Winning the war against colorectal cancer

SINGAPORE — Sprightly 71-year-old retiree Chah Meng Heng looks nothing like someone who had spent the earlier part of last year battling a terminal illness.

He was diagnosed with advanced colorectal cancer in January last year. By then, the cancer had already spread extensively to his liver.

Colorectal cancer is the most common cancer in Singapore, forming 18 and 14 per cent of all cancers diagnosed in local men and women respectively, said Dr Melissa Teo, senior consultant and head of the Division of Surgical Oncology at National Cancer Centre Singapore (NCCS).

In the early stages, symptoms do not usually show or may appear similar to those of common ailments such as bloating, stomach discomfort, diarrhoea and constipation, said Dr Teo.

As such, about half of the patients diagnosed with colorectal cancer at NCCS are in the advanced stages. When the disease spreads, it commonly does so to areas like the abdominal lining, lungs or liver as in Mr Chah’s case, said Dr Wong Seng Weng, medical director and consultant at The Cancer Centre, a Singapore Medical Group clinic.

“I was surprised that the cancer was so advanced. I thought that was the end for me,” said Mr Chah.

His pessimistic prediction could not be further from the truth.

After undergoing surgery and targeted therapy, the disease, now in remission, is a distant memory for Mr Chah. Targeted therapy is a new type of cancer treatment that uses drugs to identify and destroy cancer cells, or halt their growth.

“Now it feels like I never had the disease,” said Mr Chah, who was able to continue with his normal daily activities during treatment.

Newer treatments, better survival outcomes

If given 50 years ago, Mr Chah’s diagnosis might have been a quick death sentence.

In 1965, the average survival for advanced colorectal cancer (stage 4) was only about six months because no effective treatment was available for advanced disease then, shared Dr Wong, who treated Mr Chah using targeted therapy.

With modern treatment methods, the length of survival averages around two and a half years, said Dr Wong. He has also seen advanced-stage patients who are still doing well for more than three to four years after treatment.

A relatively new treatment strategy is cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), which have improved survival chances for patients whose cancer has spread to the abdominal lining, said Dr Teo of NCCS.

The procedure involves surgically removing the cancer within the abdomen, followed by washing the abdominal cavity with heated chemotherapy. Up to 40 patients undergo the procedure at NCCS each year.

Dr Hsieh Wen-Son, consultant oncologist at Farrer Park Hospital, added that a combination of targeted drugs and chemotherapy is now “highly effective in shrinking and controlling the tumours of colorectal cancer patients”.

“In addition, the targeted therapy and chemotherapy combination may be able to shrink tumours sufficiently to allow patients whose disease has spread to other organs to undergo potentially curative surgery,” said Dr Hsieh.

Dr Wong likened the new generation of targeted therapies, also known as smart drugs, to more effective “weapons in the war against cancer”.

He explained: “The information from genetic analysis is like military intelligence that enables me to use these weapons to their optimal effectiveness.”

Instead of adopting a one-size-fits-all approach, Dr Wong formulated a treatment based on a genetic analysis of Mr Chah’s cancer cells. The treatment has worked well for Mr Chah as there is no longer any trace of the cancer from CT scans.

However, Dr Wong stressed that there is currently no treatment that offers a 100-per-cent cure. Some forms of colorectal cancers are still resistant to certain treatments.

Early detection still important

Ultimately, survival rate still largely depends on the stage of the cancer at the point of diagnosis, added Dr Teo.

A person with early-stage cancer has a 85- to 90-per-cent chance of survival, while survival rates for advanced stages average around 50 per cent.

That is why early detection through regular cancer screening is still important.

“Screening tests like colonoscopy help prevent colorectal cancer by detecting abnormal growths in the colon or rectum, allowing doctors to take early action and to conduct further tests. Screening tests will detect this cancer earlier, when treatment can be most effective,” said Dr Hsieh.

Today, Mr Chah looks forward to spending time with his grandchildren.

He is thankful for living in an era where advances in cancer care have helped bring his disease under control while allowing him to maintain a good quality of life.

“I’d like to advise newly diagnosed patients not to give up on themselves and go for treatment, even if their cancer is in the advanced stages. Cancer treatment isn’t what it used to be,” he said.