Colorectal Cancer
Overview
The colon and the rectum together form what is commonly called the large intestine, the last part of the digestive tract. The large intestine is about 1.4 to 1.6 metres long. The colon absorbs water from digested food, which enters it from the small intestine. The rectum, which is just above the anus, holds what is not absorbed and subsequently forms faeces. From the rectum, faeces are then expelled through the anus.
Common diseases of the large intestine are haemorrhoids (also known as piles), anal fistula, anal fissure, colon cancer, rectal cancer and colon polyps. Common complaints include bleeding in the stools, irregular bowel habits and abdominal pain.
These diseases are quite common, and unfortunately, frequently cause discomfort and even embarrassment. However, with early diagnosis and treatment, many of these conditions can be managed well and have good outcomes.
- Anal Fissure
- Anal Fistula
- Haemorrhoids / Piles
- Colorectal Cancer
Symptoms of Colon and Rectal Cancer
In the early stages of colorectal cancer, there are sometimes no symptoms, or the symptoms appear as mild and vague. By the time symptoms appear, the cancer may already be at an advanced stage.
Some symptoms are:
- Change in bowel habits – more frequent, constipation, or irregular habits
- Bleeding in stools
- Inability to completely empty the bowels
- Stools becoming thin
- Recurrent or persistent abdominal pain and/or bloating
- Unexplained weight loss
- Weakness or feeling easily tired
- Anaemia
When to Seek Colon and Rectal Cancer Treatment?
- If any of the above symptoms occur, it is prudent to seek medical attention, so that assessment can be made.
- As a large proportion of patients are asymptomatic, international guidelines recommend screening of the colon for individuals aged 50 and above, even if there are no symptoms or family history.
Diagnosis of Colon and Rectal Disease
Anal Fissure
The diagnosis is confirmed by a careful examination of the anus.
Anal Fistula
The key finding from an examination is the presence of one or more small holes in the skin near the anus. An MRI or ultrasound may be performed to confirm the diagnosis.
Colorectal Cancer
The ideal test is a colonoscopy. This allows visualization of the cancer and identification of its location. Tissue biopsy can also be obtained to confirm the diagnosis.
Following the diagnosis of cancer, CT or PET scans may be performed to check if the cancer has spread to nearby lymph nodes. For cancer of the rectum, MRI or ultrasound may be done to decide if chemotherapy or radiotherapy is required.
Haemorrhoids/Pile
Physical examination will determine the presence and severity of haemorrhoids. Haemorrhoids can be classified into four grades.
Procedure for Colon and Rectal Disease
Anal Fissure
- The initial treatment for an anal fissure involves pain relief and medication to relieve constipation or stop diarrhoea.
- Other simple treatments include
- Avoiding constipation by increasing fibre and water intake, medication to soften stools.
- Sitz bath – sitting in warm water to help relieve pain and alleviate irritation.
- Topical ointments can be used to relax the tight muscle tone of the anus
Surgery known as lateral sphincterotomy may be performed if the above measures fail. A small cut is made to the anal muscles to release the tight muscles.
Anal Fistula
Surgery is usually recommended as it is the most effective treatment. An anal fistula rarely heals by itself.
The aim of surgery is to disconnect the tunnel. Special care has to be taken not to damage the anal muscles (anal sphincter) as the anal sphincter controls bowel continence.
There are many types of surgical procedures available but the choice depends largely on the type of abnormal tunnel.
Superficial Tunnels- Fistulotomy
The abnormal tunnel is opened up to allow drainage.
Superficial Tunnels- Fistulectomy
The abnormal tunnel is removed.
Deeper or Multiple Tunnels
Insertion of a specialised surgical thread called a seton, or filling the tunnel with a special glue or tying the tunnel (LIFT procedure).
All these procedures have different risks and benefits. However, most of these procedures may be performed as a day surgery procedure. If admission is required, the average length of stay is one night.
Some patients may require multiple operations especially if there are multiple tunnels or if the tunnel is very deep. The fistula can recur despite surgery. There is also a risk of damage to the muscles controlling bowel movement (anal sphincters), and thus risk of faecal incontinence. Fortunately, this is very rare.
Colorectal Cancer
The appropriate treatment will depend on the stage of the cancer. The ideal treatment is surgery to remove the cancer, as well as the lymph nodes around the cancer. Currently many of the operations to treat colorectal cancer can be performed by laparoscopic methods ( keyhole surgery).
Other methods for treating colon cancer and rectal cancer include chemotherapy and radiation therapy.
The type of colon and rectal cancer surgery depends on the location of the cancer.
Haemorrhoids/Piles
There are many treatment methods for piles. The type of treatment chosen depends on the severity of the disease. Common methods include medication, dietary modification, local treatment such as rubber-band ligation or HET, and surgery. Your doctor will advise which method is the most suitable.
Risk Factors for Colon and Rectal Disease
Anal Fissure
- Inflammatory bowel disease
- Tuberculosis
- Anal cancer
- STDs
Anal Fistula
- Past history of anal abscess
- Inflammatory bowel disease e.g. Crohn’s disease
Colorectal Cancer
- Cigarette smoking
- Regular alcohol drinking
- Intake of food high in red meats (e.g. beef, pork, lamb, etc) and processed meats (e.g. hotdogs, canned food, etc)
- Age > 50 years of age
- Personal history of colon or rectal polyps
- Personal history of colon cancer or rectal cancer
- Personal history of inflammatory bowel disease (e.g. Ulcerative Colitis or Crohn’s Disease)
- Having an inherited disease such as Lynch’s Syndrome or Familial Adenomatous Polyposis
- Family history of colon or rectal cancer, especially if the close relative was diagnosed with colon or rectal cancer at an age of < 45 years old
Haemorrhoids/Piles
Pregnancy predisposes to piles. This is due to the womb pressing on the large blood vessels in the back, causing back pressure on the veins, leading to piles.
