Colorectal cancer numbers far too high, say experts

Every day, five people here are diagnosed with colorectal cancer and two die of it. These numbers are far too high, say experts, since this is one of the most preventable cancers.

But not enough people here are using the available screening tools to detect the cancer in the early stages, or better yet, catch the problem before it becomes cancer.

Generally, colorectal cancer develops from polyps that grow on the inside walls of the large intestines and the rectum. If the polyps are discovered early and removed, they are not allowed to become cancerous.

It usually takes more than a decade for a polyp to become a tumour, so there is a large window of time for it to be dealt with.

In the US, where 60 per cent of people aged 50 and older have colonoscopy screening, the incidence of this cancer has fallen by 30 per cent over the past decade. It is now the fourth most common cancer there.

In Singapore, it remains the top cancer, although the rise in cases appears to have plateaued since 2000.

Singapore is ranked 16th by the World Cancer Research Fund in terms of the incidence of this cancer. It is higher in countries like South Korea and Australia, but lower in Japan and the United States.

Doctors advise a test every year to detect any blood in stools that could signal the cancer and a colonoscopy every decade from the age of 50, when the incidence of this cancer starts to climb.

The procedure, in which a tiny camera is inserted through the anus into the intestines to check for polyps and cancerous cells, costs about $1,200 to $2,000. Subsidised patients pay about $300 to $500. Depending on the complexity, between $1,250 and $1,850 for this test can be paid for with Medisave.

Overall, however, the rates of surviving colorectal cancer have improved vastly over the years.

The prognosis is especially good for those whose tumours are discovered in the early stages, before they have broken through the walls of the intestines.

Dr Ho Kok Sun, a colorectal surgeon at Mount Elizabeth Medical Centre, said the standard treatment is surgery if the cancer is still within the colon.

This is classified as stages one and two. Patients at this stage have a very high chance of surviving beyond five years, the holy grail for cancer survival.

But once it has spread through the four layers of the colon wall, the odds of survival plummet. Said Dr Ho: “Once it’s spread through the wall, as the intestines move, the cancer cells are like rice grains dropping off the surface. That’s one of the worst types of spread.”

When that happens, the loosened cancer cells can attach themselves to a host of organs and tissues nearby.

The cancer can also spread from the lymph nodes into the blood stream and the rest of the body, with the liver typically being the first target.

Dr Chee Cheng Ean, a consultant in haematology-oncology at the National University Hospital, said the actual stage of the cancer sometimes cannot be determined until after surgery, when the nearby lymph nodes are removed and checked. At least 12 nearby nodes need to be removed to check if they have the cancer.

At stages three to four, the cancer has spread to the lymph nodes or broken through the intestinal wall. Patients in those stages would need chemotherapy to reduce the risk of recurrence – 50 per cent in stage three without chemotherapy – to 40 per cent.

“The actual benefit is 10 percentage points, which is enough to justify chemotherapy,” she said, since it means that out of 10 patients doing chemotherapy, the cancer would not recur in one additional patient.

As a result, deaths have fallen, even though more people are getting the cancer. Between the five-year periods of 2005-2009 and 2010-2014, the five-year survival rate went up from 46 per cent to 51 per cent for men, and from 51 per cent to 53 per cent for women.

Even patients with stage four cancer, in which it has spread to other parts of the body, are living longer than they did before.

Said Dr Ho: “For stage four cancer 20 years ago, when people asked how long they had, the answer would be six weeks to six months. “Now, we have patients on long-term chemotherapy. We can control, but not cure, it.”

The effect of this treatment varies, he said. For some, quality of life is “lousy” for a few days after treatment, then fine for the next few weeks, and the whole cycle then repeats with the next treatment. This can go on for years. Others say it is so bad, they would rather die.



Childhood cancer survivors continue to have lasting health problems

NEW YORK, Nov 8 ― Despite advances that have made treatments safer and more effective, childhood cancer survivors don’t appear to have experienced gains in long-term health outcomes, a new study suggests.

Their survival odds are better, but as adults they may have chronic medical problems linked to cancer and tumour treatments, the study found.

Up to one in four childhood cancer survivors report health problems in their 20s and 30s, researchers report in the Annals of Internal Medicine.

“They have chronic conditions at higher rates than siblings and the general population and they perceive their health as worse,” said lead study author Kirsten Ness of St Jude Children’s Research Hospital in Memphis, Tennessee.

Childhood cancer survivors’ “adverse health outcomes increase with age ― like the rest of the population ― but several decades sooner,” Ness added by email.

Ness and her colleagues compared 14,566 adult survivors of childhood cancer treated in the 1970s, 80s and 90s to their siblings without a history of malignancies.

Over the past generation, there has been an overall reduction in radiation exposure and chemotherapy doses. Because the study includes survivors treated in a more recent era of more targeted and less toxic medicines, researchers expected survivors who were treated more recently to report better outcomes.

