From Screen Time to Screenings: Addressing the Spike of Colon Cancer Among Young Adults in Singapore
Colon cancer is emerging as a critical health crisis in Singapore and is particularly evident in the escalating incidence rates across the globe [1]. This type of cancer, which develops in the colon or rectum, is notably insidious, often presenting no symptoms until it has advanced to a more severe stage. The result is a condition that, although highly treatable when caught early, becomes more challenging to manage later.
The situation is particularly alarming in Asia, where changing lifestyles and dietary habits seem to intersect with genetic predispositions to significantly affect colon cancer rates. Singapore, for instance, has seen a stark rise in colon cancer cases [2]. According to statistics by the National Cancer Centre Singapore [3], the number of colon cancer patients has been increasing steadily, which makes it one of the most common cancers in the nation. This trend is mirrored in neighbouring countries, which suggests a broader regional health shift that demands immediate attention.
The rising number of colon cancer cases in Singapore is more than just a statistic; it signals a pressing need to explore the underlying causes of this trend. Factors such as increased urbanisation, adoption of Western diets, and stress-related lifestyle changes contribute to this rise. In this blog, we aim to analyse the trends contributing to the increase in colon cancer cases and review effective prevention strategies. Our objective is to raise awareness of colon cancer in Singapore and provide individuals with the knowledge they need to take action to prevent colon cancer.
Colon cancer begins in the colon or rectum, parts of the large intestine, and is characterised by the growth of tumours in the inner lining of these organs.
What is colon cancer, and how does it affect the body?
Colon cancer, also known as colorectal cancer, is a type of cancer that begins in the colon or rectum, which are key components of the digestive system. The colon, also known as the large intestine, absorbs water and nutrients from digested food and forms solid waste (stool). The rectum, the final segment of the large intestine, stores stool until it is expelled from the body.
This form of cancer typically starts as small, benign clumps of cells called polyps that form on the inner lining of the colon or rectum. Over time, some of these polyps can become cancerous. The progression from benign polyp to cancer can take many years, which is why screening and early detection [4] are crucial in preventing and effectively treating colon cancer.
The body parts primarily affected by colon cancer are:
Rectum: located at the end of the colon, the rectum is a common site for cancer to develop, especially in its lower sections.
Understanding the stages of colon cancer is critical for determining treatment and prognosis. The stages of colon cancer are categorised as follows:
Stage 0: also known as carcinoma in situ, the cancer is in a very early stage where it has not grown beyond the inner layer of the colon or rectum.
Stage I: cancer has grown into the next layer of tissue but has not reached the outer walls of the colon or rectum or spread outside the colon.
Stage II: cancer has spread through the muscle layer of the colon or rectum but has not spread to nearby lymph nodes.
Stage III: cancer has invaded nearby lymph nodes but is not affecting other parts of the body.
Stage IV: cancer has metastasised to distant organs, such as the liver or lungs.
Each stage of colon cancer not only suggests the extent of the disease and guides the treatment strategy but also impacts the prognosis. Early detection significantly increases [5] the chances of successful treatment, highlighting the importance of regular screenings, especially for those over 50 or with risk factors for the disease.
The stages of colon cancer range from Stage 0, indicating cancer in situ, to Stage IV, where the cancer has spread to distant organs.
Why is the incidence of colon cancer rising in Singapore?
Colon cancer rates have been rising in Singapore and around the world, which presents a significant public health concern. This increase is evident across various age groups and geographical regions, which prompts a closer look at the underlying causes and risk factors contributing to this trend.
Recent data [6] indicate that colon cancer is no longer a disease predominantly affecting the older population. Increasingly, individuals under 50 are being diagnosed, a group previously considered at low risk. Geographical variations [7] also show that higher rates of colon cancer are found in developed regions, such as North America, Europe, and parts of Asia, including Singapore. These regions have seen a steady climb in cases over the past few decades.
Historical data comparison further underscores the rise. For instance, over the last 20 years, colon cancer incidence in young adults has increased by more than 2% per year [8] in the United States alone. Similarly, countries [9] like Japan and South Korea, which traditionally had lower incidence rates, have witnessed a rapid increase, aligning more closely with Western figures.
Research [10] suggests that this uptick may be linked to a combination of factors, including dietary habits, increased sedentary lifestyles, and environmental influences. The Westernisation of diets [11] across the globe—characterised by high consumption of red and processed meats, refined sugars, and fat, along with low intake of fibre—has been closely associated with higher colon cancer risks. Urbanisation has also led to more sedentary lifestyles [12], further elevating the risk.