Cost of Procedure
Anal Fissure
Based on the Ministry of Health (Singapore) historical transacted billsizes and fee benchmark, for an operation to treat anal fissure
- Typical Doctors’ Fees range (includes surgeon and anaesthetist fees) is S$2800 to 4400 (not inclusive of GST)
However, other factors that can affect the final bill includes your insurance plan and coverage for Co-payments and Deductibles as well as Medisave withdrawals.
This procedure is a Medisave claimable procedure if there is medical justification. The Medisave withdrawal limit for this procedure performed as a Day Surgery procedure is S$1950.
Anal Fistula
Based on the Ministry of Health (Singapore) historical transacted billsizes and fee benchmark, for a operation to remove a simple anal fistula:
- Typical Doctors’ Fees range (includes surgeon and anaesthetist fees) is S$2900 to 4600 (not inclusive of GST)
- Typical Hospital Fees range is S$2300 to 3500 (not inclusive of GST)
However, other factors that can affect the final bill includes your insurance plan and coverage for Co-payments and Deductibles as well as Medisave withdrawals.
This procedure is a Medisave claimable procedure if there is medical justification. The Medisave withdrawal limit for this procedure performed as a Day Surgery procedure is S$1950.
Haemorrhoids/Piles Treatment
Based on the Ministry of Health (Singapore) historical transacted billsizes and fee benchmark, for a haemorrhoidectomy (surgical removal of piles/haemorrhoids):
- Typical Doctors’ Fees range (includes surgeon and anaesthetist fees) is S$3700 to 4800 (not inclusive of GST)
- Typical Hospital Fees range is S$3000 to 4300 (not inclusive of GST)
However, other factors that can affect the final bill includes your insurance plan and coverage for Co-payments and Deductibles as well as Medisave withdrawals.
This procedure is a Medisave claimable procedure if there is medical justification. The Medisave withdrawal limit for haemorrhoidectomy performed as a Day Surgery procedure is S$1950.
Colon and Rectal Cancer Surgery Treatment FAQs
Yes, colon cancer is treatable in the early stages. Treatment of colon cancer in the early stages usually produces good results. Colorectal cancer screening is therefore important, so that cancer can be diagnosed in the early stages, before any symptoms appear.
Treatment for colorectal cancer varies, depending on the stage of the disease. The common treatment modalities are surgery, chemotherapy and radiation therapy.
Chemotherapy can be used in different stages of colon cancer. The decision to have chemotherapy and the type of chemotherapy given is made after consultation with a medical oncologist.
The chances of survival are high, especially with disease in the early stages.
No, this is not always the case. Majority of patients do not need to use a colostomy bag.
There may be some minor changes to the bowel pattern. For the large majority of patients, good quality of life can be expected after recovery from surgery.
No, they do not. These are 2 different diseases. However, they may both cause rectal bleeding, and it is easy to assume that the bleeding is due to haemorrhoids, whilst it may actually be from rectal cancer.
It is possible, but not definite. Some stools may also appear thinner than usual.
Common symptoms include bleeding during or after a bowel movement, change in bowel movement pattern, change in stool appearance, frequent sensation of wanting to have a bowel movement but with no stools being passed, passage of mucus.
To definitively diagnose rectal cancer, the best test is a colonoscopy, as the cancer and the rest of the colon can be clearly seen, and biopsies can be taken to determine the type of cancer.
In the early stages, very good outcomes from treatment can be expected. If the disease is advanced, results of treatment will be poorer.
The traditional approach would be an open procedure. However, minimally invasive procedures with much smaller incisions are now widely performed. The affected part of the colon is removed together with the draining lymph nodes, and healthy bowel is joined back to allow bowel movement.
Not necessarily so, however, this very much depends on the extent of disease for that individual.
These are complementary treatment modalities. Surgery is the mainstay of treatment. Chemotherapy and radiation therapy, where applicable, provide good adjuncts that can improve the results remarkably.
Not necessarily so. The possibility of a colostomy bag is present, and this depends on the individual’s disease profile. However, many such stomas are temporary and not permanent.
Very much so, especially if the disease is diagnosed in the early stages, the results may be quite remarkable.
Dr Jane Tan Jye Yng
Colorectal & General Surgeon
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Consult Our Doctors
Dr Jane Tan Jye Yng
Colorectal & General Surgeon
Dr Lim Khong Hee
Upper Gastrointestinal, Bariatric & General Surgeon
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Colon Cancer Treatment FAQs
How Can I Prevent Varicose Veins?
Avoiding standing still for long periods will reduce the pressure in the veins in the legs. For people who need to stand for long periods at work, wearing compression stockings will reduce the pressure build up in the legs.
How do I prepare for my vascular ultrasound?
The ultrasound will be done of the legs from the thigh to the calves. Please wear or bring along a pair of shorts to change into for the scan.