted with late stage Colorectal Cancer strengthened my resolve to treat and heal others with this disease. I thus set out to acquire the knowledge and surgical skills required to specialise in the field of colorectal surgery. I surrounded myself with excellent mentors both locally and overseas and honed my skills in this exciting field of surgery.

My specialisation in minimally-invasive and keyhole (laparoscopic and robotic) surgery has allowed me to harness technological advances to deliver better patient care, while at the same time allowing for patients to have a quicker recovery with smaller wounds and less pain.

Colorectal Cancer is the most common cancer in Singapore and its incidence is on the rise. Unfortunately, despite advances in modern medicine, the majority of such cancers are still diagnosed in their advanced stages, as many are not coming early enough for screening or are simply unaware of its symptoms.

This underscores the importance of the annual Colorectal Cancer Awareness Month in March to raise public awareness of this potentially curable disease. Furthermore, it is an opportune time to reaffirm the importance of screening through Colonoscopy.

I hope that in the coming years, with greater awareness, more people will come forward to be screened for Colorectal Cancer so that they can either prevent or detect it early enough to have good treatment outcomes and quality of life.

In the latest report compiled by the NRDO in 2019, it was also revealed that more than 9,800 new cases in total were diagnosed between 2011 and 2015. Yet not many are aware of the fundamental facts of Colorectal Cancer – one of the most detectable, preventable and curable forms of cancer.

Colorectal Cancer refers to a malignant tumour that starts as a polyp along the inner wall of the colon or rectum. Since polyps generally take years to become cancerous, regular screening using Colonoscopy can intercept their development by removing them before they become cancerous. While not all polyps turn cancerous, it is not possible to tell which ones will and which ones will not. Therefore, these growths are routinely removed during Colonoscopy.

Another reason why screening is critical is because there are often no warning signs in the polyp stage and even in the early stages of Colorectal Cancer. Certainly, one should seek treatment and not ignore a change in bowel habits, such as persistent or alternating patterns of diarrhoea or constipation, a change in the frequency of stools, unexplained weight loss and the presence of blood in stools.

In view of rising trend of young Colorectal Cancer patients, below the age of 50 years old, the American Cancer Society now recommends that people at average risk for Colorectal Cancer should begin screening at age 45 years³. If your family has a medical history of Colorectal Cancer or precancerous polyps, speak with your doctor about screening early. The math works like this: Take the age of the youngest affected relative when they were diagnosed with polyps or cancer. Subtract 10 years from that number and that is the age when you should start screening or from 45 years old, whichever is earlier. For example, if your father had cancer at 52 years old, you should consider beginning Colonoscopy at age 42 years.

There is no sure way to completely prevent cancer. But there are things you can do that might help lower your risk. A balanced and holistic approach is recommended: Adopt a healthy diet by incorporating all food groups in moderation, stay active through regular exercise and most importantly, go for regular screening.

Watch more of Dr Mark Wong’s videos and gain insights at https://www.markwongsurgery.com/media/videos/

Sources:

¹ https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html
² https://www.nrdo.gov.sg/publications/cancer
³ https://www.cancer.org/latest-news/american-cancer-society-updates-colorectal-cancer-screening-guideline.html

Even seemingly healthy people can be suffering from colorectal cancer and not be aware of it until it is too late. Thus it is very important to come for a colonoscopy.

How Do You Get Checked for Colorectal Cancer?

Screening is a process where our doctor recommends testing to help detect colorectal cancer. It is hoped that the check will either detect polyps or early cancer, thus reducing your risk of dying from this disease. Since it is the most common cancer in Singapore, it is worthwhile to spend your time to check for this. Furthermore, unlike many other cancers, if colorectal cancer is detected early, it is potentially curable.

The test used depends on your risk profile and symptoms. These include a simple stool test called FIT (faecal immuno-histochemical test) or Colonoscopy.

FIT is used to detect invisible traces of blood in the stool, which could be a sign of colorectal polyps (where cancers grow from) or cancer itself. This test is suitable only if you do not have symptoms (eg. no pain, bleeding, change in bowel patterns), but are aged of 45 years and older or have a family history of cancer. If this test is positive for blood, then you should do a colonoscopy.

If you already see blood in your stool, toilet paper or bowl or you are already experiencing the earlier mentioned symptoms, you should just proceed for a colonoscopy instead.

FIT is not full-proof and the Gold Standard for colorectal cancer screening is Colonoscopy. Consult our doctor on the recommended test for you.

What is an Endoscopy?

Endoscopy is a general term to describe tests to check the inside of the body using tubes. For the digestive system, endoscopy is either done though the mouth or anus. For the purpose of detecting colorectal polyps and cancer, this is done through the anus and is called Colonoscopy. A Gastroscopy is done through the mouth to detect problems in the stomach and small intestine.

Colonoscopy detecting a polyp

What is a Colonoscopy?

Colonoscopy is a safe procedure in which our doctor uses a flexible tube (called a colonoscope) to examine the inside of your colon and rectum, with an attached high-definition camera and fibre-optic lights to take videos and pictures. Under sedation (not general anaesthesia) with the patient comfortably asleep, our doctor inserts the scope through the anus to check the colon and rectum for abnormalities like cancer and polyps.

Our doctor will sample or remove these abnormalities while you are asleep and send them for testing; and results will usually be ready within 2 to 3 days. This will confirm if it is cancerous or benign and the necessary advice will be given.

Find out more about the types of endoscopy services that we provide at Mark Wong Surgery.

Why Screen for Colorectal Cancer?

Not all cancers can be easily prevented or detected through regular screening. The good news is that for colorectal cancer, since they start from small non-cancerous polyps, detecting and removing these polyps can potentially prevent the cancer from forming.

You should come for a Colonoscopy by the age of 45 years old or 10 years before the first cancer in the family, whichever is earlier. If you have any symptoms like pain or bleeding or loss of weight or change in bowel habits, you should not wait and at least come for a consultation with our doctor, regardless of your age.

How Do We Screen for Colorectal Cancer?

Colonoscopy is the Gold Standard for screening.

Not only can it remove polyps and prevent the cancer, even detecting an early cancer may still you can be cured. This is not the case for most other cancers.

The key is for people to come forward for screening even when they do not show any symptoms.

This is because patients are often well (e.g. with no pain or bleeding or loss of weight) when they only have polyps or even in the early stages of cancer. Furthermore, we are seeing more young colorectal cancer patients, presenting even in their early 40s and 30s! It is never too early to start, so come speak to our doctor.

Removing a polyp during Colonoscopy

What is a Colonoscopy?

This is the best screening test for colorectal cancer.

During the colonoscopy, you are comfortably asleep throughout. Our doctor is a trained expert in this field and performs the procedure safely, by inserting a thin flexible tube which is called a colonoscope into the anus. Our doctor carefully examines the inner lining of the colon and rectum and if there are any polyps or tumours, the doctor will sample/biopsy them immediately and send them for further testing. The colonoscope contains a high-definition video camera and fiber optic lights that will take videos and pictures of what our doctor sees.

Our team will give you instructions on how to prepare for the colonoscopy including the food to avoid before the scope. You do not need to stay overnight in the hospital and will be back to work the very next day.

What About Other Screening Tests?

Other tests include a stool test called FIT (Faecal Immuno-histochemical Test). This is for detecting invisible traces of blood in the stool, but this is not as accurate and cannot remove polyps or tumours. Furthermore, if the FIT is positive, you will still be recommended to do a colonoscopy.

So, remember, screening can save your life!