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

At Mark Wong Surgery, we have commenced our Teleconsult service for this very purpose.

Teleconsult uses modern technology to provide you with medical advice in the comfort of your own home, without needing to travel out to meet us at the clinic. Amidst the current COVID-19 outbreak, this has become even more important, as we practice social distancing to reduce our risk of exposure.

All you need is a PC or MAC and programs like Skype or Zoom to use this service. Below are some FAQs to guide you along.

Teleconsult FAQs

1. IS TELECONSULT SUITABLE FOR ME?

This service is useful if you are relatively well as a physical examination cannot be performed. It is also good for routine follow-ups, seeking advice on your test results and getting a second opinion.

You should also be familiar with the technology (PC or Mac), as the quality of communication (ie. image and sound) can be limited by your equipment and internet speed.

As such, you must accept the above limitations before proceeding.

2. WHAT CAN I EXPECT FROM A TELECONSULT?

There are 3 types of services offered and the fees are as follows:

a) Consultation only
b) Consultation + medical report
c) Consultation + medical report, + Radiology and/or Pathology (slides) report

3. CAN WE ORDER MEDICATIONS?

Yes. And we will courier them to you.

Cost of medications and delivery charges will be made known prior to delivery. For overseas delivery, you will also have to pay any local taxes when they arrive in your home country.

4. HOW DO I MAKE AN APPOINTMENT?

Simply email us at info@markwongsurgery.com for more information.

Our dedicated team will help to schedule an appointment.

Stay Safe & Stay Healthy!

The Team from Mark Wong Surgery

Singapore is affectionately known as a ‘food paradise’, blessed with a wonderful variety of delicacies that we can often enjoy 24/7. However, such daily conveniences have also been severely disrupted.

As well as protecting ourselves from the virus on the outside, we should not forget to strengthen our immune system. Our body’s natural defenses keep us healthy in the face of mild infections, including contaminants in the food that we may accidentally consume.

Our intestines are actually one of our main ‘pillars of defence’, containing trillions of microbes collectively known as the microbiome. Research has shown that the gut microbiome plays an essential role in the body’s immune response to infection and in maintaining overall health.

As well as mounting a response to infectious agents like the coronavirus, a healthy gut microbiome also helps to prevent potentially dangerous immune over-reactions that damage the lungs and other vital organs, which often cause respiratory failure and death. In addition, the microbiome has been shown to influence the development of cancer and drug behaviour as well. Hence it is essential that we eat the right foods to keep our gut healthy so that we can better protect ourselves against the ravages of diseases.

The food we eat has a more important and direct impact on the microbes in our gut. Do not fall into the trap of taking health supplements that claim to’boost your immune system’ without any real scientific evidence. Also never eat any foods (including fiber ) in excess as this will always lead to problems. Find out more about common myths here.

A diverse microbiome is a healthy microbiome, containing many different species that interact with one another and each play their part in immunity and health. Microbiome diversity declines as we get older, which makes it even more crucial to start eating right early in life and then maintaining a healthy microbiome throughout your life.

The best way to increase our microbiome diversity is by eating a wide range of healthy foods. These include fresh lean meats and plant-based foods, which are high in fibre, and limiting ultra-processed foods including junk food. Following a Mediterranean diet has also been shown to improve gut microbiome diversity and reduce inflammation: eating a mixture of fruit, vegetables, nuts, seeds and whole grains; healthy fats like extra-virgin olive oil; and lean meat or fish. Avoid excessive alcohol, salt, sweet drinks, and artificial sweeteners and preservatives.

(Source: Ministry of Communications and Information website)

During this period of staying at home, if you are concerned about getting hold of fresh produce, do consider that frozen fruits and vegetables are also healthy and will last much longer. Canned fruits and beans are another long-lasting option. You can also support your microbiome by regularly eating natural yoghurt and artisan cheeses, which contain live microbes (probiotics). Another source of natural probiotics are bacteria and yeast-rich drinks like kefir (fermented milk) or kombucha (fermented tea). Fermented vegetable-based foods, such as Korean kimchi (and German sauerkraut) are another good option.

Remember that choosing foods that support a healthy gut microbiome is much more important than stockpiling toilet paper or instant noodles. Maintaining your mental health by staying physically active and getting enough sleep will also help to keep your immune system in good shape. And don’t forget to wash your hands and avoid touching your face and wear a mask when you leave your house.

