10 Mar 2011
Two to three out of every 100 patients seen at some hospitals here are below the age of 40. Experts want to draw attention to the rising number of patients across all age groups as part of Colorectal Cancer Awareness Month
Every day for three months in 2009, Ms Loh Hui Ping passed blood in her stool. But she told herself it was nothing because there was no pain.
The medical social worker, now 22, recalled: "I read on the Internet that blood in the stool could be due to colorectal cancer, but this usually happened to people over 50 years old. I didn't think it would happen to me."
When she finally saw a doctor four months later in June 2009, she found out she did indeed have stage one rectal cancer (see other story).
Colorectal cancer is so uncommon in those under 40 that its warning signs tend to be ignored, said Associate Professor Tang Choong Leong, who is acting head of colorectal surgery at the Singapore General Hospital (SGH).
"Or they may dismiss blood in the stools for piles," he said.
The concern is that when the cancer finally comes to light, they may not be as lucky as Ms Loh and it may be advanced.
People under 40 made up two out of every 100, or about 14, patients with colorectal cancer seen at the SGH last year. The hospital takes in nearly half of all new colorectal cancer cases in Singapore.
At the National University Hospital (NUH), colorectal cancer patients below 40 years old also make up three out of every 100, or about five patients every year, in the last few years.
Across all age groups, there has been a rise in colorectal cancer cases, a consequence of changing lifestyles and, to a lesser extent, earlier detection, so awareness is important.
Latest figures from the Singapore Cancer Registry show that about 1,455 Singaporeans were diagnosed with the cancer every year from 2003 to 2007, a 19 per cent increase from the previous five years. About 638, or more than four out of every 10, colorectal cancer patients die every year.
Colorectal cancer, which affects the large intestine or the rectum, is the most common cancer here and the second most common in women, after breast cancer.
And Singaporeans, together with Americans, have one of the highest rates of colorectal cancer in the world, said NUH senior consultant colorectal surgeon, Assistant Professor Dean Koh.
He believes the high incidence among Singaporeans is partly a price paid for affluence. Rising incomes and the changing nature of jobs have given rise to sedentary lifestyles, obesity and a diet low in fibre and high in calories, red meat such as beef and processed foods such as canned food.
All of these have been shown in overseas studies to put a person at higher risk of colorectal cancer.
The increase in the number of people with diabetes, another lifestyle-related condition, may also be contributing to the rise in colorectal cancer, he said.
Though the mechanism of how they are linked is not yet understood, a study by the National University of Singapore in the 2006 issue of the Journal Of The National Cancer Institute confirmed that those with diabetes are more likely to develop colorectal cancer.
Warning signs of colorectal cancer include blood in stools or a change in bowel patterns such as diarrhoea or constipation, or a feeling that the bowel does not empty completely.
But people should not wait for symptoms to appear, said SGH's Professor Tang.
He said: "By that time, it is likely that the cancer would have spread to the lymph nodes or other organs."
When this happens, surgery or taking out the affected part of the intestines alone may not be enough.
Treatment such as chemotherapy or radiotherapy might be necessary.
Rather than wait till symptoms show up, individuals should assess their own risk of colorectal cancer and go for the appropriate screening (see table).
A colonoscopy can detect polyps, which usually begin as benign abnormal growths in the colon, so they can be removed. More than 90 per cent of colorectal cancers are caused by polyps, which can take up to 10 years to turn cancerous.
The first risk factor is age, so anyone aged 50 and above should have a faecal occult blood test every year. The test requires them to collect a sample of their stool and send it to a laboratory to be tested for occult or hidden blood, which can indicate cancer.
If occult blood is present, a colonoscopy will be done to confirm cancer.
Last week, the Ministry of Health announced that those aged 50 and above can now use their Medisave funds to pay for a colonoscopy, which can cost around $1,500.
Hopefully, this will spur people who need it to have the procedure done, as the cost has proven before to be a stumbling block, according to a survey by the Singapore Cancer Society a few years back.
The second risk factor is family history. Professor Tang from SGH said that someone with a family member, specifically a parent or a sibling, who has colorectal cancer, is more than twice as likely to develop colorectal cancer as the average person. They should see a doctor and start screening before they turn 50 (see table).
These individuals will need a colonoscopy once every few years.
In a colonoscopy, a thin tube with a camera is inserted into the intestine through the anus to check for abnormalities.
However, most young people under 40 with colorectal cancer do not have a family history, said Associate Professor Charles Tsang, the head of colorectal surgery from NUH.
It is not known what causes them to contract cancer.
So to rule out the worst, it is best for young people to consult their family doctor if they have persistent bleeding in the stools or other bowel symptoms, said Professor Tsang.
One young patient, Mr Louis Ng, a part-time educator, was diagnosed with stage two rectal cancer in 1998, when he was 37.
He had his entire rectum removed and has lived with a stoma bag since then.
Like Ms Loh, he had blood in his stools for more than two months and thought it was piles. He tried a topical Chinese herbal ointment for three days, but the blood started to "gush out like urine" each time he passed stool. On the third day, he blacked out for a few seconds at home and had to be rushed to hospital and given an emergency blood transfusion.
That was when he was diagnosed with the cancer. Now 49, the bachelor has had no relapses since and his doctor told him he is cured.
Mr Ng, who is the ambassador of the colorectal cancer support group at SGH, said: "My advice to younger people out there is that, if you have blood in the stools, do not take it lightly. Go see a doctor."
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Dept of Colorectal Surgery
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