The following article was published on The Straits Times.
What do cancer of the pancreas, colon and liver have in common? Apart from the fact that they are cancers that affect the digestive system, they are also preventable if detected early.
However, these cancers are difficult to detect at an early stage as symptoms appear only much later on. By then, it may already be too late as the cancer would have spread.
The only way to detect them is through screening, although most people are either not aware or see the need for it, says Dr Christopher Kong, senior consultant, Gastroenterology & Hepatology (Liver) at StarMed Specialist Centre. The one-stop private ambulatory care centre, which also offers other health screenings and services by general practitioners, comprises specialist clinics, operating theatres, endoscopy suites and radiology facilities.
“People think that they will notice early warning signs and have the cancer diagnosed, or think that these cancers only happen to old people,” he says.
These cancers are actually more common than we think.
What are these silent killers of the digestive system?
According to the National Cancer Centre Singapore, colorectal cancer – cancer of the colon and rectum – is the top most diagnosed cancer in men and second most diagnosed in women from 2015 to 2019.
Colon cancer may not have symptoms until it is at later stages of the disease. Symptoms may include diarrhoea, constipation, a constant need to have a bowel movement, bloody stools, or weakness and fatigue.
Available data shows that the five-year survival rate of stage 4 colon cancer in the United States is just 12 per cent.
Cancers of the liver and pancreas may not be as frequent, but they are the second and third most common cause of death from the digestive organs in Singapore.
Symptoms of liver cancer are even less obvious, with patients experiencing loss of appetite and weight, jaundice, tiredness or a feeling of being generally unwell.
The five-year survival rate is 20 per cent for liver cancer. If you get a liver transplant at an early stage, the survival rate goes up to 60 to 70 per cent, according to the American Cancer Society.
However, Dr Kong notes that the number of liver transplants in Singapore is less than 40 per year – far fewer than the 3,800 people who are diagnosed with liver cancer per year in Singapore.
For pancreatic cancer, the five-year survival rate is a low 11 per cent and there is a 90 per cent chance of death if one is diagnosed with pancreatic cancer later than Stage 2.
“Not many people have heard of the pancreas or even know where it is,” he says.
The pancreas plays an important role in digestion and has two parts – exocrine, which produces enzymes to digest food, and endocrine, which regulates blood sugar levels. Majority of pancreas cancers are from the exocrine part.
Dr Kong feels that there is a lack of awareness of the pancreas, and hence, of pancreas cancer. That is why screening, even the detection of any pre-cancerous cells will put people on the alert and prevent further deterioration, he adds.
How early detection of these diseases can help save lives
Getting screened for these cancers is one way to detect them early and save on healthcare costs, prevent suffering and improve one’s chances of survival in the long run, says Dr Kong.
But when and who should go for screening? Certain groups of people who are more at risk for these cancers should make screening a priority. Here are the recommendations for the three cancers:
Those above age 50 are encouraged to get screened for colon cancer annually. The easiest and cheapest way is to take a stool test. The Singapore Cancer Society distributes free Faecal Immunochemical Test kits to eligible Singaporeans and permanent residents.
However, even with the free stool test, the uptake for colorectal screening is considerably less than 50 per cent. This is based on findings in Cancer Screening Knowledge and Behavior in a Multi-Ethnic Asian Population: The Singapore Community Health Study that was published on Frontiers in Oncology in 2021.
Although the test of free and can be easily done, there are various reasons for its low uptake. Dr Kong feels that one reason could be that culturally, people may be reluctant to work with faecal material, even though it is a natural product of their own body. Also, some people prefer not to take the test after realising they may have to do it every year.
However, a limitation of the test is that it can only detect polyps (growth) of a certain size.
Another option is to take a colonoscopy, the gold standard for detecting colon cancer. According to Dr Kong, a colonoscopy done in a well prepared colon with no faecal residue is valid for at least five years, with no need to repeat it during that period if no lesion is found. This gives people peace of mind and they do not need colon screening for five years or more.
People with certain genetic conditions, hereditary polyposis syndrome or Lynch syndrome, those with multiple polyps in the colon, or those who suffer from inflammatory bowel disease for more than 10 years, require regular colonoscopy.
Those who have had their polyps removed require surveillance as a follow up to check for any new growths.
A family history of the disease and certain genetic syndromes put one at greater risk of pancreas cancer such as Lynch syndrome or Peutz-Jegher syndrome. These individuals should think about getting screened, advises Dr Kong.
Those who suffer from chronic pancreatitis (inflammation) should also seek medical advice about screening.
Surveillance is required for people who have pancreatic cysts, which may still be benign, but may turn cancerous at a later time. There are no obvious symptoms, except that the cyst may grow by a few millimetres over time.
According to medical research, people with pancreatic cysts of less than 1cm should have a CT or MRI scan in six months, then every two years if there is no change. More frequent surveillance is recommended for those with larger cysts.
There are several factors that lead to a higher risk of liver cancer. One is a Hepatits B infection, which causes inflammation of the liver and leads to liver cirrhosis.
Liver cirrhosis is a progressive condition that causes scarring of the liver, and increases your chances of getting liver cancer.
Obese people are another at risk group. Obesity may lead to non-alcoholic fatty liver disease, where there is a build-up of fat in the liver, which may further progress to liver cirrhosis.
Globally, it is also recommended that people with certain metabolic syndromes such as Type 2 diabetes be screened for fatty liver disease.
While cost is a factor that may prevent people from going from screening, Dr Kong notes that the government has initiatives to help patients with healthcare costs.
For instance, the Screen for Life National Health Screening Programme offers subsidised rates to eligible Singaporeans for colorectal cancer screening.
“In the long term, it is financially more prudent to go for screening or surveillance than to suffer the treatment or the complications of cancer,” he says.
Get your screening done early by booking an appointment at StarMed today.