COLON CANCER TREATMENT IN SINGAPORE

Indeed, colon cancer surgery is the only treatment that a colon surgeon can offer for the definitive cure of colon cancer. While there are other colon cancer treatment options such as chemotherapy, they are best used as supporting treatments, not as standalone treatments, as they merely reduce the risk of occurrence but do not always offer a cure.

In the treatment of colon cancer, the main point is to remove the part of the colon affected by cancer, along with surrounding areas containing the lymph nodes where the cancer would typically spread to. After the affected part of the colon is removed, the remaining part of the colon will be joined back together so bowel movements are not affected.

WHAT ARE THE DIFFERENT TYPES OF COLON CANCER SURGERY?

• Open Surgery
• Laparoscopic Surgery
• Single Port Incision Surgery
• Robotic Surgery

This is the traditional method of colon cancer surgery, where a long incision (10 to 30 cm long) is made through the centre of the abdomen. It provides your surgeon with a direct view and better access to the surgical site. However, this results in a large incision that cuts through the entire core muscle in the centre, giving rise to longer recovery periods and greater pain. Once the procedure is completed, your surgeon will close the incisions with stitches or surgical tape.

This is the preferred method of colon resection surgery today as it is minimally invasive, offering benefits such as reduced scarring and a faster recovery time. However, laparoscopic surgery is more complex than traditional open surgery, as the colon surgeon will have to skillfully manoeuvre his way around the three to five small incisions around the abdomen. The surgeon will insert surgical instruments into the incisions and perform the removal of part of the colon and lymph nodes with the help of a long, thin, lighted tube with a surgical camera on the end known as a laparoscope. The laparoscope enables the surgeon to observe the abdomen and manipulate the instruments through the monitors to operate with enhanced precision.

This is one of the latest advancements in laparoscopic surgery in the past few years. Instead of 3-5 incisions, only one incision (2-5 cm) will be made at the navel. A camera and two instruments are inserted through this single port and the surgery is performed. The tumour and the affected part of the colon are then removed through this incision. As a minimally invasive approach, this offers potential benefits such as reduced scarring and a faster recovery time.

This is one of the more recent and advanced types of minimally invasive surgery. Like a laparoscopy, it requires only small incisions to insert instruments. However, in this approach, the surgical instruments are controlled using robotic machines. The surgeon, sitting at a console, manipulates the robotic arms to operate the camera and surgical instruments. The surgical camera provides a 3D view, greater magnification, and clarity for the colon surgeon. This provides accurate depth perception and an increased level of precision not found in other forms of laparoscopic techniques.

What are the Differences Between the 4 Types of Colon Cancer Surgery?

Laparoscopic surgery, single port incision surgery and robotic surgery are all considered minimally invasive surgery (keyhole surgery). The actual amount of cutting done in all forms of surgery, be it minimally invasive or open, is the same. The only difference is in the approach (large versus small incisions on the abdominal wall, and the instruments used to do the cutting).

The advantage of minimally invasive (keyhole) surgery compared to open surgery is well-proven in patients’ lower levels of pain and faster recovery.

What is unclear is the relative advantage of the various forms of minimally invasive surgery. Studies have shown that the results of robotic surgery and laparoscopic surgery are comparable with no advantage favouring one over the other. What is clear, though, is that robotic surgery is more expensive than laparoscopic surgery.

How to Prepare for Colon Cancer Surgery?

As part of the preparation for colon cancer surgery, you will need to take these steps:

• Preoperative assessment to assess your fitness for surgery.
• Inform your surgeon about your medications and allergies, if any, in case any of them need to be temporarily adjusted or stopped prior to the surgery.
• Discussion of the procedure, benefits, possible risks, and what to expect post-surgery.
• Bowel preparation, which includes light diets, fasting, and bowel cleansing.
• Planning for post-surgery recovery and accommodations.

What Is Recovery Like After Colon Cancer Surgery?

Recovery after colon cancer surgery can vary depending on the individual and the type of surgery performed. Most patients typically spend 2-7 days in the hospital, with careful monitoring of their progress. During this time, you will gradually transition from a more liquid-based diet to soft foods, and your physiotherapist will guide you through exercises to improve mobility and reduce the risk of complications.

