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Colon and Colorectal Cancer Treatment and Diagnosis

COLON AND COLORECTAL CANCER TREATMENT AND DIAGNOSIS

What are Colon and Colorectal Cancers

Colorectal cancer is cancer affecting the large intestines (colon and rectum), which is the last part of the digestive tract.  Colorectal cancer is very common and is one of the top cancers in the world including Singapore.  While colorectal cancer typically affects older adults more than 50 years old, it can happen at any age and there is a rising incidence in younger adults worldwide.  Having a family history of colorectal cancer increases one’s risk. 

Are Colorectal Cancers curable?

When diagnosed early, this condition is highly treatable and curable.  The reason is because colorectal cancer usually begins as small, non-cancerous lumps inside the large intestines (polyps) and can transform into cancer over time (usually years). 

Lung Cancer Awareness

What Are the Signs and Symptoms of Colon Cancers?

Symptoms of colorectal cancer are NON-specific and can include 

  • frequent abdominal pain or bloating
  • change in bowel habits, for example, alternating diarrhoea and constipation
  • Blood in the stools
  • Weight loss

Unfortunately, by the time these symptoms occur, the colorectal cancer may be in a more serious stage.  

Cervical cancer treatment: Radiation therapy

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Diagnosis of Colon or Rectal Cancer

THE KEY is to diagnose colorectal cancer early, BEFORE the onset of symptoms.  This requires SCREENING.  Options for screening include

  • FOBT/Faecal Occult Blood Test – Testing the stool for blood NOT visible to the eye 
  • Colonoscopy – inserting a flexible tube with a camera into the rectum & colon to examine the inside of the large intestines
  • Computer Tomography (CT) Colonography or ‘Virtual Colonography’ – undergoing a scan of the intestines to examine the inside of the large intestines

Each of these tests has their pros and cons and it is worth discussing with your doctor which option is best for you.

What are the Stages of Colon Cancer?

The stages of colorectal cancer are

  • Pre-Cancer (Stage 0) – NON-cancer polyps, usually found on screening
  • Stage I-II: Cancer found in the colon or rectum wall ONLY.
  • Stage III: Cancer found in the colon or rectum AND nearby lymph nodes, but not to other parts of the body.
  • Stage IV: The cancer has spread to other parts of the body, such as the liver or lungs.

What are the Treatments for Colon or Colorectal Cancers?

The treatment options for colorectal cancer depend on the stage of the cancer.  Early cancers require less treatment and result in higher cure rates.  Treatment options are:

  • Pre-Cancer (Stage 0) – Removal of the polyps via colonoscope.  Rarely, surgery is required
  • Stage I-II: Surgery, usually minimally invasive (keyhole), if possible.  Chemotherapy and radiation may be necessary for some Stage II colorectal patients.  
  • Stage III: Surgery, usually minimally invasive (keyhole), if possible, followed by chemotherapy (for colon cancer) and chemotherapy and radiation (for rectal cancers).  Radiation with low dose chemotherapy is now usually performed BEFORE surgery for Rectal cancers.   
  • Stage IV: Surgery, chemotherapy, targeted therapies, immunotherapy and radiation tailored to each individual’s needs.

Side effects from Colon Cancer treatment

Side effects of treatment are dependent of the type of treatment and are largely well managed.  Discussion with your treating doctor will help you understand these issues better.

Finally, although the exact cause of colorectal cancer remains unclear, LIFESTYLE CHANGES can help to reduce the risk of getting colon cancer.  These include

  • A well balanced diet including a variety of fruits and vegetables.  Cutting down processed meats, for example, bacon, sausages, ham is also advisable.  
  • Drink alcohol in moderation
  • Stop smoking
  • Exercise regularly.  Remember that if you have been inactive for a while, start slow and build up along the way.
  • Maintain a healthy weight
Cervical cancer treatment: Radiation therapy

Oncologists at OncoCare with Clinical Interests in Colon Cancers

Dr Akhil Chopra

Senior Consultant, Medical Oncologist

MBBS (Delhi) – American Board Certified (Int Med) – American Board Certified (Hematology) –

American Board Certified (Med Oncology)

Dr Chopra completed his medical school training from Delhi University and he is American Board Certified in Internal Medicine, Hematology, and Medical Oncology. He completed his fellowship training from Hahnemann University Hospital/Drexel University College of Medicine in Philadelphia, USA.

