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Colorectal (colon or rectal) cancer: what happens now

Colorectal cancer is one of the most common cancers in Singapore for both men and women.

A diagnosis is a shock, and the first two weeks feel like chaos: appointments, scans, unfamiliar words, and big decisions while you are frightened. There is a normal sequence to this, and you do not have to figure it all out today.

Two things help most early: bring someone to every appointment for a second pair of ears, and ask for a Medical Social Worker early, because they handle the money and admin and unlock most financial help.

What the early appointments are for

  • Confirming the diagnosis: usually a biopsy plus lab tests, to identify exactly what type of cancer it is.
  • Staging scans: imaging such as CT, MRI, PET, or ultrasound to see the size and whether it has spread.
  • Meeting your specialist team: often a surgeon, a medical oncologist, and a radiation oncologist; complex cases are discussed by a multi-disciplinary tumour board.
  • The treatment-plan discussion: the appointment to come prepared for.

Understanding your stage

Stage is how much cancer there is and whether it has spread. A common system is TNM, combined into stages 0 to 4. Some cancers use their own system, shown on each cancer-type page.

Grade is how abnormal the cells look under the microscope, a hint at how fast they may grow.

  • Early or localized (the cancer is contained): treatment is often aimed at cure, and local treatments such as surgery or radiotherapy may be enough.
  • Locally advanced (spread to nearby tissue or lymph nodes): often a combination, for example surgery plus chemotherapy or radiotherapy.
  • Advanced or metastatic (spread to distant parts): the goal is more often to control the cancer and keep you well for as long as possible, usually with drug treatments. Advanced is not the same as untreatable: many advanced cancers are controlled for a long time, and a few such as some lymphomas can still be cured.

Two people with the same cancer can have very different plans, because the stage, the cancer's biology, and your general health all feed into the decision.

Ask your team to explain your specific stage in plain words and what it means for your goal of treatment. Avoid general survival statistics online: they are averages across very different people, often out of date, and not your prognosis.

How your stage is described for Colorectal (colon or rectal) cancer: Colorectal cancer uses the TNM system, stages 0 to 4. Whether it is colon or rectal, and the RAS, BRAF, and MSI results, also shape the plan, not stage alone.

Tests you are likely to have

  • Colonoscopy with biopsy, which lets the doctor see the whole colon and rectum and take tissue samples.
  • CT scans of chest, abdomen and pelvis to stage it; MRI is often used for rectal cancer to plan treatment.
  • CEA blood test, a marker sometimes used to monitor the cancer over time.
  • Tumour genetic testing (RAS, BRAF, and MSI), especially if advanced, because it decides whether certain targeted or immunotherapy drugs can help.

Treatments commonly involved

  • Surgery to remove the affected section, often the main treatment. Depending on location you may need a stoma (an opening on the abdomen for waste), temporary or permanent.
  • Chemotherapy, often after surgery for stage 2 to 3 to lower recurrence risk.
  • Radiotherapy, used more often for rectal cancer, sometimes before surgery.
  • Targeted therapy or immunotherapy in advanced disease, guided by the RAS, BRAF, and MSI results.

Questions to ask (all cancers)

  • What type of cancer is this, and what is my stage and grade?
  • What is the goal of treatment: to cure, to control, or to relieve symptoms?
  • What are my options, and what do you recommend and why?
  • What are the main side effects, and how long will treatment take?
  • Are any recommended drugs on the Cancer Drug List, and what will it roughly cost?
  • Is a clinical trial an option for me?
  • Who do I contact between appointments, and is there a 24-hour number if I feel unwell during treatment?
  • Can I see a Medical Social Worker about costs and support?

Questions specific to this cancer

  • Is this colon or rectal cancer, and does that change my treatment?
  • Will I need a stoma, and if so, is it temporary or permanent?
  • Has my tumour been tested for RAS, BRAF, and MSI, and what do the results mean?
  • Will I have chemotherapy before or after surgery, and for how long?
  • If I need a stoma, who teaches me to care for it?

Money and support

The financial and admin load is heavy, and most help is unlocked by people, not websites. The single most useful early action is to ask for a Medical Social Worker. One assessment can open MediFund, hospital and charity cancer funds, subsidised-patient status, and caregiver grants. See the support directory for the full list.

Open the support directory

Support specific to this cancer

  • Stoma supplies via Singapore Cancer Society; stoma care support and the Ostomy Association of Singapore.
  • A dietitian for eating well during and after treatment.
  • Plus everything in the shared support directory.