Key risk factors for developing colon cancer in Singapore include:
Age: while traditionally more common in older adults, rising cases in younger age groups are concerning.
Genetics: a family history [13] of colon cancer significantly increases risk.
Diet:diets [14] high in red meat and processed foods and low in fruits, vegetables, and fibre are linked to higher incidence.
Obesity: being overweight [16] or obese increases the likelihood of developing colon cancer.
Modern lifestyle contributions: the shift towards more sedentary jobs, less physical activity [17], and poor dietary choices have contributed significantly to the rise in colon cancer rates. Modern diets are often deficient in essential nutrients and fibres that help protect against colon cancer.
A sedentary lifestyle coupled with a diet rich in fats and low in fibre is linked to colon cancer.
What are the first signs of colon cancer?
Identifying the early signs of colon cancer is crucial for timely intervention, which significantly enhances the chances of successful treatment and survival. Colon cancer often begins silently, without symptoms, but as it progresses, several key indicators can signal the presence of this disease. The initial symptoms of colon cancer can be subtle and easily mistaken for less serious health issues, which makes regular screening and awareness of these signs vital. Common symptoms of colon cancer include:
Changes in bowel habits: sudden alterations such as constipation, diarrhoea, or a change in the consistency of stool that lasts for more than a few days can be an early sign of colon cancer.
Rectal bleeding or blood in stool: the appearance of bright red or very dark blood in the stool is one of the most noticeable signs of colon cancer.
Persistent abdominal discomfort:abdominal discomfort, like cramps, gas, or pain that does not go away, might indicate the presence of a tumour.
Feeling of incomplete bowel movement: a sensation that the bowel does not empty completely after a bowel movement can also be a warning sign of colon cancer.
Weakness or fatigue: unexplained weakness or fatigue can occur if cancer causes blood loss, leading to anaemia.
Unintended weight loss: losing weight without a change in diet or exercise habits is often a sign of cancer, as the body and appetite are affected by the disease’s metabolic demands.
Rectal bleeding can be a sign of colon cancer when it occurs persistently.
Can colon cancer be cured?
The possibility of curing colon cancer depends mainly on the stage at which the cancer is detected and treated. Early detection and intervention significantly increase the likelihood of a cure, which emphasises the need for regular screening and awareness of symptoms.
Early stages (I and II): in these stages, colon cancer is often localised to the lining of the colon or has just begun to penetrate the walls. Surgical removal of the cancerous section of the colon, known as a colectomy, is typically very effective. The cure rate is relatively high if the cancer is detected and treated at these stages. The 5-year survival rate [18] for stage I colon cancer can exceed 90%, while stage II has a survival rate of about 85% to 89% [19], depending on the extent of cancer spread within the walls.
Stage III: at this stage, colon cancer has spread to nearby lymph nodes but not to distant sites. Treatment often involves surgery followed by adjuvant chemotherapy to kill any remaining cancer cells and reduce the risk of recurrence. The 5-year survival rate for stage III colon cancer is around 65% [20], again dependent on the extent of spread and response to treatment.
Stage IV: this is the most advanced stage, where the cancer has spread to distant organs such as the liver, lungs, or other parts of the body. Cure rates at this stage are lower because the cancer is more challenging to eliminate.
The key to curing colon cancer lies in early detection through screening. Procedures like colonoscopies not only detect cancer at its earliest and most treatable stages but can also prevent cancer by allowing for the removal of polyps before they develop into cancer. For individuals at average risk, screening should begin at age 45. Those with additional risk factors, such as a family history of colon cancer or genetic predisposition, may need to start colon cancer screening earlier.
How can you prevent colon cancer in Singapore?
Colon cancer is a formidable health challenge, but it is also one of the most preventable types of cancer. A combination of dietary and lifestyle modifications, regular screenings, and advancements in treatment options can significantly reduce risk and improve patient outcomes.
Diet: dietary choices play a crucial role in colon cancer prevention. High-fibre diets [21] rich in fruits, vegetables, and whole grains are associated with a reduced risk of developing colon cancer. Conversely, diets high in red and processed meats have been linked to an increased risk. Limiting alcohol consumption and avoiding tobacco use also contribute to lower cancer risk.
