Ready for some toilet talk?
Most of us don’t like discussing our toilet habits but ignoring the subject might not be in your best health interests. Sudden changes in bowel motion are a common sign of colorectal cancer – the most common cancer in Singapore. That’s not to say that all changes in bowel motion are cancer-related, however – they could be due to other illnesses, which you’d want to know about, too.
Back to colorectal cancer. After doing some research, I found three big reasons why I should take colorectal cancer more seriously (and pay more attention to my poo the next time I use the toilet).
Jump to the 1-minute colorectal cancer quiz
Why everyone needs to know about colorectal cancer
- It’s a very common cancer among men and women
- It doesn’t just affect people over 50 and younger patients tend to have advanced stage of the illness which means poorer prognosis
- It’s treatable when caught in time
What is colorectal cancer? Exactly how common is it?
Colorectal cancer, also known as bowel cancer, can affect the colon (colon cancer) or rectum (rectal cancer), which are parts of the digestive system. As colon cancer and rectal cancer have a number of similarities, they’re often grouped together and called colorectal cancer. It usually starts as polyps or non-cancerous growths in the lining of the colon or rectum. However, some of these polyps may turn cancerous over time.
According to the latest Singapore cancer statistics, colorectal cancer is the most common cancer among men and the second most common cancer among women.
Top 3 cancers affecting men in Singapore
Top 3 cancers affecting women in Singapore
Colorectal cancer patients are getting younger
A recent news report revealed that colorectal cancer patients are getting younger – they’re no longer just individuals over 50 years. More patients are being diagnosed in their prime, when they’re building careers and starting families… in other words, when they least expect it.
The late Hollywood actor Chadwick Boseman was diagnosed with colorectal cancer at just 39 and it’s not unheard of for individuals younger than this to be diagnosed with the illness.
Dr Chong Choon Seng, colorectal and general surgeon at Ark Surgical Practice and Mount Elizabeth Hospital, says, “National statistics show that the most common age group among colorectal patients is still those above 50 years of age, however, there’s increased incidence of the illness in individuals under 50 years.”
What’s also concerning is that compared with the older patients, colorectal cancer in younger patients tends to be more advanced.
Dr Chong explains, “Advanced cancer at the point of first seeing a doctor indicates an overall poorer prognosis, i.e. low chance of recovery and/or more aggressive treatment methods are needed. In general, for younger patients, we tend to be more aggressive in our treatment strategies.”
“Poor prognosis” isn’t something anyone wants to hear, especially if you have dependants you need to look after. Neither is aggressive treatment, which could entail more risks and complications, higher medical bills and a longer recovery period. So, being proactive about your health is key. As Dr Chong says, “Earlier detection is always better and prevention is always better than cure.”
So, why are colorectal cancer patients getting younger?
“One hypothesis for this has to do with increased awareness and more people getting tested early. The other is our westernised diet and increasing prevalence of obesity – obesity is a risk factor for cancer,” says Dr Chong.
Curious to dig deeper, I looked up some population statistics on colorectal screening participation levels and obesity and body mass index. I identified two trends:
More people are getting screened
- 36.6% were screened for colorectal cancer in 2021 compared to only 14.6% in 20071
Obesity and unhealthy weight levels are rising among the young
- 10.5% were obese in 2020 compared to 8.6% in 2017, and the number is higher at around 12% among 30- to 59-year-olds1
- 20.7% were in the high-risk BMI category for Asians in 2020 compared to 18.7% in 2017, and high-risk BMI is more common at around 25% among 30- to 59-year-olds1
These numbers are reason enough for younger folk like me to be concerned about the risk of colorectal cancer.
As with many other cancers that are affecting younger people, the reasons are usually lifestyle related.