Dr Chopra is experienced in treating multiple cancer types including lung cancer, breast cancer, cancer of the stomach, colon, rectum, liver, prostate, kidney, testicular and bladder. He also has experience in treating more rare cancers like sarcoma and neuroendocrine tumors. 

MEDICAL PROFILE

  • Graduated from Delhi in 2001
  • American Board Certified, Internal Medicine
  • American Board Certified, Medical Oncology
  • American Board Certified, Hematology
  • Fellowship Training at Hahnemann University Hospital/Drexel University College of Medicine in Philadelphia, USA
  • Fellowship Training at Hahnemann University Hospital/Drexel University College of Medicine in Philadelphia, USA
  • Special interest in treating multiple cancer types including lung cancer, breast cancer, cancer of the stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers; as well as lymphomas and chronic leukaemia’s/multiple myeloma.

Dr Benjamin Chuah

Senior Consultant, Medical Oncologist

MBBCH, BAO (Ireland) – MRCP (United Kingdom) – FRCP (Edinburgh) – FRCP (Medical Oncology)

Dr Benjamin Chuah graduated in medicine from Trinity College Dublin in 1998 where he was awarded the Professor Prize in Physic (Surgery) and the Arthur Ball Prize (2nd Place). Dr Chuah returned to Singapore and obtained his Membership of the Royal College of Physicians of the United Kingdom in 2002.

Dr Ben Chuah’s subspecialty interest is in Gastrointestinal Cancers including oesophageal, gastric, biliary tract, pancreatic, liver (hepatocellular carcinoma), neuroendocrine cancers and colorectal cancers. He has published research about screening colorectal cancer and he was involved in a randomized, phase 2 study of ganitumab or conatumumab in combination with FOLFIRI (5-FU, leucovorin, irinotecan) for second-line treatment of mutant KRAS metastatic colorectal cancer.

​MEDICAL PROFILE

  • Graduated from Trinity College, University of Dublin, Ireland in 1998.
  • MRCP (UK), Royal Colleges of Physicians of the United Kingdom, 2002.
  • Awarded the Professor’s Prize in Physic (Surgery) 1998, Arthur Ball Prize (2nd place) 1998, NUH Innovative Grant 2007, the Kobayashi Foundation Award 2010 and NUH Postgraduate Teaching Excellence Award 2011.
  • He was the Director of Post Graduate Medical Education (Medical Oncology) and Core Faculty for the Residency Program (internal Medicine) at National University Hospital.

Dr Thomas Soh

Senior Consultant, Medical Oncologist

​MBBS (Singapore) – MRCP (United Kingdom)

Dr Thomas Soh graduated from National University of Singapore in 2003 and received his Membership of the Royal College of Physician (United Kingdom) in 2007. He completed his advanced specialist training in Medical Oncology in 2012. Throughout his career, Dr Soh has been actively involved in both research and education in cancer medicine. His research publication in colorectal cancer involves working with cell free DNA,  chemotherapy drugs Regorafenib, and FOLFIRI regimen (irinotecan, 5-fluorouracil and folinic acid). 

Dr Soh believes in the delivery of quality healthcare, and was the lead and co-lead in several healthcare improvement projects. He has received multiple awards for his involvement in the Clinical Practice Improvement Programmes that he had implemented in NUH. From 2013-2015, he contributed a leading role being the Honorary Secretary of the Executive Committee, Singapore Society of Oncology.

​MEDICAL PROFILE

  • Graduated from the National University of Singapore in 2003
  • Obtained Membership of the Royal College of Physician (United Kingdom) in 2007
  • Awarded Teaching Excellence Award in 2014, NCIS
  • Awarded NUH UMC Undergraduate Teaching Best Tutor Award in 2015
  • Research funding from the National Medical Research Council (NMRC), Singapore, being awarded the Clinical Investigator Salary Support Program (CISSP) award 3 times
  • Research work was published in more than 10 publications relating to hepatocellular carcinoma, colorectal cancer, pancreatic cancer and other gastrointestinal cancers.
  • Sub-specialty oncology interest in gastrointestinal (oesophageal, stomach, colon and rectal cancers) and hepatobiliary cancers (liver, pancreas, bile duct and gallbladder cancers).

