For half a year in 2009, sales executive Michael Heng put up with blood in his stools and more frequent bowel movements without doing anything.
The 67-year-old father of three chose not to heed his family doctor's advice to have colonoscopy done at a hospital. This is a visual examination of the inner lining of the colon and rectum through a flexible tube known as a colonoscope to check for abnormalities including cancer.
The sales executive in an edible oil company recalled: "I was afraid of injections and felt that it was better not to know what was wrong anyway."
His first thought was that the blood could have come from pus near the anus. He said his family doctor thought so too, but later urged him to go for further tests when medication did nothing to alleviate his symptoms.
In November that year, Mr Heng finally underwent the colonoscopy, which he now said was "nothing".
It was surprisingly simple, he said, noting: "You feel sleepy because you're sedated. When you wake up, everything is over."
In fact, Mr Heng found the preparation for the colonoscopy more trying than the actual test. On the evening before the procedure, he had to consume large amounts of laxative.
Mr Heng said with a laugh: "I have never had to clear my bowel so frequently. The moment I stood up from the toilet bowl, I felt the urge to go again.
"At one point, I just sat in the toilet and chose not to come out."
The colonoscopy detected an abnormal growth in the sigmoid colon (last part of his colon), which joins to the rectum. Mr Heng was told it was likely cancerous and had to be removed.
He and his wife, a 65-year-old senior sales executive, took in the news with heavy hearts, but hoped for the best.
ROBOTIC SURGERY PREFERRED
The good news was that Mr Heng was deemed suitable for robotic-assisted surgery, which causes less pain and scarring and promotes a faster recovery.
His surgeon, Dr Dean Koh, a visiting senior consultant at the National University Cancer Institute, Singapore, said the surgical site was in close proximity to vital structures such as the prostate gland, bladder and urethra (the tube that connects the bladder to the genitals through which urine flows out).
If any nerves were affected during surgery, Mr Heng could suffer complications such as erectile dysfunction and bladder control problems, said Dr Koh, who is also a senior consultant surgeon in Mount Elizabeth Novena Specialist Centre.
Hence, robotic technology, with its greater precision, was preferred.
During the operation on Dec 16 that year, Dr Koh removed a fifth of Mr Heng's colon, lymph nodes (small, oval glands in the body that are part of the immune system) linked to the colon and part of his bladder wall, which had stuck to the growth.
Dr Koh said it was possible that the cancer had invaded his bladder or it was simply that the tissue had become sticky around the tumour.
A procedure called biopsy (testing of a sample of cells) found it was the latter.
But two out of the 17 lymph nodes removed tested postive for cancer, which meant Mr Heng had stage 3 colorectal cancer and faced a cancer recurrence rate of 50 to 80 per cent, Dr Koh said.
After surgery, he went through six cycles of chemotherapy, and he was lucky to have suffered only discolouration of his hands and feet and some numbness in his fingers.
Mr Heng went through an uneventful 2010, but his battle with cancer was far from over.
Within several months in 2011, routine computed tomography (CT) scans detected several nodules in his right lung and one measuring between 1 and 2cm in his abdomen. The growth in his abdomen was removed surgically and found to be cancerous.
In August 2011, it became clear his cancer had spread outside the colon to other parts of the body and was deemed to be in the most advanced stage - stage 4.
Dr Koh said the nodules in Mr Heng's lungs were in several places and so could not be removed surgically but could be controlled with chemotherapy drugs.
This worked for more than a year as no new lesions were detected in his lungs. Last December, though, a lesion was found in his bladder and, by last month, it had grown slightly despite chemotherapy.
Mr Heng has now been referred to a urologist for further assessment and will be considered for other chemotherapy drugs, Dr Koh said.
INCREASE IN COLORECTAL CANCER CASE
These drugs have given patients such as Mr Heng a better shot at survival. Figures from the National Registry of Diseases Office (NRDO), released last month, showed that 41.1 per cent of men diagnosed with stage 4 colorectal cancer in the years 2003 to 2007 survived at least one year after that.
It reported a 12.8 per cent three-year survival rate and a 7.9 per cent five-year survival rate.
Dr Koh said about 10 to 15 years ago, a stage 4 patient who failed to respond to the only chemotherapy drug then, 5-Fluorouracil, would probably live for only six months to a year.
Colorectal cancer is the top cancer for men and second for women. Two weeks ago, the Singapore Cancer Society launched a campaign with the theme "Don't flush away early detection", in conjunction with the 12th Colorectal Cancer Awareness Month this month.
Those aged 50 and above are advised to get screened for the cancer. One method is through a DIY faecal occult blood test kit, which tests for blood found in stools and can detect the disease even at an early stage.
The Singapore Cancer Society plans to give out 65,000 free test kits this year, 5,000 more than last year.
Between 2007 and 2011, a total of 8,459 new cases of colorectal cancer were detected, up from about 8,200 from 2006 to 2010, figures from NRDO showed.
Mr Heng has a positive attitude and takes the upcoming tests and chemotherapy in his stride. He has even planned an overseas trip in June with his wife.
Before the interview ended, Mr Heng asked, flashing a wide smile: "Do I look like a cancer patient?"
The advice he has offered his friends and colleagues: Go for colonoscopy to pick up cancer early.
He said: "A lot of people may be scared like me but the colonoscopy really feels like nothing. For me, I know the delay was all because of my fear."
This story was first published in The Straits Times on March 14, 2013
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