Upon discharge, the surgeon will prescribe medications and provide instructions on wound care, exercises, and diet. While recovering at home, you should still keep up with your physiotherapy. Although normal activities may resume in about 6 weeks, strenuous activities and heavy lifting should still be limited. A complete recovery from colon cancer surgery may take approximately a few months.

• What is a Stoma?
  A stoma is an artificial opening created in the abdomen to allow the small or large intestines to come through and discharge the faeces into a bag. Many patients who have to undergo surgery for colon cancer are concerned that they might need a stoma.
• Who Needs a Permanent Stoma?
  It is not common to require a permanent stoma. This usually happens only if the cancer involves the anal muscles, and the muscles need to be removed to clear the cancer. If the anal muscles are removed, putting the intestines back there would lead to the loss of control of stools, hence these patients are offered a permanent stoma so that stools can be collected into a bag without any leakage or smell.
• Who Needs a Temporary Stoma?
  In some patients with rectal cancer, the position of the cancer is low, hence after removing the colon/rectum, the joint (anastomosis) is very close to the anus. It is known that the closer the anastomosis is to the anus, the higher the risks of it not healing well, opening up and causing severe infection. In such cases, the surgeon may opt to bring out a temporary stoma. This diverts the faeces away from the anastomosis and avoids major spillage and infection if the anastomosis does not heal properly. The stoma is then closed up in 6-12 weeks when the anastomosis has healed.

What are the Types of Non-Surgical Colon Cancer Treatment?

There are numerous treatment options that do not require colon cancer surgery. However, most of these are used together to enhance cure rates of surgery, or used for control of the cancer in situations where it cannot be cured.

• Chemotherapy

  This may be an oral drug or injection that acts to kill or slow down the growth of cancer cells. When the tumour reaches a significant size, doctors may administer chemotherapy before surgery to shrink it, facilitating easier removal. Chemotherapy may also be administered post-surgery to eliminate any remaining cancer cells that cannot be removed surgically. For advanced colon cancers that have spread to other organs, chemotherapy can shrink the tumours and provide symptomatic relief.

• Targeted therapy

  Targeted therapy is typically used for stage 4 cancer. This treatment involves administering drugs or other substances that target the cancer's specific genes, proteins, or the tissue environment contributing to cancer growth and survival. Typically combined with chemotherapy, it can be used independently as well. Targeted treatments cause cancer cells to die without damaging healthy cells; they achieve this by blocking certain chemical signals and proteins specific to cancer cells.

• Immunotherapy

  These are drugs that help the body’s own immune system to destroy cancer cells.

  The immune system can normally destroy cancer cells, but cancer cells may produce proteins that turn off the immune response. Immunotherapy drugs target these proteins to turn on the body’s immune response and utilise its natural defences to attack abnormal or cancerous cells.

  Immunotherapy is used for cancers that show certain types of genetic changes.

• Radiotherapy

  Radiotherapy, also called radiation therapy, utilises high-energy X-rays or other particles to destroy cancer cells, stop them from growing, and ease symptoms. This therapy is typically a local treatment aimed at specific areas where the cancer is located. Radiotherapy is often used in conjunction with chemotherapy, called chemoradiation, but it can also be used alone or with surgery. Radiotherapy may be used before surgery to shrink the tumour to make surgery easier and reduce the recurrence rate.

Post-Colon Cancer Surgery Care

This usually involves regular follow-ups for physical examinations, colonoscopies and other imaging tests to ensure that the wound is healing as expected and the cancer does not recur.

At each follow-up, your colon surgeon may also conduct a CEA blood test as a rising CEA may suggest a recurrence of colon cancer.

Facing a colon cancer diagnosis can be overwhelming. At HKS Colorectal Cancer Clinic, our MOH-accredited surgeon, Dr Ho Kok Sun, provides a comprehensive range of medical and surgical treatment to manage the disease. If you or your loved one is seeking colon cancer treatment in Singapore, please reach out to us today.