Few signs of inner turmoil
Elizabeth Lee, 53, was constantly constipated and felt dizzy every time she stood up from her desk at work. Lee (name changed for patient confidentiality reasons) put these changes down to menopause. But when her daughter, who is based in Australia, saw how pale and fatigued her mother had become since her last trip to Hong Kong, she quickly arranged a doctor's appointment.
A blood test showed that Lee had low levels of both haemoglobin (red blood cells) and serum ferritin, which is a protein in the body that binds to iron. She was initially diagnosed with iron deficiency anaemia, but since her menstrual blood losses were infrequent, the doctor decided to further investigate the underlying cause of her anaemia.
Stool samples sent for faecal blood testing came back positive. This warranted a colonoscopy to check the colon and rectum. Lee had to follow a liquid diet for a day before the procedure, drinking only clear soups, strained fruit juice, water, plain tea and coffee, sports drinks and gelatin. She had to steer clear of drinks with red or purple food colourings, which could be mistaken for blood in the colon. She also had to use a laxative the night before the colonoscopy to empty the gastrointestinal tract.
During a colonoscopy, a long flexible tube with a light and camera on the end - which is connected to a display monitor - is inserted into the anus under local anaesthesia and slowly guided through the rectum and into the colon.
A careful examination of the gastrointestinal tract is done by inflating the colon with carbon dioxide.
The colonoscopy showed the presence of an abnormal growth in Lee's colon, from which a sample of tissue was removed and examined for cancer cells. This test confirmed that Lee had colorectal cancer, the second most common cancer in Hong Kong.
A CT scan of her abdomen, pelvis and chest found the cancer had grown through the outermost layers of her colon, but had not yet grown through the layers or spread into the lymph nodes. Lee had stage IIA colorectal cancer.
The incidence of colorectal cancer is increasing here, says Dr Judy Ho Wai-chu, consultant colorectal surgeon at Queen Mary Hospital. 'According to data from the Hong Kong Cancer Registry, the number of new cases of colorectal cancer in 2008 was 4,031. The registry predicts that the number of new cases in 2020 will be more than 6,100, which is a more than 50 per cent increase,' Ho says.
Symptoms of the condition vary depending on the location of the tumour and if it has spread to other body parts, says Ho. If the tumour is near the rectum, local symptoms may include blood and mucus in the stools; persistent changes in bowel habits, such as constipation or diarrhoea over a period of six to eight weeks; persistent abdominal pain over a number of weeks; and the presence of an abdominal mass, which is a localised swelling.
Ho says that cancers arising from the right side of the colon usually have minimal bowel symptoms. Instead, the slow bleeding from the tumour usually gives rise to symptoms of anaemia, including postural dizziness and tiredness. In 10 per cent to 20 per cent of colorectal cancer cases, patients may have no initial bowel symptoms, but when they do have symptoms, these are due to the spread of the cancer to other organs.
Lee is now waiting for surgery to remove the tumour. In the meantime, she's trying to remain positive and follow lifestyle recommendations from the World Cancer Research Fund. She has removed processed meats such as sausages and ham from her diet, cut down on red meat, limited herself to only one glass of wine a day, and is trying to eat more wholegrains, beans, fruit and vegetables. She has also started taking 30-minute walk each day.
'The most important predictor of survival for colon cancer is the stage of the cancer upon clinical presentation,' Ho says. 'The earlier the stage, the better the prognosis.'
For stage I colon cancer, the five-year survival rate approaches 80-90 per cent; for Stage II, 60-70 per cent; Stage III 40-50 per cent; stage IV less than 10 per cent. 'On average, the five-year survival rate of colon cancer is quoted as about 50 per cent,' Ho says
It's no surprise, then, that prevention is better than cure.
'For the general public - and people with personal or familial risk factors - I strongly recommend colon screening above the age of 50,' says Ho. The recommended screening methods include: annual faecal blood testing, a flexible sigmoidoscopy and barium enema (a special X-ray of the large intestine) every five years and a colonoscopy every 10 years.