Ask Dr Wong Nan Yaw: Colon Cancer

Hi Yvette, A colonoscopy is the most accurate screening test for colon cancer in Singapore. However, there are risks and costs involved with the procedure. As such, the stool tests offered (FOBT, FIT) are alternatives for patients who want a low-cost screening tool that determines their need for a colonoscopy. If a stool test is positive, one should undergo a colonoscopy as soon as possible. To understand more about getting a colonoscopy in Singapore, read The Complete Guide To Colonoscopies In Singapore (2018).

Robotic surgery can sometimes be used in colo-rectal cancer. It may or may not be necessary. It can be useful in cases whereby the tumour is near vital structures like that of the anal sphincter. It is best you discuss this with your treating doctor.

Colon surgery can be done via open surgery or via laparoscopic approach ('keyhole surgery'). The feasibility to perform via laparoscopic approach sometimes depends on the stage of the disease. For instance, a locally advanced disease may not be suitable for a laparoscopic approach. In addition, the stage of the disease may also affect the timing of the surgery. For example, a stage 4 disease with distant sites of spread may benefit from a course of chemotherapy first before considering surgery especially if the colon cancer itself is not causing too much symptom.

The success of colon cancer surgery depends a lot on the stage of the disease. The earlier the stage, the higher the chance of cure of the cancer. However, with current options of chemotherapy regime, it is still possible to achieve a high chance of cure with later stages of colon cancer. For instance, when the cancer has spread to the liver (stage 4), and liver alone, by removing all the tumor nodules in the liver, together with chemotherapy treatment, it is possible to achieve 40% to 50% chance of long term survival.

There are 2 types of colostomy : temporary and permanent. During colorectal cancer surgery, the segment of bowel containing the cancer is removed and healthy bowels are joined back together to form a joint, or what surgeons call an anastomosis. For cancers that are near the anus muscles (so called low tumours), the chance of leakage after the anastomosis is formed is higher than cancers that are further away from the anus (high tumours).