- Unhealthy diet – younger people’s diets tend to be high in fat and processed meats like sausages and ham and low in fruits and veggies
- Sedentary lifestyle – long working hours and spending too much time on digital devices for shopping, paying bills, getting meals, watching movies and everything else that used to require physical activity means we’re not exercising regularly
- Smoking – daily smoking is most prevalent among adults aged 30 to 39 years2
Other reasons include family history of colorectal cancer and personal history of other bowel diseases. If more people in the population are being diagnosed, it naturally follows that the number of people with family history will increase. However, the upward trend is reversible.
Should we start screening for colorectal cancer earlier?
The Screen for Life programme recommends starting regular colorectal cancer screening from the age of 50 for those without other symptoms. Should I start screening in my 30s or 40s since more patients are now being diagnosed before 50?
Dr Chong says, “The answer today is still ‘no’, as the absolute number of young colorectal cancer patients remains low. Only those with family history of colorectal cancer should consider screening earlier than 50 years of age.”
However, given the availability of resources and the fact that younger patients present with more advanced cancer when they first see a doctor, it’s important to protect yourself in these ways...
- See a doctor early should there be any symptoms that can be due to colorectal cancer
- Consume a healthy diet and exercise regularly
- Quit smoking
Good news: Colorectal cancer is highly treatable
Cancer myths are not helpful to patients. Many people think that cancer cannot be treated and that it cannot be prevented, however it’s the exact opposite with colorectal cancer. Dr Chong elaborates, “There are many cases where patients are treated for colorectal cancer even at stage 4. Patients with cancer at 90 years old have undergone successful surgery and remain well.”
Unlike some other aggressive cancers, colorectal cancer develops slowly over a few years. This makes regular screening tests like the faecal immunochemical test and colonoscopy very effective at detecting colorectal cancer in its early stages. Detecting and removing polyps before they become cancerous saves lives.
Dr Chong explains, “Removing polyps is an effective prevention strategy as cancer develops mainly from polyps. By removing polyps at regular screening intervals, the cancer is effectively prevented.
“Although not all types of polyps can progress to cancer, it’s better to remove any polyps seen during a scope rather than leaving them alone. In cases where there is an excessive amount of polyps due to genetic condition and removal of every polyp is not possible, there’s the option of either a yearly colonoscopy to survey the polyps or remove the affected colon to prevent the polyps from turning into cancer. This is known as prophylactic surgery.”
If an individual is diagnosed with colorectal cancer, treatment could involve surgical removal of the cancerous section of the colon/rectum, keyhole surgery, chemotherapy and/or radiotherapy. Early treatment is better as it means longer life expectancy. The more advanced the cancer, the more complex the treatment.
Dr Chong adds, “While stage 1 cancer can simply be treated by surgical removal, stage 4 cancer needs chemotherapy, possibly targetted therapy and sometimes radiotherapy with surgery. The outcome depends on factors like the patient’s fitness level, the disease burden and the location of the metastasis or cancer spread.”
Try this quiz to test your knowledge about colorectal cancer. You might learn a thing or two that could save your life – or someone else’s.
Surprising facts about colorectal cancer. Take this quiz to find out what they are.
Which of the following is a sign of colorectal cancer?
Correct
Answer: All the above
Other signs and symptoms of colorectal cancer include sudden changes in bowel motion, unexplained weight loss, anaemia, and abdominal pain which may or may not be accompanied by bloating. Read about the unusual culprits of abdominal bloating here. It’s also important to note that early stages of colorectal cancer are often symptomless and the presence of blood in the stool may not always be apparent to the naked eye.
Incorrect
Answer: All the above
Other signs and symptoms of colorectal cancer include sudden changes in bowel motion, unexplained weight loss, anaemia, and abdominal pain which may or may not be accompanied by bloating. Read about the unusual culprits of abdominal bloating here. It’s also important to note that early stages of colorectal cancer are often symptomless and the presence of blood in the stool may not always be apparent to the naked eye.
How frequently should healthy individuals over 50 go for colorectal screening?
