SINGAPORE – Mr Ambrose Lee was 36 when he was diagnosed with colorectal cancer – a disease that usually strikes those in their 50s and older.
In July 2022, he experienced heart palpitations and shortness of breath. He would feel unusually winded after walking short distances, something he attributed to the lingering effects of a Covid-19 infection.
Concerned about his health, he saw a general practitioner (GP), who found nothing abnormal, but referred him to Ng Teng Fong General Hospital for further tests.
At the hospital, doctors conducted a series of blood tests and found that Mr Lee’s red blood cell count was alarmingly low.
Initially, the doctors suspected thalassemia, an inherited blood disorder that affects the body’s ability to produce haemoglobin and healthy red blood cells. They administered iron infusions, but his iron levels remained critically low.
“This raised concerns of internal bleeding, prompting doctors to conduct further investigations,” says Mr Lee, who is single and works as a freelancer in the psychology field.
Over several days, he underwent multiple scans. These showed no visible signs of internal bleeding. As a last step, doctors performed a colonoscopy and an upper endoscopy to check for abnormalities in his digestive tract and colon.
It was during these procedures that they discovered a tumour in his colon. Mr Lee was then told he had Stage 2 colon cancer.
Unlike typical colorectal cancer patients – who experience symptoms such as changes in bowel habits, blood in the stool or abdominal discomfort – Mr Lee had none of these clear warning signs.
“The only indication was a persistent feeling of incomplete bowel evacuation, which I had been experiencing for at least six months before my diagnosis. Despite having regular and normal bowel movements, I often felt that my bowels were not fully emptied,” says the 39-year-old.
During the surgery, doctors discovered that the cancer had already spread beyond the colon to his lymph nodes. This led to a revised diagnosis of Stage 3 colorectal cancer, requiring the removal of half his colon.
After the surgery, he underwent eight cycles of chemotherapy over six months.
Increasing trend of early-onset disease
Mr Lee is part of a growing number of younger adults being diagnosed with early-onset colorectal cancer.
Also known as young-onset colorectal cancer, it refers to colon or rectal cancer diagnosed in people under the age of 50.
Colorectal cancer usually starts with growths of tissue, called polyps, on the inner lining of the colon or rectum, which may develop into cancer over time.
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Rising incidence of colorectal cancer among adults below the age of 50. Mr Ambrose Lee was 36 in 2022 when he found out he had colon cancer.
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Mr Ambrose Lee underwent surgery and chemotherapy to treat the cancer. ST PHOTO: DESMOND FOO
A recent study by the Singapore General Hospital (SGH) and National Cancer Centre Singapore (NCCS) has shed light on shifting trends in colorectal cancer in Singapore, particularly among adults below the age of 50.
The study, published in JMIR Public Health and Surveillance journal in February, analysed 53,044 colorectal cancer cases identified from the Singapore Cancer Registry between 1968 and 2019.
Among these, 6,183 cases involved individuals aged 20 to 49 who were diagnosed with early-onset colorectal cancer.
The study found that the age-specific incidence rate of early-onset colorectal cancer increased from 5 per 100,000 population in 1968 to 9 per 100,000 in 1996, rising at an annual rate of 2.1 per cent.
This was followed by a slower increase to 10 per 100,000 in 2019, rising at 0.64 per cent annually.
The data also revealed demographic differences.
Malays experienced a rapid and persistent rise in colorectal cancer incidence across all age groups. Among Chinese aged 20 to 49, however, only rectal cancer cases showed an upward trend.
Colorectal cancer is the most common cancer among men and the second most common cancer among women in Singapore, after breast cancer.
Dr Lionel Chen, consultant at SGH’s department of colorectal surgery, says early-onset colorectal cancer makes up 10 to 12 per cent of all colorectal cancer cases diagnosed every year, and about one in 10 patients may be younger than 50 years old.
Assistant professor Dawn Chong, senior consultant at NCCS’ division of medical oncology, says younger people who are diagnosed with colorectal cancer may have hereditary conditions.
These include familial adenomatous polyposis (characterised by the development of numerous polyps in the colon and rectum) or hereditary non-polyposis colorectal cancer.
Both Dr Chen and Prof Chong were involved in the study.
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