Q1. Who are more likely to develop colorectal cancer?
Colorectal cancer has been the first or second most common cancer in Hong Kong for many years.
As age is a risk factor, the first high-risk group is the elderly, or those aged over 50. The second is those with a family history, e.g. tumour was found in first-line relatives. Other risk factors include smoking, heavy drinking, obesity and chronic colitis.
Q2. Is blood in stool the only symptom of colorectal cancer? What are the other symptoms?
While it is not necessarily caused by colorectal cancer, you should seek medical attention if blood is found in stool. Even if there is no blood in stool, you still need to consult your doctor if you experience any abnormal change in bowel habits, such as more frequent diarrhoea, mucus in stool, more severe constipation, anus pain, etc. Instead of focusing on the presence of blood in stool, seek medical attention as soon as there is any abnormality in bowel habits.
Q3. What are the complications if treatment is delayed?
Delayed treatment can worsen the condition. As the cancer progresses, one may suffer discomfort such as more severe abdominal pain and bowel obstruction. In case of metastasis, the cancer may even spread to other organs like liver and affect their functions.
The major problem with delayed treatment is turning a cancer that is mostly curable into incurable if not treated in time. Once you are diagnosed with or worried about tumours, seek medical attention without delay.
Q4. What may happen after partial colectomy?
As the large intestine is quite long, the impact of partial removal is minimal. But it could be symptomatic if the tumour is near or even located in the rectum. Removal of rectum can cause less effective and more frequent bowel movements.
In short, partial removal of the tumour found only in the large intestine should have minimal impact to patients.
Q5. Is it hopeless once colorectal cancer is at advanced stage or metastatic?
This is the biggest worry of most patients and their family members that it will become hopeless once metastasis occurs. In fact, there are now many promising treatment options for metastatic colorectal cancer for disease control. In a minority of cases, where cancer has metastasised or spread to parts of the liver or lungs, cure is still possible with removal of tumour in the liver and lungs.
As for extensive metastasis, a wide array of medications, including targeted therapy and radiotherapy, are now used in patients with different conditions. All in all, they contribute to a substantial increase in the survival of metastatic colorectal cancer patients. Therefore, stay hopeful and positive against all odds, hold on to your family support and continue the treatments. Most importantly, let your doctor and medical team make the best decisions for you at appropriate times and choose the most suitable treatments for you. It is definitely not hopeless thanks to different medications. Stay positive and get prepared to live with the disease. It may be unrealistic to expect the cancer to go away, it is more about adjusting when the disease impact is milder and living with the cancer, make the best use of your time with your loved ones. Some of my patients even return to work. Even if metastasis occurs, the goal is to plan for a better control of the disease and to maintain a normal life as far as practicable.
Q6. What should I do after recovery from colorectal cancer?
Try to think about making the best use of the time and how to reduce the risk of recurrence.
To reduce the risk of recurrence, some patients need chemotherapy. Dietary advice is also important, e.g. no smoking and drinking, eat less preserved meat, and limit consumption of red meat like pork, beef and lamb to less than 1lb per week. Remember to reduce salt intake and maintain a normal weight with regular exercise. They all help reduce the risk of recurrence.
Regular follow-up and examination are also crucial. Some patients may still need to check tumour marker levels, have imaging examinations and undergo colonoscopy by a surgeon. Even if recurrence occurs, the earlier it is detected, the more treatment options that is available.
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