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Ask the Doc: Butterflies in your stomach… or colon cancer?

In the second of a four-part Q&A series on cancer, Dr Zee Ying Kiat, a medical oncologist at Parkway Cancer Centre sheds light on some early signs of gastrointestinal cancers you should look out for

The three most common gastrointestinal cancers affecting both men and women are those of the colorectum, liver and pancreas. PHOTO: GETTY IMAGES

What are the most common types of gastrointestinal cancers in Singapore?

The three most common gastrointestinal cancers affecting both men and women are those of the colorectum, liver and pancreas. These accounted for 24 per cent of the 23,632 new cases diagnosed in 2020.

What are the symptoms and risk factors for such cancers?

It is important to note that cancer does not always cause symptoms, especially when in its early stages. Just as importantly, the presence of the symptoms mentioned below does not always mean a person has cancer. It is advisable to have such symptoms checked out by a doctor.

Colorectal cancer

Common symptoms:

  • A change in bowel habits
  • The presence of blood in the stool
  • Persistent abdominal discomfort
  • A feeling of incomplete bowel emptying and unexplained weight loss

Risk factors:

  • Increasing age (especially over 50 years)
  • Colorectal polyps (only a small fraction of these develop into cancer, which takes years. A polyp that is one cm across has roughly a one in six chance of growing into cancer over 10 years)
  • Personal or family history of colorectal cancer
  • Inflammatory bowel disease
  • Dietary factors (diets high in red meat and processed foods, and low in fibre)
  • Lifestyle factors (sedentary lifestyles, alcohol consumption, smoking)


Stomach cancer

Common symptoms:

  • Persistent abdominal discomfort
  • Loss of appetite
  • Unexplained weight loss

Risk factors:

  • Infection with Helicobacter pylori (a bacterium that lives in the lining of the stomach)
  • Chronic gastritis (inflammation of the stomach lining)
  • A family history of stomach cancer
  • Dietary factors (high in salty and smoked foods, low in fibre)
  • Lifestyle factors (smoking)


Liver cancer

Common symptoms:

  • Unexplained weight loss
  • Loss of appetite
  • Feeling full after a small meal
  • Nausea or vomiting
  • An enlarged liver (felt as fullness under the ribs on the right side)
  • Abdominal pain
  • Abdominal distension from fluid build-up (ascites) in the abdomen
  • Itching and yellowing of the skin and eyes (jaundice)

Risk factors:

  • Chronic viral hepatitis B infection (increases risk by 100-fold that of an uninfected individual)
  • Chronic viral hepatitis C infection
  • Non-alcoholic fatty liver disease
  • Excessive alcohol consumption

It is advisable to see your doctor if you experience symptoms such as persistent abdominal discomfort, feeling full after a small meal, or unexplained weight loss. PHOTO: GETTY IMAGES


What are some treatment options for gastrointestinal cancers?

Treatment recommended will depend on several factors, including the type of cancer, cancer stage and overall health of the patient. Different treatments can also be combined to achieve better outcomes for patients.

Broadly, they are:

  • Surgery to remove the affected part of the body
  • Chemotherapy drugs, administered by mouth or into a vein, to attack cancer cells
  • Radiotherapy utilising high-energy particles or waves such as x-rays, gamma rays, electron beams or protons to destroy or damage cancer cells
  • Targeted therapy to block the action of proteins that help tumour cells grow, or help tumours form new blood vessels to feed themselves, thereby stopping the growth of cancer cells
  • Cancer immunotherapy to activate a patient's own immune system to find and destroy cancer cells

Look out for the next instalment of this series on 8 Apr 2021, where our doctor will answer questions relating to women's cancers. Submit your question by clicking on the ad above or here, and it could be featured.

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