“We expected their perceived health to be better ― but it was not,” Ness said.

The proportion of survivors with severe, disabling or life-threatening conditions did go down, from about 33 per cent in the 1970s to about 21 per cent among those treated in the 90s.

But compared to people treated in the 70s, survivors from the 90s were more likely to report poor general health and cancer-related anxiety, the study found.

By the 90s, survivors of leukaemia, a blood cancer, were more likely to report poor general health and survivors of osteosarcoma, a bone cancer, were more likely to report persistent pain.

Changes in radiation or drug doses over time weren’t associated with changes in the proportions of cancer survivors reporting health problems, the study also found.

No matter when they were treated, survivors were also more likely to report poor health when they smoked, didn’t exercise enough or were unusually underweight or obese.

Certainly, changes in treatment and survival outcomes over time may have allowed people who would have died from cancer in the 70s to live long enough to complain of other health issues in the 90s, the authors note.

It’s also possible that some personal risk factors patients had for certain health problems might have preceded cancer, rather than being an outcome of tumours or treatment.

“While the quantity of survival has improved, it remains to be seen whether the quality of survival has improved,” said Dr Saro Armenian, director of the Childhood Cancer Survivorship Clinic at City of Hope Comprehensive Cancer Centre in Duarte, California.

“Research on childhood cancer survivorship issues during the past two decades has highlighted the high burden of chronic health conditions in this aging population,” Armenian, who wasn’t involved in the study, added by email.

While it can be difficult for patients and families to focus on other health issues when their main concern is cancer, leading a healthy lifestyle with good diet and exercise habits may help minimise the risk of additional medical problems, said Dr Joann Ater, of the childhood cancer survivor program at the University of Texas M.D. Anderson Children’s Cancer Hospital in Houston.

Avoiding obesity, high cholesterol, and high blood pressure can decrease risk of cardiac side-effects and possibly second cancers, Ater, who wasn’t involved in the study, said by email. She added, “Children should also participate in all preventive health measure such as not smoking or using tobacco, HPV vaccine, wearing sun screen to prevent skin cancer, and following recommended adult cancer screening, such as Pap smears for young women.” ― Reuters Health

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Alcohol’s cancer toll revealed

PARIS, Nov 3 — Alcohol consumption caused more than 700,000 new cancer cases and around 366,000 cancer deaths in 2012, mainly in rich countries, according to data reported yesterday to the World Cancer Congress in Paris.

Comparing the cancer risk of people who drink, to that of people who do not, researchers calculated that alcohol was responsible for an estimated five per cent of all new cancer cases, and 4.5 per cent of deaths per year.

“A large part of the population is unaware that cancer can be caused by alcohol,” study co-author Kevin Shield of the International Agency for Research on Cancer (IARC), told AFP of the preliminary report, not yet published.

Alcohol was most strongly linked to new breast cancer diagnoses — more than one in four of all alcohol-attributable cancer cases, the researchers found, followed by colorectal cancer at 23 per cent.

For breast cancer, particularly, it was clear that “the risk increases with the dose” of alcohol, said Shield.

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Reports warn of explosion in cancer deaths among women

NEW YORK, Nov 2 — Two reports have warned of an explosion in cancer deaths among women, with a toll, mainly from breast cancer, of some 5.5 million per year by 2030 — roughly the population of Denmark.

This represented a near 60-per cent increase in less than two decades, said an analysis conducted by the American Cancer Society (ACS), released yesterday at the World Cancer Congress in Paris.

As the global population grows and ages, the highest toll will be among women in poor and middle-income countries, it said, and much of it from cancers which are largely preventable.

“Most of the deaths occur in young- and middle-aged adults”, placing a heavy burden on families and national economies, said Sally Cowal, senior vice president of global health at the ACS, which compiled the report with pharmaceutical company Merck.

A second report, published in The Lancet medical journal today, said the number of women diagnosed with breast cancer alone could almost double to 3.2 million a year by 2030 from 1.7 million in 2015.

For cervical cancer, the number of diagnoses could “rise by at least 25 percent to over 700,000 by 2030”, mainly in low- and middle-income countries, said a statement from The Lancet.

Cancer is already killing one in seven women around the world, said the ACS report — the second highest cause of death after cardiovascular disease.

All four of the deadliest cancers — breast, colorectal, lung and cervical cancer — are mostly preventable or can be detected early, when treatment is more successful.

In poorer countries, a much smaller proportion of cancer cases are diagnosed and treated than in rich ones, while a much bigger group dies.

The relative burden is growing for developing countries as people live longer due to better basic healthcare.

Women in these countries are also increasingly exposed to known cancer risk factors “associated with rapid economic transition,” said Cowal, “such as physical inactivity, unhealthy diet, obesity, and reproductive factors” such as postponing motherhood.

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