Colorectal cancer

We often hardly think about the colon until there’s any sort of discomfort like constipation, diarrhoea, etc. The body’s ‘garbage shoot’ however needs much timely attention and care. One of the most common and enervating problems of the colon to watch out for is the colorectal cancer.

Colorectal Cancer In Singapore

Did you know that colorectal cancer is the number 1 diagnosed cancer among men in Singapore, and number 2 among Singaporean women? This means that every day, 3 men and 2 women are diagnosed with colorectal cancer in Singapore. Between 2010 and 2014, 9320 Singaporeans were diagnosed with the cancer of the colon and rectum. Today, it accounts for the 2nd highest number of cancer deaths in men and 3rd highest deaths in women.1

The Journey From Polyps To Cancer

Our colon consists of an ascending colon, transverse colon, descending colon, the rectum and anus. Colorectal cancer starts with the growth of benign colon polyps on any part of the colon. Not all polyps grow out into cancer, but they carry the risk of developing into Every little space around us needs a regular clean up; so do the insides of your body. Guess who’s doing this for us? It’s our own mighty ‘colon’! This March, let’s learn more about what we can do to care for the colon. By Rashmi Ullas cancer over a period of time.

The risk of developing colon polyps increases as we age. The number and size of polyps also increase with age. This is true, especially in families that carry the risk of colorectal cancer in their genes, people who carry polyps in the rectum or have chronic inflammatory bowel disease.2

Colorectal Cancer often does not show symptoms at an early stage, but there are warning signs, which could indicate the presence (or risk) of cancer:

  • Blood in your stool
  • Change in bowel habits, including diarrhoea or constipation
  • Feeling full or bloated
  • Incomplete emptying of the bowel
  • Persistent abdominal pain or discomfort
  • Presence of a lump in the abdomen
  • Why Is Screening Important?

    Like other cancers, colorectal cancers advance in four stages. With colorectal cancer, the common trend is that the symptoms are usually perceived only when the cancer reaches advanced stages. The Health Behavioural Surveillance of Singapore (HBSS 2015) has found that only 1 in 3 Singaporeans screen for Colorectal Cancer regularly. The 2007 – 2011 report by the National Registry of Diseases Office indicates that over half of colorectal cancer patients are diagnosed in the advanced stages, reducing their chances of cure significantly.

    The good news is, polyps, the benign growths that are precursors to colon cancer tumours, can be detected and removed with a colonoscopy, if they are not too big. Once the polyp is removed, we have in a way prevented this polyp from becoming cancerous. So early detection of both pre-cancer and cancer growths can improve survival rates and improve the patients’ quality of life.

    How is Colorectal Cancer Screened?

    There are many methods used for screening colorectal cancer and all of them assist in detecting the presence or risk of cancer early.

    Faecal Occult Blood Test (FOBT)

    Polyps are most commonly detected by changes in bowel habits, which accompany bloody or black stools. A Faecal Occult Blood Test (FOBT) on the stools can help confirm the existence of dangerous cancerous cells.

    Faecal Immunochemical Test (FIT)

    The FIT is a simple non-invasive test used to detect microscopic (very small amounts) blood in the stool, which cannot be seen by the naked eye. Blood in the stools does not always appear red. You will need specific tests like the FIT to accurately detect for signs of blood. Presence of blood in the stool does not always indicate presence of polyps or colorectal cancer because there are many other conditions (like piles and peptic ulcers) that cause blood in the stool.

    Free distribution of the FIT package

    The Singapore Cancer Society distributes the FIT Kit to Singaporeans and Singapore permanent residents who are 50 years old and above at no charge all year round. Once you cross 50 years of age, you are strongly encouraged to be screened through the FIT on a yearly basis.

    In the FIT package, you will receive a package that comes with 2 test kits, 2 FIT reply slips, an instruction pamphlet and pre-paid envelopes. This instruction pamphlet will explain how to collect your stool samples at home. Once you collect the stool sample, you will need to send them back to the Singapore Cancer Society through post (using the pre-paid envelopes) to process the results. You will be notified if the result is positive, and will be called for further follow-ups with a hospital to determine the exact cause of blood in the stool. You may be recommended additional screenings and tests if necessary.2

    For more details, please contact them at 6421 5868 or email to


    Colonoscopy is a technique that uses a long, flexible lighted tube for screening. The lighted tube is inserted into the anus and is moved up the colon to examine the entire large intestine. This screening method takes about 20 minutes and is done by a specialist in the clinic.