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

COVID-19 (the illness caused by the new coronavirus SARS-CoV-2) has officially been declared a pandemic by the World Health Organization. To date, more than 1.7 Million people have been infected with more than 100,000 deaths recorded in this span of 4 months. Many countries have sealed their borders and more than 1 Billion people now live in some form of nationwide lockdown in an attempt to curb the spread of this virus.

In Singapore, the government has taken decisive measures and together with our modern healthcare system, we are confident of weathering this storm together as one United SG. Nonetheless, normal routines have been disrupted and we are now having to adjust to a new norm of social distancing and improved personal hygiene.

Amidst these unprecedented changes to our lifestyles, we must always remember to keep ourselves and our loved ones safe. These include following the National guidelines of regularly washing your hands, avoiding touching your face, wearing a mask when outdoors and reducing social contact, especially with high-risk groups such as the elderly of our family.

(Source: Ministry of Communications and Information website)

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!

Colorectal Cancer Screening

This is your best bet of preventing colorectal cancer and reducing your risk.

Screening is a process in which doctors use specific tests to detect pre-cancerous lesions (e.g. polyps) and treat these to prevent the actual cancer from forming. For screening to be effective, the disease (i.e. colorectal cancer) has to be common (it is the MOST common cancer in Singapore) and ideally should be performed on those who do not yet have any symptoms of the disease.

For colorectal cancer, the best screening test is the Colonoscopy.

Colorectal cancer starts as small non-cancerous growths on the inner lining of the colon or rectum. These are called polyps. They seldom cause symptoms due to their small size and usually take months to years to ever become a cancer. Regular screening is therefore your best chance of detecting these ‘silent’ polyps before they transform into cancer. Removing them early will therefore prevent cancers from forming in the first place.

Colorectal cancer as seen during Colonoscopy

One should come for a colonoscopy by the age of 45 years old OR 10 years before the youngest cancer in the family, whichever is earlier. If you already have symptoms like pain, bleeding, change in bowel habits (i.e. irregular patterns, flipping between constipation and diarrhoea) or weight loss, you should come to speak to our doctor early and have a discussion about doing a colonoscopy.

Factors that you cannot change or modify

You cannot change your family tree and these have genetic risks that are passed down from one generation to another.

1. Age

All those aged 45 years old and above are at increased risk of having colorectal cancer.

2. Family history of Colorectal Cancer or Polyps

Those with a family history will have a higher risk of developing colorectal cancer themselves. The more family members and the closer they are to you (eg. immediate siblings or parents), the higher the risk you have of getting this cancer.

3. Personal History of Inflammatory Bowel Disease (IBD)

Long-standing IBD (e.g. ulcerative colitis) increases the risk of developing colorectal cancer.

4. Inherited Syndromes or Gene-related Risk

Although only a small percentage, gene-related issues in the family can also increase the risk of colon cancer greatly. Usually such individuals can develop cancer at a much younger age, even in their 20s or 30s.

Factors you can modify to reduce your risk

There are things you can do to reduce your risk of colorectal cancer. These relate to your lifestyle choices.

These are 5 factors that you should pay attention to:

1. Smoking and Alcohol Consumption

Smoking and excessive alcohol intake are bad for your health. It also increases your risk of developing colorectal and many other cancers. The best thing to do is quit smoking and drink only occasionally and not in large quantities.

2. Diabetes

People with diabetes are also susceptible to getting cancer, especially those whose diabetes is not well controlled. Diabetics therefore must ensure that their condition is monitored closely and that their medications and diet are optimised.

3. Bodyweight

Being obese or overweight increases your risk of having colorectal cancer, regardless of gender. Know your ideal weight and ensure that you keep to it through a combination of eating a balanced diet and regular exercise.

4. Well-Balanced Diet

People who take a balanced diet comprising a good mix of fibre and meat have a lower chance of developing colorectal cancer. There is no guarantee and even vegetarians can get colorectal cancer, due to factors you cannot change as above. To reduce the overall risk, one should also avoid eating processed foods (e.g. fast foods) or preserved foods, as well as deep-fried or barbecued foods.

5. Regular Physical Activity

Avoid a sedentary lifestyle, i.e. do not be a couch potato! Increasing your physical activity level can lower your risk of having colorectal cancer. You should maintain an active lifestyle with regular exercise of at least 3 times per week lasting at least 30 minutes each time. Remember that exercising regularly is not an excuse to eat anything you want!

