What is Colorectal Cancer?
The colon-rectum is the last part of the gastrointestinal tract and the functions to absorb water. CRC is formed from cells lining the colon and the rectum. As the cancer grows, it invades through the colon wall and spreads via several routes:

Polyps are benign growths in the colon-rectum which may transform in to cancer. If polyps are detected they should be removed.

How Common Is Colorectal Cancer?
CRC is the second most common cancer in Singapore men and women. Combined together, CRC is the most common cancer in Singapore, with close to 1000 new patients diagnosed yearly. The Chinese have a higher risk than the Malays or Indians.

Risk Factors

	Age: 90% of colorectal cancers occur in persons aged 50 and above. The Chinese appear to have a higher risk than other races in Singapore
	Family History: Personal or family history of colorectal cancer of polyps in the colon increases a person’s risk
	Diet: Persons on a low fiber and high fat diet are 8 times more likely to develop colorectal cancer. There is convincing evidence that vegetables reduce risk. Cereals have not been proven to protect against CRC. Certain types of foods are linked to a higher risk, e.g. meat cooked at high temperatures, animal fat, tobacco and alcohol
	Inflammatory bowel disease: Persons suffering from ulcerative colitis and Crohn’s disease have a higher chance of developing colorectal cancer
	Drugs: Current users of HRT (hormone replacement therapy) are at a lower risk but this protection disappears within 5 years of stopping HRT
	Aspirin and NSAID (a group of painkillers) are known to reduce the risk. However it is too early at this stage of research to recommend the routine use of these drugs for this purpose
	Sedentary lifestyle and obesity: These two related factors increase the risk of colorectal cancer
	Past history of colorectal polyps or colorectal cancer

Screening for Colorectal Cancer
Colon screening is to detect polyps or colorectal cancer early. The current methods include faecal occult blood test (FOBT), digital rectal examination, flexible sigmoidoscopy or colonoscopy and barium enema x-ray.

Studies have shown that yearly FOBT in people over 45 can detect polyps and early CRC. Current recommendations for CRC screening are:

	FOBT and Digital Rectal Examination yearly. FOBT is a simple test conducted on a person’s stool to detect blood. Sometimes blood that is hidden in the stool may not appear red. Many conditions cause blood in the stool. These include piles, peptic ulcer, colonic polyps (benign growth from the lining of the colon) which are pre-cancerous, and Colorectal Cancers
	Sigmoidoscopy every 5 years
	Colonoscopy every 10 years
	Or Barium Enema every 5 – 10 years

Signs & Symptoms
Unfortunately, these symptoms only appear when the CRC is advanced: