Going into battle
Fighting Singapore?s number one cancer
by Joseph Lim
Dr Koh: FCH occupies a unique position as the first and only hospital in Southeast Asia with a dedicated focus on the full spectrum of colorectal care. Our area of focus allows us to be very attuned and focused on the needs of our colorectal patients, ensuring optimal clinical outcome and patient experience. Resources will also be fully committed to this focus area, allowing for the provision of the most advanced medical technologies, and furthering the expertise, knowledge and skills of our medical team. Our team of four colorectal surgeons ? Dr Francis Seow Choen, Dr Ho Kok Sun, Dr Lim Jit Fong and myself ? each has a specific area of interest within the field of colorectal disease management and can effectively tap into one another?s experience and expertise as we seek the best treatment available to ensure optimal surgical outcome for our patients. Dr Lim?s area of focus is in pelvic floor disorders including fecal incontinence; Dr Ho in robotic surgery; and myself in colorectal cancer genetics and genetic counselling. Our Medical Director Dr Seow-Choen is one of the earliest to offer stapled haemorrhoidectomy in Singapore and also a pioneer in laparoscopic colorectal surgery in the private sector. This group practice model has enabled our patients to benefit from the expertise of not one, but multiple specialists with super-specialty interests in various aspects of colorectal care. In addition to clinical care, FCH, as a hospital focuses on a single specialty, in a unique and advantageous position to contribute actively to research and education in colorectal surgery. This focus on the academic mission is a crucial component, and unprecedented in Singapore?s private healthcare scene. We hope that through the education of other healthcare professionals in Singapore and the region, we are able to enhance and uplift the skills necessary to effectively treat colorectal conditions and create new knowledge that will help us as a medical community care better for colorectal patients.
EHB:? What are latest innovations in colorectal treatments today?
Dr Koh: The last two decades bear witness to the development of advanced minimally invasive (key-hole) surgical techniques in the management of colorectal cancers. Starting with conventional laparoscopic resections, single-port laparoscopic surgery and robotics-assisted surgical resections are now becoming more commonplace in many top centres in the world. At Fortis Colorectal Hospital, we are now embarking on the use of advanced robotic systems to more precisely dissect and remove colorectal cancers. Significant advancements are also seen in endoscopic techniques. We can now remove large polyps in the colon using the latest ?Hybrid Knife? system through a colonoscope. Previously, these large polyps would require surgery for?safe removal. In the area of anal disease management, hemorrhoidal surgery can now be done in a less painful manner using a stapling device to remove prolapsing piles. Those where symptoms of bleeding piles is the main issue can be treated using a doppler-ultrasound guided procedure to target the vessels for ligation with minimal discomfort and no down time from physical activities. Our understanding of the genetics of both sporadic and hereditary colorectal cancer has also advanced by leaps and bounds with the dawn of the genomic era. Deep sequencing technology has made available new discoveries and allowed more insight into the genetic changes that leads to colorectal cancer formation.? There are suggestions that hereditary colorectal cancers (such as Lynch Syndrome) in Asians may not share the same genetic expression as those in the West. We can expect more collaborative research and data sharing taking place to elucidate if there is indeed a unique genetic subtype in Asians. This will allow for better risk stratification and clinical management through comprehensive predictive genetic testing. To enable this effort to bear fruit, we have started a collaboration with one of the key research institutes under A*Star, the Institute of Bioengineering and Nanotechnology (IBN). Through a S$4.5 million grant, we have started the Fortis-IBN Tissue Bank that will allow us to perform cutting edge molecular research to gain more insights into the biology of colorectal cancer.
EHB: What is the mortality rate in Asia for colon cancer?
Dr Koh: Colorectal cancer is the third most common cancer worldwide with almost one million new cases diagnosed each year. It is now also the third leading cause of cancer mortality in men and women with more than half of diagnosed patients dying from the disease. Over the past three decades, the age-standardised incidence rate for colorectal cancer has increased from two to fourfold in Asian countries such as China, Japan, South Korea and Singapore. Mortality rates in Asian countries have risen concomitantly and in Singapore rates have doubled over the same period, now with incidence rates amongst the highest in Asia; colon cancer has recently surpassed lung cancer as the commonest cancer diagnosed in Singapore.
