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Dr QM Leong

Colon cancer and treatments in Singapore

Colon cancer, a malignancy of the large intestine, is a significant health concern in Singapore. Given its increasing prevalence and the complexities involved in its treatment, it’s crucial to understand the disease, its progression stages, and the various treatment options available. 

In Singapore, continuous improvements in colon cancer treatment protocols reflect the country’s commitment to medical excellence and patient care. This article provides an in-depth look at colon cancer, focusing on the stages of the disease, factors influencing treatment decisions and the support necessary for patients.

What Is Colon Cancer?

Colon cancer originates in the large intestine (colon), which is the final part of the digestive tract. It typically starts as small, noncancerous clumps of cells called polyps that form on the inside of the colon. Over time, some of these polyps can become colon cancers. Emphasising early detection, Singapore colorectal cancer screening programs are designed to identify precancerous conditions before they develop into full-blown cancer.

While the exact cause of colon cancer is not entirely understood, several risk factors have been identified, including age, a family history of the disease, certain genetic mutations, a diet high in red and processed meats, and lifestyle factors such as smoking and physical inactivity. With ongoing research and clinical trials, colorectal cancer treatment in Singapore continues to evolve, offering new hopes for better outcomes.

The Stages Of Colon Cancer

Colon cancer is classified into stages based on the extent of its spread. Understanding these stages is critical for determining the appropriate treatment strategy. Recognizing the signs can be crucial for catching potential issues early, enabling timely medical intervention and increasing the chances of a favourable outcome.

Stage 0 – Carcinoma In Situ

Stage 0, also known as carcinoma in situ, is the earliest form of colon cancer. At this stage, the cancerous cells are confined to the innermost layer of the colon’s lining and have not invaded deeper tissues or spread to other parts of the body. This stage is typically highly treatable, often through surgery to remove the localised area of abnormal cells.

Stage 1 – Early Stage Colon Cancer

In Stage 1, cancer has spread beyond the inner lining of the colon to the second and third layers of the colon wall, but it has not yet spread to the lymph nodes or distant sites. Treatment at this stage usually involves surgical resection of the affected section of the colon, often followed by a comprehensive monitoring plan to ensure that the cancer does not return.

Stage 2 – High-Risk Early Stage

Stage 2 colon cancer is more advanced, as the cancer has penetrated through the colon wall and may have reached nearby tissues but has not spread to the lymph nodes. It is further divided into sub-stages:


    • Stage IIA: Cancer has spread through the muscle layer to the outermost layers of the colon or rectum.

    • Stage IIB: Cancer has grown through the outermost layer but hasn’t reached nearby organs.

    • Stage IIC: Cancer has grown through the outermost layer and into nearby structures.

Treatment for Stage 2 typically involves surgery to remove the tumour, possibly followed by chemotherapy, especially if there are high-risk features such as poorly differentiated cells or lymphovascular invasion.

Stage 3 – Regional Spread

At Stage 3, cancer has spread to nearby lymph nodes but not to other parts of the body. This stage is divided into three subcategories based on the number of affected lymph nodes and the extent of tumour invasion:


    • Stage IIIA: Cancer has spread to up to three nearby lymph nodes and has penetrated the muscle layer.

    • Stage IIIB: Cancer has spread to up to four to six nearby lymph nodes or into surrounding tissues.

    • Stage IIIC: Cancer has spread to seven or more nearby lymph nodes but not to distant organs.

Treatment usually involves a combination of surgery, chemotherapy, and sometimes radiation therapy to address the cancer’s spread to lymph nodes.

Stage 4 – Metastatic Colon Cancer

Stage 4, or metastatic colon cancer, is the most advanced stage. Cancer has spread to distant organs such as the liver, lungs, or distant lymph nodes. This stage is further classified based on the extent and number of distant metastases:


    • Stage IVA: Cancer has spread to one distant organ.

    • Stage IVB: Cancer has spread to more than one distant organ or area.

    • Stage IVC: Cancer has spread to the peritoneum (the lining of the abdominal cavity).

Treatment for Stage 4 focuses on controlling the cancer and relieving symptoms. This may include a combination of surgery, chemotherapy, targeted therapy, and immunotherapy to extend life and improve quality of life.

Colorectal cancer screening in Singapore is regarded as a key preventive measure that is highly encouraged among adults over the age of 50.

Factors Influencing Treatment Decisions

While we have covered various treatments above based on the stages of cancer, there are other factors in play, too:


    • Patient’s overall health: Comorbidities and overall fitness can affect the choice of treatment.

    • Genetic mutations: Specific genetic profiles, such as those involving KRAS, NRAS, and BRAF mutations, can influence treatment options, particularly concerning targeted therapies.

    • Patient preferences: The patient’s quality of life, personal preferences, and treatment goals are essential in shaping the treatment plan.


The treatment for colon cancer, as seen above, includes a variety of options. They may also be used in combination depending on the stage and characteristics of the cancer. Here are more details for each treatment:


    • Surgery: The primary treatment for early-stage colon cancer, involves the removal of the tumour and surrounding healthy tissue. Types of surgery include polypectomy, colectomy, and proctectomy.

    • Chemotherapy: Uses drugs to destroy cancer cells or stop them from growing. It is commonly used post-surgery in stages 2 and 3 and as a primary treatment for advanced stages.

    • Radiation therapy: Employs high-energy radiation to kill cancer cells or shrink tumours. Though it is used for colon cancer, it is more commonly used for rectal cancer.

    • Targeted therapy: Uses drugs or other substances to target specific molecules involved in cancer growth and spread. Commonly used drugs include cetuximab and bevacizumab.

    • Immunotherapy: Boosts the body’s natural defences to fight cancer. It is an option for certain advanced cancers that have specific genetic mutations or markers.

    • Palliative care: Focuses on relieving symptoms and improving the quality of life for patients with advanced cancer.

Supporting Patients Through Treatment

Supporting colon cancer patients involves a multidisciplinary approach that includes medical treatment, emotional support, and practical assistance.


    • Multidisciplinary care teams: These teams consist of oncologists, surgeons, radiologists, nurses, and social workers who collaborate to provide comprehensive care.

    • Patient education: Providing patients with detailed information about their diagnosis, treatment options, and side effects to empower them to make informed decisions.

    • Psychosocial support: Offering counselling services and support groups to help patients and their families cope with the emotional impact of cancer.

    • Financial assistance: Helping patients navigate financial resources and insurance options to ease the burden of treatment costs.

    • Rehabilitation services: Providing physical therapy and nutritional counselling to help patients recover and maintain their health during and after treatment.

Colon Cancer Treatment In Singapore

Colon cancer can be daunting, but with expert care, it’s manageable and treatable. At Advanced Colorectal and General Surgery, we specialise in the comprehensive screening and treatment of colorectal cancer in Singapore. We are committed to providing personalised and compassionate support every step of the way.

Ongoing public education efforts emphasise the importance of regular colon cancer screening in Singapore as a critical step towards maintaining long-term health. The colorectal cancer treatment services in Singapore are not only advanced but also emphasise compassionate care, recognizing the emotional and physical challenges faced by patients.If you or a loved one is facing a colon cancer diagnosis or you want to learn more about our services, don’t wait. Contact us today to schedule a consultation.