We know how frightening it is to have a doctor tell you that you have cancer. Over here at the NUH Colorectal Clinic, we have a team of caring doctors, nurses and healthcare staff who are here for you. We will accompany and guide you through your various treatments during this trying period.

We understand that colorectal cancer is a complex disease and needs a team effort for the best results. When you see us in NUH, you can rest assured that there is a dedicated team of cancer specialists including colorectal surgeons (surgery), oncologists (chemotherapy), radio-oncologists (radiotherapy) plus physiotherapists (exercise), dietitians (food) all working together to tailor the best treatment for you.

Some thoughts that run through your head:

Q1: Is it for real? How do you make the diagnosis?

Q2: What is cancer?

Q3: What to do when my loved one is diagnosed with cancer?

Q4: What did I do to get cancer?

Q5: Am I going to die?

Q6: What's my chance of living?

Q7: What if I can't deal with it and want to run away?

Q8: What if I don't do anything?

Q9: I'm so old already, I don't want to do anything

Q10: My family can't cope with looking after me, are there any avenues I can look at?

Q1: Is it for real? How do you make the diagnosis?

Most of the time the final diagnosis is made based on looking at the biopsy tissue under the microscope. The cancer cell looks abnormal and sometimes, the pathologist can see these groups of abnormal cells invading (growing into) into the domain of normal cells. We also use other evidence to help us make a diagnosis, such as imaging studies like CT scans or xrays which show abnormal growths in certain parts of the body.
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Q2: What is cancer?

The body is made up of millions of cells. The cell is the basic 'building block', like one of the bricks that make up the house (body). Each cell has a certain 'code of behaviour' where it reproduces when it needs to, dies off when it has to, stays put in the original position. Cancer happens when the cancerous cell runs amok, reproduces madly, doesn't die off, grows into other cells territory, 'swims' into other organs in the body and starts growing there. Back to top >

Q3:What to do when my loved one is diagnosed with cancer?

It is very frightening to be diagnosed with cancer. Usually, our mind gets bogged down by many emotions and thoughts and sometimes we freeze up and the easiest thing to do is to not deal with it. It takes a lot of courage to try to deal with it.

It pains us, just to see our loved ones suffer. It also pains us, as we have to deal with the possibility of losing a loved one as well. One thing to remember is to be strong for them so that they can lean on us, for strength, comfort and support.

It is a hard journey to come to acceptance with such a diagnosis. Typically, people go from denial, anger, bargaining, depression and finally acceptance. There is a lot of emotional turmoil. Being close to them, it pains us, just to see our loved ones go through them. In addition, we ourselves will also be dealing with the possibility of losing our loved ones and will also be going through those phases as well. Even if we can’t do much, patients get a lot of comfort when their loved ones are patient with them, are there, are shoulders to cry on and lean on.

Perhaps we can help them go from a ‘why me?’ to a ‘what can we do about it?’ stage.

As we move towards the acceptance phase, we are then able to get a sense of control and empowerment and hence minimize the feeling of helplessness.

Hope is very important and underrated aspect of treatment. Sometimes with patients who have terminal cancer, a common question is ‘How long do I have to live?’ Oftentimes, as doctors, we refrain from answering that question as it takes away hope. Hope gives patients a source of motivation, an avenue for enduring the difficulties, especially when the ‘going gets tough’. We have seen how hope and motivation help a patient recover or bounce back faster.

Cancer treatment is not cheap. Surgery, chemotherapy drugs and even radiotherapy all cost money.

Undergoing treatment for cancer can take a person off work for half a year or even more. Many worry about the loss of income and financial issues. This is especially so if the person stricken with cancer is the sole breadwinner of the family. Do let us know if you are facing such problems as our medical social workers can advise you accordingly or let you know the ways of seeking help to help alleviate costs.

Going through surgery, chemotherapy and radiotherapy can be physically demanding. Sometimes it can be quite frustrating for patients to see their bodies weakening as they go through treatment. This can be temporary and as family members, it is important for us to give support, become cheerleaders and help our loved ones focus on getting stronger by eating better and exercising.

Death is one of the main worries and fear in many people’s minds. Many people deal with this differently and there is no set way of doing so and this takes time. One thing we as loved ones can do is to give them as much support as they need. Sometimes, dealing with death is like preparing for a long journey. Many patients have a mental list of things to do before they leave in peace. It helps to accommodate them as they continue to check off their lists.

Caring for a cancer patient can be very demanding. Sometimes, we are not able to fully cope with the needs of a cancer patient. There are organizations which can help support the care of a cancer patient. Do talk to us so that you know what resources are available for you.

Remember that caring for the sick can be prolonged and needs energy. Oftentimes, focus is always given to the sick such that the needs of the caregiver are forgotten. As a caregiver, do remember to take the time to recharge, and take care of yourself, so that you are able to be a more effective caregiver. Secondly, being close to the patient, the caregiver is often dealing with his or her own grief from the patient’s diagnosis, whilst also trying to be strong for the patient. Do let us know if you need help, so that we can take care of you as well. Back to top >

Q4: What did I do to get cancer?

There are many possible causes for cancer and it is the interaction of these factors that give rise to cancer. No one knows exactly all the steps involved to create a cancer. One cannot blame oneself for getting cancer, remember that. In fact, there is no way a person can totally prevent cancer. Back to top >

Q5: Am I going to die?

Having the diagnosis of cancer is not the end of the world. There is still hope. Colorectal cancer can be cured if diagnosed early. Back to top >

Q6: What's my chance of living?

This is dependant on the stage of the cancer. There are 4 stages: Duke's A where the cancer has not penetrated through the whole bowel wall, Duke's B where the cancer has involved the whole bowel wall but the lymph nodes (lymph nodes are filter stations located near the organ which trap abnormal cells, ie cancer cells, bacteria) are not affected. Duke's C is when the cancer cells have traveled to the lymph nodes and Duke's D is when cancer cells have gone to other parts of the body, like the liver or lungs. Duke’s A is the earliest stage. The earlier the stage of cancer, the higher the chance of survival. Back to top >

Q7: What if I can't deal with it and want to run away?

The diagnosis is definitely unpleasant. But as with other unpleasant things in life, ignoring it and running away from things will not make the unpleasant things go away. When you deal with it, you empower yourself to do something about it. Back to top >

Q8: What if I don't do anything?

The simple idea behind treatment of cancer is trying to weed out all the cancerous cells from the body. Each cancer cell has the potential to grow into a cancer growth and the usual progression is for the cell to grow into a lump of cells in the tissue of origin (colon) and then for cells to travel to new places like lymph nodes and other organs and establish new colonies of cells. Hence, the earlier one treats the cancer, the higher the chance for cure. The idea is to 'catch all the cancer cells before it has a chance to spread'.

If you do not do anything, the cancer cells can still continue to grow and spread to other parts of your body. Back to top >

Q9: I'm so old already, I don't want to do anything.

The final decision is always yours; no one has a right to force you to do anything. But our advice is to be fully aware of the consequences of your decision before you choose your path.

Do talk to your doctor about your decision, such that he or she can discuss the options with you.
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Q10: My family can't cope with looking after me, are there any avenues I can look at?

Do let us know so that our medical social worker can helpyou look at the various resources available in Singapore.
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