EHB: Do you think Asian diets and lifestyle have a huge role to play in the increase of colorectal cancer?
Dr Koh: I think the increasing ?westernisation? of our diet with more ingestion of refined, processed foods coupled with the pollution of our environment (especially air pollution) plays a role in our increased risks of developing colon and rectal cancer. Cigarette smoking is known to increase the risk of colorectal cancer by 30% and increase by two to three times the risk of developing polyps in the colon. A more sedentary lifestyle with a rising incidence of obesity in developed countries can also increase the risk of colorectal cancer by 1.5 to 3 times.
EHB: What is the leading cause of colorectal cancer?
Dr Koh: Colorectal cancer (CRC) arises from a combination of lifestyle/environmental factors (e.g. cigarette smoking) as well genetic factors. In some individuals with a strong family history of cancers, genetic factors probably play a larger role to increase their risks of developing colorectal cancer. Hence, even if one eats and lives healthily, genetic predisposition can still lead one to develop colorectal cancer. In fact, up to 30% of all colorectal cancers exhibit some degree of familial inheritance.?At least 5% to 8% of these are inherited in an autosomal dominant fashion, i.e. the children of affected individuals carrying the mutated gene(s) have a 50% chance of inheriting the defective gene. Patients carrying these genes are at extremely high risk of cancers of multiple organs, including the colon, rectum, uterus, ovaries, stomach, small intestine, liver, kidneys and the brain. Their estimated lifetime risk of CRC is 80% and the lifetime risk of uterine and ovarian cancer is 30%.
EHB: What is your day-to-day profession like?
Dr Koh: My day starts with a quick breakfast at 6.30am with my wife then it is off to the office by 7.30am where I attend to emails. By 8am, I am usually at the wards to see the inpatients before starting the clinic at 9am. In between patients, I may do a few colonoscopies or minor surgical procedures. Afternoon usually see me performing major surgeries at the hospital. Evenings are mostly filled with administrative meetings at FCH or research meetings at A*Star starting at 5pm till 8pm. Then it is home for dinner and a couple of hours with my two daughters (aged three and eight). I usually read them bedtime stories before putting them to bed.
Dr Koh: I am particularly interested in the genetics of colorectal cancer as I firmly believe that young people shouldn?t be afflicted with cancer. Unfortunately, most of the young people who develop cancer are likely to have a hereditary genetic problem that predisposed them to getting cancer. I hope that through my work in colon cancer genetics, I can help to better assess the risk of these high risk families and help to prevent more family members from getting cancers. I am particularly excited about the use of advanced technology such as the Da Vinci surgical robot that we now have to treat colorectal cancer. Which guy doesn?t like playing with fancy toys?
EHB: What is your most gratifying experience in this job?
Dr Koh: The most satisfying experience is in being able to remove a tumor from a patient whom others could not resect and being able to give the patient a chance to live. Seeing the patient recover from the brink of death and being able to spend meaningful time with their loved ones brings tremendous job satisfaction.
EHB: What are three main tips you can share with regard to having a healthy colon?
Dr Koh: Eat healthy, do regular exercises and most importantly, have a regular colonoscopy!
EHB: How do you spend your leisure time?
Dr Koh: I run regularly for leisure and to keep fit. I try to do at least two runs a week with a longer 10km run on the weekends. I take part in half-marathons yearly and as a Commander of a NS Battalion, I take my physical fitness very seriously. In my leisure time, I also indulge in writing Chinese calligraphy. This art form requires steady hands and a stillness of mind. Such attributes are useful in my line of work where surgical precision is a must.
Short URL: http://www.ezyhealth.com/magazine/?p=4865
Source: http://www.ezyhealth.com/magazine/colorectal-cancer-interview-with-dr-koh-poh-koon/
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