Good Food Choices for Lowering Your Colorectal Cancer Risk

A balanced diet is key to a healthy life. This balance is different for everyone and must be individualized. But there are some foods that are particularly important, these include:

1. Dairy Foods

According to recent studies, calcium-rich foods like dairy products (milk, yogurt, cheese) can reduce the risk of forming polyps (adenomas), some of which can develop into colorectal cancer.

2. Whole Grains

Whole grain foods (oatmeal, brown rice, and whole wheat bread) contain important protective nutrients like magnesium and fiber, which help to maintain good bowel movement and keep your intestines healthy.

3. Beans

Beans and legumes (soybeans, peas, and lentils) are a rich source of fiber, protein, vitamin B, and E. The flavonoids and antioxidants found in beans and legumes are also protective against colorectal cancer.

4. Multi-Coloured Fruits and Vegetables

Colourful fruits and vegetables contain phytochemicals, which have antioxidant properties that help to reduce inflammation in the body, thus helping to lower your risk of cancer.

5. Fish

Many fish, especially salmon, are rich in omega-3 fatty acids, which have anti-cancer growth properties. It is recommended that you take 80-100g daily for good health.

Foods to Be Eaten in Controlled Portions Only

1. Red Meats

Red meat by itself is not unhealthy. Taking lean red meat is a healthier option. More importantly, the method in which it is cooked also influences cancer risk, e.g. barbecued and deep-fried styles of cooking meat is unhealthy and should be limited. Therefore, it is advised to eat read meats in moderation, perhaps up to 2 to 3 times a week or not more than 18 ounces weekly.

2. Processed Foods and Meats

All processed foods (vegetables or meat) are prepared and preserved with chemicals which can increase your risk of cancer. The regular consumption of these foods, including sausages, bacon, ham, burgers, salted vegetables etc. can increase the chance of cancer from increased exposure to such chemicals in the body.

3. Items High in Refined Sugar, Caffeinated drinks, and Other Sugary Beverages

The excessive consumption of sugary foods, artificial sweeteners, caffeine, soft drinks, sweetened juices, and other sugary beverages also increases the risk of cancer. Therefore, it is best to avoid or minimize intake of such beverages.

4. Alcohol

Drinking alcohol daily may increase the risk of colorectal cancer by up to 20-40%. Alcohol should only be consumed sparingly.

We are what we eat. So, eat wisely since a Healthy Gut is a Healthy Life!

The burning question is, “how can we reduce our risk of getting colorectal cancer naturally?”. Studies have shown that engaging in regular physical exercise can lower colorectal cancer risks by as much as 15%. A study involving 1.4 million participants also highlighted that those with the lowest levels of physical activity had higher rates of colorectal cancer.

How Does Exercise Help to Reduce the Risk of Colorectal Cancer?

Obesity and a sedentary (‘couch potato’) lifestyle are risk factors of colorectal cancer. Those who exercise less tend to be more obese and overweight, hence putting them at higher risk of getting this cancer.

Research shows that exercise can lower your risk of developing colorectal cancer in the following ways:

• Improving immune function
• Reducing inflammation
• Reducing the time food stays in your colon, therefore reducing intestine exposure to potential carcinogens (cancer causing chemicals) in the food we eat
• Lowering levels of certain hormones, including insulin and oestrogen, that may contribute to the development and growth of cancer
• Decreasing growth factors associated with the development and growth of cancer

Recommended Exercise Plans (Intensity & Duration)

The type of exercise, intensity, and duration is still the subject of intense research. Remember to always consult your doctor before you start any exercise plan. This will vary from person to person, depending on your age and overall physical health. As with any exercise plan, you should always start slow and increase the intensity when the body has built up endurance.

Generally, at least 30 minutes of exercise 3 times a week is a good start. Good exercises to try are those which can help you work up a good sweat, such as walking, swimming, running, cycling, skipping, or hiking.

Our doctor personally prefers the outdoors to any gym, for a good dose of fresh air and to enjoy the scenery!

How Do Exercises Help Colorectal Cancer Survivors After Treatment?

Research has also shown that regular exercise helps to reduce the risk of cancer relapse by as much as 50%. Even colorectal cancer survivors who have undergone chemotherapy or radiotherapy can decrease their risk of relapse by doing moderate walking regularly, according to several case studies.

As such, consistent physical workouts adjusted to your age and physical health, is a good way to reduce the risk of colorectal cancer recurrence, in a natural way.

Stay healthy and have fun doing it!