    Flexible Sigmoidoscopy

    The Flexible Sigmoidoscopy is a procedure that examines the internal lining of the lower end of your large intestine. A short, flexible, lighted tube is inserted into the rectum and slowly guided into the sigmoid (“S” shaped) colon.

    Risks of Colorectal Cancer

    Colorectal cancer is preventable and this can be achieved via regular screening. When signs of pre-cancer or cancer growths are detected in the early stages, the chances of recovery and survival are much higher for the individual.

    These below factors increase the risk of developing colorectal cancer:

  • Age of 50 and higher
  • A family history or previous history of colorectal cancer
  • Presence of polyps in the colon
  • Lack of exercise, sedentary lifestyle and obesity
  • Low fibre and high fat diet increases the risk considerably
  • Presence of inflammatory bowel disease (such as ulcerative colitis and Crohn’s disease)
  • Consumption of certain foods such as processed meat, red meat, and meat cooked at high temperatures, animal fat, tobacco and high alcohol consumption are linked to an increased risk of developing colorectal cancer. There is convincing evidence that regular fibre intake reduces the risk.

    Switch to a Healthy Lifestyle

    Your diet plays a very important role in your health and well-being. According to doctors, a high-fat, low-fibre diet is implicated in the development of colorectal cancer. Specifically, people who ingest a diet high in unsaturated animal fats and highly saturated vegetable oils, such as found in red meat or processed meats, have a higher incidence of colorectal cancer.3

    On the other hand, ingestion of a high-fibre diet may be protective against colorectal cancer. Fibre causes the formation of a soft, bulky stool that dilutes carcinogens; it also decreases colonic transit time, allowing less time for harmful substances to contact the mucosa.

    In populations with low average intake of dietary fibre, researchers found that an approximate doubling of total fibre intake from foods could also reduce the risk of colorectal cancer by 40%, according to a study.4

    There may also be risk reduction from consuming probiotics. Today, you can find probiotics in many dairy-based products, such as yoghurt and cultured milk drinks, which are aimed at optimising gut health. While direct studies are still on-going for the impact of probiotics on colon cancer development, there is a wealth of indirect evidence, based largely on laboratory studies, on its protective effects.5

    Additionally, probiotics thrive on the soluble fibre that is found in most vegetables, called prebiotics. Prebiotics help support growth of good bacteria in the intestines and act as food for probiotics. Prebiotics have been shown to help in improving digestion and preventing constipation. It can increase absorption of calcium and other minerals, stimulate the effectiveness of the immune system and promote optimal bowel pH. Also, by being fibre, it reduces the risk of colorectal cancer.6

    Making healthy changes to your lifestyle can help prevent colorectal cancer. Here’s what you can do to adopt a healthier lifestyle:

  • Avoid overeating
  • Quit smoking
  • Limit alcohol intake
  • Increase fibre intake in your diet
  • Reduce intake of processed meat and red meat (especially those cooked at high temperatures) and animal fat intake
  • Exercise at least 2 – 3 times weekly
  • Maintain a healthy body weight.

  • 1. Singapore Cancer Registry, Trends in Cancer Incidence in Singapore (2010- 2014).
    2. Colorectal Cancer. Available at: images/publications/brochures/scs-colorectal-cancer-brochure.pdf. Accessed on: 9 March 2017.
    3. Chao A, et al. Meat consumption and risk of colorectal cancer. JAMA. Jan 12 2005;293(2):172-82.
    4. Sheila Bingham et al. Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): An observational study, Lancet. 2003;361:1491-1495, 1496-1501.
    5. Rafter J: The effects of probiotics on colon cancer development. Nutr Res Rev. 2004 Dec;17(2):277-284.
    6. Bingham SA, et al: Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): An observational study. Lancet. 2003; 361:1496-1501.