Dr Wong Nan Soon

Dr Wong Nan Soon

Senior Consultant, Medical Oncologist

MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology) – MHsc (Duke, USA)

Dr Wong Nan Soon is a Senior Consultant Medical Oncologist with more than 15 years of experience in the diagnosis and management of a wide range of cancers.

His subspecialty interests are in the field of breast cancer and gastrointestinal cancers (which include colon cancer, rectal cancer, anal cancer, biliary cancer, pancreatic cancer, liver cancer, GI stromal cancers (GIST) and neuroendocrine cancers.

In addition, he is also well versed in the treatment of a wide variety of cancers which include lung cancers kidney cancers, uterine, cervical and ovarian cancers.

He graduated from the Faculty of Medicine, National University of Singapore in 1994 and obtained the degrees of Master’s in Internal Medicine and Membership of the Royal College of Physicians of the United Kingdom in 2000.

In 2003, he completed advanced specialty training in general medical oncology.

This was followed by a 1 year clinical fellowship sub-specializing in breast medical oncology in Sunnybrook and Women’s Health Science Centre, Toronto, Canada where he trained under world renowned breast oncologists including Professor Kathleen Pritchard.

He was promoted to the position of consultant in 2006 and subsequently rose to the position of senior consultant and chief of breast team in the department of medical oncology, National Cancer Centre Singapore in 2009.

In 2009, he was awarded the prestigious Singapore National Medical Research Council overseas research fellowship to develop expertise in phase I clinical trials at Duke University, North Carolina, USA. During this year, he broadened his subspecialty interest to encompass gastrointestinal cancers, training under Professor Herbert Hurwitz. He also underwent further training in biostatistics and clinical research methodology, graduating with a master’s degree in health science research.

With this knowledge and experience in novel drug combinations, he is able to offer cutting edge medical treatment for both early stage cancers and also drug resistant difficult to treat advanced cancers.

​MEDICAL PROFILE

  • Novartis Oncology Young Canadian Investigator Award 2005
  • Canadian Association of Medical Oncology Annual Meeting Best Poster Award 2005
  • Chairperson, Medical Treatment Fund Committee, Singapore Cancer Society 2007
  • Clinical teacher, Yong Loo Lin School of Medicine, National University of Singapore from 2006-2011
  • Adjunct Associate Professor in the Department of Clinical Sciences, Duke-National University of Singapore, 2011-2013
  • Visiting Senior Consultant, KK Women’s & Children’s Hospital, Singapore 2010-2011
  • Senior Consultant, Dept of Medical Oncology, National Cancer Centre Singapore 2009-2011
  • Visiting Consultant, Dept of Medical Oncology, National Cancer Centre Singapore 2012-2014
  • Committee member, Specialist Training Committee (Medical oncology), Ministry of Health from 2009 to 2012
  • Invited lecturer at Nanyang Polytechnic School of Health Sciences
  • Director of Public and Patient Education, National Cancer Centre Singapore 2008-2011
  • Deputy Director in the Division of Community Outreach and Philanthropy, National Cancer Centre Singapore
  • Vice President, Singapore Society of Oncology 2011-2012
  • Board Member, Chapter of Medical Oncologists of Singapore 2009-2012
  • Honorary Secretary, Chapter of Medical Oncologists, College of Physicians, Academy of Medicine, Singapore 2007-2008
  • Member, Clinical Trials Steering Committee, National Cancer Centre Singapore, 2008-2011
  • Member, Singapore Society of Oncology
  • Member, American Society of Clinical Oncology
  • Member, HepatoPancreatoBiliary Association of Singapore.
  • Chairman, Singapore Cancer Network Breast Cancer Workgroup since 2014
  • Involvement in more than 30 local and international pharmaceutical and investigator initiated clinical trials
  • Awardee of multiple institutional and national level research grants.
  • More than 60 abstracts and papers in both local and international oncology journals, including Journal of Clinical Oncology, Clinical Cancer Research and Annals of Oncology.
  • Faculty and lecturer at numerous national and international oncology conferences