Colorectal Surgery & Colon Cancer
Ask Dr Nan Yaw Wong about:
- Colon cancer causes
- Risk factors for colon cancers
- Surgical treatments for colon cancers
- Common colorectal surgery procedures in Singapore, such as haemorrhoid surgery
- Treatment options for piles/haemorrhoids
- How to prevent piles
Dr Wong is a certified specialist colorectal and general surgeon. He obtained his basic medical degree from the National University of Singapore Faculty of Medicine in 1993. Since graduation, he has worked and trained in the largest and busiest Tertiary Hospitals in Singapore, including National University Hospital and Singapore General Hospital.
He obtained his Fellowship with the Royal College of Surgeons in Edinburgh in 1999, and was accepted in the internationally renowned Department of Colorectal Surgery in Singapore General Hospital as a surgical trainee. He was granted two overseas training awards : one in the United Kingdom at the busy Royal Infirmary in Yorkshire, and another at the Weill-Cornell Medical College in New York, USA. He qualified as a fully trained laparoscopic colorectal surgeon in 2003.
Dr Wong’s specialist interest is in colorectal cancers. Beyond colonoscopy screening for early colorectal cancer, he also performs Minimally Invasive Surgery for excellent surgical outcome. He offers the latest and most advanced techniques in management of benign colorectal diseases like haemorrhoids and fistulae. He also performs standard general surgical operations like laparoscopic gallbladder and hernia surgery.
Dr Wong is also a faculty member of the Asian Endosurgery Task Force, where he helps train the next generation of laparoscopic surgeons.
Based on your age and your 6 years of symptoms, and assuming you have no family history of colorectal cancers, the odds of your symptoms being due to a tumour are low. However, a screening colonoscopy is still your best bet in excluding a potentially serious condition. Discuss with your GP to explore this option. Colonoscopy is still the gold standard and in trained hands a very safe and quick procedure.
As far as possible, surgery should be the first choice to deal with the problem. Stenting is done when the patient is too weak to undergo surgery at the point of presentation. The patient may be dehydrated and have severe electrolyte imbalance due to the obstruction. In good hands, stenting produces good results, and allows both the patient and surgeon to buy time for proper stabilisation and work-up before definitive surgery. For this reason stenting is often called the "bridge to surgery".
There are 2 types of colostomy : temporary and permanent. During colorectal cancer surgery, the segment of bowel containing the cancer is removed and healthy bowels are joined back together to form a joint, or what surgeons call an anastomosis. For cancers that are near the anus muscles (so called low tumours), the chance of leakage after the anastomosis is formed is higher than cancers that are further away from the anus (high tumours).
Colon cancer surgery is complex and requires a team of specialists, nurses and specialised equipment. The average number of days in hospital is 7-10 days after the operation. As the cost depends on the complexity of the case and the technique used, it is difficult to quote a number but it would roughly range from $40,000 to $70,000 all inclusive. Colorectal cancer surgery is Medisave and insurance claimable. It would be best to contact your insurance provider as they are the best persons to answer your policy questions.
Change in stool caliber and consistency can be due to a narrowing in the anus or rectum. Patients who had haemorrhoid surgery done may develop narrowing of the anus and pass narrow caliber stools. The most sinister cause would be a narrowing of the rectum or descending colon due to an inflammatory or malignant process. In older patients, these symptoms should never be taken lightly and a diagnostic colonoscopy would be the obvious next step. At 25 and assuming no family history the odds of it being cancer is low, but not zero.
Anal fissures are classified into acute or chronic. Acute fissure (lasting 8-12 weeks) may be treated conservatively with stool softeners, sitz bath and analgesics. Chronic fissures (more than 3 months) are more stubborn and difficult to heal. Treatment is surgical division of the anal muscles known as Lateral Anal Sphincterotomy. In experienced hands the results are very good with near instant relief of symptoms. Other options include creams and suppositories but these are associated with side effects like headaches.
Haemorrhoidal disease is common during pregnancy. Most would resolve after delivery but some can remain persistent and refractory to medication. If the haemorrhoids are symptomatic and distressful, surgical excision may be carried out with no compromise to the integrity of the episiotomy wound. If the hemorrhoids are prolapsed, then stapled hemorrhoidectomy is the ideal solution. This can be done as a day procedure and patients are frequently relieved after the operation.