Correct
Answer: Once every year
If you’re 50 and above and don’t have any colorectal cancer symptoms, it’s recommended that you do an annual faecal immunochemical test (FIT). Colorectal polyps and cancers can bleed into the colon causing tiny traces of blood to be visible in the faeces. Under the national Screen for Life programme, you can do a FIT at just a few dollars. If results are positive, you may need further testing, such as a colonoscopy (where a flexible tube with attached camera is inserted into the body to examine the colon). If you notice any signs of colorectal cancer in spite of a normal FIT result, see a doctor. If you’re in the high-risk group, the table in this article tells you how frequently to get screened and what tests to do.
Incorrect
Answer: Once every year
If you’re 50 and above and don’t have any colorectal cancer symptoms, it’s recommended that you do an annual faecal immunochemical test (FIT). Colorectal polyps and cancers can bleed into the colon causing tiny traces of blood to be visible in the faeces. Under the national Screen for Life programme, you can do a FIT at just a few dollars. If results are positive, you may need further testing, such as a colonoscopy (where a flexible tube with attached camera is inserted into the body to examine the colon). If you notice any signs of colorectal cancer in spite of a normal FIT result, see a doctor. If you’re in the high-risk group, the table in this article tells you how frequently to get screened and what tests to do.
men in Singapore have the highest age-standardised incidence of rectal cancer in the world.
Correct
Answer: Chinese
Chinese men in Singapore have the highest age-standardised incidence of rectal cancer in the world. This means that Chinese men in Singapore are particularly at risk.
Source: Health Hub, Screening for colorectal cancer, accessed on 10 August 2023.
Incorrect
Answer: Chinese
Chinese men in Singapore have the highest age-standardised incidence of rectal cancer in the world. This means that Chinese men in Singapore are particularly at risk.
Source: Health Hub, Screening for colorectal cancer, accessed on 10 August 2023.
Half of colorectal cancer patients have no known risk factors.
Correct
Answer: True
According to the Singapore Cancer Society, 50 percent of colorectal cancer patients have no known risk factors, however, the following can increase one’s risk:
- Being 50 years or older
- Personal history or colorectal polyps and colorectal cancer
- Family history of colorectal polyps at a young age
- Ulcerative colitis, a bowel disease that leads to inflammation and cancerous changes
- Sedentary lifestyle and obesity
- Unhealthy diet
Incorrect
Answer: True
According to the Singapore Cancer Society, 50 percent of colorectal cancer patients have no known risk factors, however, the following can increase one’s risk:
- Being 50 years or older
- Personal history or colorectal polyps and colorectal cancer
- Family history of colorectal polyps at a young age
- Ulcerative colitis, a bowel disease that leads to inflammation and cancerous changes
- Sedentary lifestyle and obesity
- Unhealthy diet
Blood in the stool is always due to colorectal cancer.
Correct
Answer: False
There are many reasons for blood in the stool, including haemorrhoids and colorectal cancer, which should not be confused with each other. Haemorrhoids or piles are swollen blood vessels that appear as soft lumps around or in the anus, whereas colorectal cancer are cancerous polyps or growths in the inner lining of the colon. Both have similar symptoms including bright red blood in the stool or on toilet tissue, a lump around the anus and being painless. Consult a doctor if you have these symptoms.
Incorrect
Answer: False
There are many reasons for blood in the stool, including haemorrhoids and colorectal cancer, which should not be confused with each other. Haemorrhoids or piles are swollen blood vessels that appear as soft lumps around or in the anus, whereas colorectal cancer are cancerous polyps or growths in the inner lining of the colon. Both have similar symptoms including bright red blood in the stool or on toilet tissue, a lump around the anus and being painless. Consult a doctor if you have these symptoms.
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Notes
1. Source: Epidemiology & Disease Control Division and Policy, Research & Surveillance Group Ministry of Health and Health Promotion Board, Singapore, National Population Health Survey 2020, published in November 2021.
2. Source: Epidemiology & Disease Control Division and Policy, Research & Surveillance Group Ministry of Health and Health Promotion Board, Singapore, National Population Health Survey 2021, published in November 2022.