Physical activity: regular physical activity is another effective measure. Engaging in moderate to vigorous exercise for at least 150 minutes per week has been shown [22] to significantly decrease the likelihood of developing colon cancer. Exercise helps to reduce inflammation, regulate hormones, and improve gut health, all of which play a role in cancer prevention.
Weight management: maintaining a healthy weight is critical. Obesity [23] increases the risk of colon cancer, particularly in men. Efforts to manage weight through diet and exercise can also help reduce this risk.
Regular screenings and medical check-ups:screening [24] is the most powerful tool for preventing colon cancer or catching it in its earliest stages when it is most treatable. Colonoscopies, in particular, can detect precancerous polyps, which can be removed before they become cancerous. Beyond colonoscopies, other screening tests, such as stool-based tests, are available and can be done more frequently. Regular medical check-ups also help manage other risk factors, such as diabetes and high cholesterol, which can indirectly influence the risk of colon cancer.
A high-fibre diet helps reduce the risk of colon cancer by promoting healthy bowel movements and enhancing gut health.
How have recent advances improved treatment for colon cancer?
The treatment of colon cancer has evolved significantly, with several advanced options now available that improve outcomes and offer hope even in more advanced stages. The choice of treatment typically depends on the cancer stage, the patient's overall health, and specific cancer characteristics. Here’s an overview of the current mainstays in colon cancer treatment:
Surgery
Surgery is the most common treatment for localised colon cancer and may range from minimally invasive techniques to more extensive resections:
Polypectomy: this is a procedure used during a colonoscopy to remove polyps before they potentially turn into cancer.
Local excision: if the cancer is very small and located on the surface, it can sometimes be removed without cutting through the abdominal wall.
Partial colectomy: removing part of the colon that contains the cancer along with a margin of normal tissue on either side. This procedure can often be done laparoscopically, using small incisions.
Chemotherapy
Chemotherapy is used to kill cancer cells and is typically employed when cancer has spread beyond the original tumour or to reduce the risk of recurrence:
Adjuvant chemotherapy:adjuvant chemotherapy is used after surgery to eliminate any remaining cancer cells. This therapy can prevent the cancer from coming back.
Neoadjuvant chemotherapy:neoadjuvant chemotherapy is given before surgery to shrink tumours, making them easier to remove and sometimes allowing for less extensive surgery.
Radiation therapy
Radiation therapy uses high-energy rays to target and kill cancer cells. While more common in rectal cancer, it is sometimes used in colon cancer for shrinking tumours before surgery or to relieve symptoms of advanced cancer.
Targeted therapies
Targeted therapies focus on specific abnormalities within cancer cells. By blocking these abnormalities, targeted drugs can cause cancer cells to die. Some of the targeted therapies for colon cancer include:
Anti-angiogenesis drugs:anti-angiogenesis drugs [25] stop tumours from making new blood vessels, starving the tumour of the nutrients it needs to grow.
EGFR inhibitors:epidermal growth factor reception or EGFR drugs [26] help block the growth of new cells, which is particularly effective against colon cancers that express the EGFR protein.
Immunotherapy
Immunotherapy is a type of treatment that uses the body's immune system to fight cancer. It is particularly effective in patients whose tumours have specific genetic markers such as high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR):
Checkpoint inhibitors:checkpoint inhibitors [27] help the immune system recognise and attack cancer cells. They have been a significant breakthrough in treating advanced colon cancer in Singapore.
Precision medicine
Precision medicine [28] tailors treatment to the individual characteristics of each patient's cancer based on genetics, biomarkers, and other diagnostic tests. It allows doctors to select treatments that are most likely to help patients based on a genetic understanding of their disease.
These treatment options, used alone or in combination, offer comprehensive approaches tailored to the individual patient’s condition, which aims not only to treat the cancer but also to maintain quality of life through and beyond treatment. The ongoing advancements in medical research continue to enhance these treatment strategies, which offer new hope to patients facing colon cancer.
Conclusion
The increasing incidence of colon cancer globally, particularly noted in regions like Asia and among younger demographics, emphasises the critical importance of awareness, early detection, and proactive prevention measures.
By understanding the risk factors, recognising early symptoms, and utilising the latest advancements in treatment, individuals can significantly enhance their chances of preventing or successfully managing colon cancer.
It is essential to maintain a healthy lifestyle, participate in regular screening programmes, and stay informed about the developments in cancer care to combat this prevalent but curable disease effectively.
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