Colorectal cancer is curable if detected early. Individuals with colon polyps or early colon cancer may not display any symptoms. We encourage all patients above the age of 50 to undergo regular screening for colorectal cancer. There are two common screening methods in Singapore.

Faecal Immunohistochemical Test (FIT)

The FIT tests for blood in the stool that may not be visible to the naked eye. The FIT kit comes with a stick that is used to collect a small sample of stool. However, this test is not useful if you already have symptoms of passing blood in your stools.

Colonoscopy

A colonoscopy is the 'gold standard' for screening for colorectal cancer. During a colonoscopy, the doctor uses an endoscope - a flexible tube with a camera - to evaluate the inner lining of the colon and rectum. During the colonoscopy, any identified polyps are removed and sent for microscopic evaluation. Other areas of concern may be biopsied as well. The removal of polyps can be both diagnostic and therapeutic as some of these polyps may eventually develop into cancer.

If you or your loved ones have a history of the following conditions, you may be required to start screening before the age of 50. Click here to make an appointment with us.

• Colon polyps
• Personal or family history of colon cancer
• Inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• Genetic diseases such as:

1. Familial adenomatous polyposis
2. Lynch syndrome 

Blood in the stool

Passing blood in the stool (hematochezia) is a commonly encountered symptom. The colour of the blood can suggest the location of bleeding: Bright red bleeding tends to occur due to conditions of the anus and rectum, such as haemorrhoids, anal fissures and rectal cancer.

Dark red bleeding tends to occur due to bleeding higher up in the digestive tract, such as the colon. Conditions that cause this include diverticulosis and colon cancer.

If you have blood in the stools, as well as associated symptoms such as unexplained weight loss, a change in your usual bowel habits, or a strong family history of colorectal cancer, you should be evaluated for colorectal cancer. 

Constipation or diarrhoea

Normal bowel movements differ between people. Some may have up to 3 bowel movements a day, while others may go a few days in between without having one. Factors that contribute to constipation include inadequate intake of water, fibre and physical activity. Medical conditions that contribute to constipation include high calcium levels and hormonal derangements.

On the other hand, diarrhoea is most commonly due to benign causes such as a viral infection (gastroenteritis). In Asians, it is also commonly due to lactose intolerance. Persistent diarrhoea should prompt evaluation for underlying causes such as chronic infectious causes, inflammatory bowel disease and spurious diarrhoea from colorectal cancer.

If you have new onset constipation that is persistent, you should undergo evaluation for a medical cause, including a colonoscopy for colorectal cancer. 

Anal Pain
Pain around the anus commonly occurs due to anal fissures, which are traumatic tears in the lining around the anus due to the passage of hard stools. Treatment usually includes stool softeners, painkillers and medications to relieve the associated spasm in the anal sphincter muscles.

Pain around the anus may also be due to prolapsed or thrombosed haemorrhoids. These are usually treated with stool softeners and topical anaesthetic agents initially, while surgery may be indicated once the acute event has settled down.

If anal pain is associated with discharge and fever, these may be due to perianal abscesses or anal fistulas. These may be treated with antibiotics, and some may require surgery for definitive management. 

Incontinence
Faecal incontinence can be a distressing symptom. It may manifest as passive seepage of solid or liquid stools or as an inability to reach the toilet in time during periods of urgency. Incontinence is commonly associated with a history of obstetric trauma or previous anal surgery.

The Division of Colorectal Surgery offers an exhaustive range of up-to-date medical treatments, clinic-based therapies and surgical procedures to our patients, some of which are mentioned below.

​	​Minimally Invasive Surgery Laparoscopic (keyhole) surgery: Small incisions are made over the abdomen and special instruments are used to perform surgery under general anaesthesia. These avoid the need for large wounds and reduce post-operative pain, wound infection rates and decrease lengths of stay. Robotic surgery: Small incisions are made over the abdomen and surgeon-controlled robotic arms are used to perform surgery under general anaesthesia. This is similar to laparoscopic surgery.
​	​Transanal Surgery Transanal Minimally Invasive Surgery (TAMIS) uses a specialised platform to remove growths from the mid to upper rectum. It avoids the need for major abdominal surgery for large polyps or early rectal cancers. Transanal Total Mesorectal Excision (taTME) is a novel surgical approach for treatment of rectal cancer. Two surgical teams work in tandem using a combined abdominal and transanal approach to remove low rectal cancers.
​	Advanced Endoscopy ​Previously, large colon polyps require a resection of the colon for complete removal. Today, advanced endoscopic resection techniques such as Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) have allowed patients to avoid surgery.
​	Cytoreductive Surgery and Heated Intra-peritoneal Chemotherapy (CRS and HIPEC) ​Patients with advanced cancer affecting the peritoneum may be suitable for CRS and HIPEC. This is an advanced surgery involving the resection of all visible cancer and the delivery of heated chemotherapy directly into the abdominal cavity.  Pressurised Intra-Peritoneal Aerosolised Chemotherapy (PIPAC)​ PIPAC is a novel, promising technology for the treatment of patients with advanced cancer involving the peritoneum. Chemotherapy is delivered in an aerosolised form into the abdominal cavity using laparoscopic (keyhole) techniques.