Optimal Timing for Treating Colorectal Cancer | Expert Says

Colorectal cancer is the most common cancer, despite it being one of the most detectable and preventable cancers. Ironically, its diagnosis tends to be made in the later stages. Indeed, about one-third of cases are diagnosed at stage three and another one-quarter at stage four, according to Health Promotion Board¹.

In this article, we speak to Consultant Colorectal Surgeon Dr Charles Tsang to learn more about the importance of treating colorectal cancer at an optimal timing and the medical advancements available upon diagnosis.

Understanding Colorectal Cancer

Colorectal cancer is a type of cancer that begins in the large intestine (colon). Anatomically, the colon is the final part of the digestive tract.  This cancer typically affects older adults, though it can happen at any age. Usually, it begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time, some of these polyps can become colon cancers.

However, in some cases, patients receive diagnosis of late stage colorectal cancer due to delay in screening and detection. At this juncture, the cancer cells might have spread to the lungs, liver or any other organ, and this is known as metastatic colorectal cancer. The most common site of metastases for colon or rectal cancer is the liver. Notably, colorectal cancer cells may also spread to the lungs, bones, brain or spinal cord.

Treatment for Colorectal Cancer

In more advanced colorectal cancer cases where the tumor is large, causing blockage or invading into surrounding organs, minimally invasive methods are not applicable. In this scenario, treating the disease would require open surgery.

According to Dr Tsang, surgical margin is important in colorectal cancer surgery. As an illustration of the importance of optimal timing in colorectal cancer treatment, here are some of the challenging cases he had encountered and dealt with.

“I had a 33-year-old patient who was 9 weeks pregnant. She first presented with worsening right back pain for over two months. From the MRI, we found a large ulcerative tumor mass in the retroperitoneal space, where the kidneys, adrenal glands, pancreas, nerve roots and lymph nodes are. It was a challenge as removing the tumor means the patient has to sacrifice her baby. The patient agreed on chemotherapy first. Subsequently, upon delivering her 29-week-old baby, she proceeded with her resection surgery,” shared Dr Tsang.

According to Dr Tsang, colorectal cancer treatment in pregnant women can be optimized with neoadjuvant chemotherapy (the use of chemotherapy to reduce a tumor’s size prior to the main treatment course with low risk to the mother and baby.

When the Cancer Advances

Further, Dr Tsang went on to share another challenging case he experienced.

“I had a patient who was a 50-year-old, diagnosed with rectal cancer which had spread to the liver. At this juncture, he underwent pre-operative chemotherapy. This resulted in improvements in both the rectum and liver. Thereupon completion of chemotherapy, the patient underwent liver resection followed by more chemotherapy. However despite the good response, a tumor nodule was detected on his right lung upon surveillance scans. So, surgery was performed on the lung laparoscopically to remove the tumor nodule” shared Dr Tsang.

Dr Tsang highlighted that metastatic cancer can be managed with carefully timed chemotherapy, radiation therapy and surgery of the primary tumor.

A Time for Everything

“Modern treatment of colorectal cancer involves a team of experts, including surgeons, oncologists and radiation therapists and there is a timing for everything” Dr Tsang added.

With Singapore having a total of 11,238 cases of colon cancer cases from 2014-2018 with both men and women equally at risk according to the Singapore Cancer Society², it is important for regular screening to avoid late detection of colon cancer.

The Importance of Screening and Early Detection

Colorectal cancer is a disease that is highly treatable and preventable with early detection. The recommendation is annual screening for adults that are 50 years and above.

Today, there are various screening procedures available to help in the detection of colorectal cancer. They are colonoscopy, virtual (CT) colonoscopy, double contrast barium enema and fecal occult blood test. Screening can detect and identify precancerous polyps—abnormal growths in the colon or rectum, allowing surgeons to remove them before they turn into cancer.

As a matter of fact, the early stages of colorectal cancer usually present with no symptoms. They start to appear only as the cancer progresses. Nevertheless, safeguard your health — test annually, change your lifestyle and stay informed.