Cancer / 22 May, 2020

Detecting cancer early in men

Dr Lau Pik Onn

What is cancer?

Cancer is a disease where abnormal cells divide in an uncontrolled way and usually form a lump (tumour). As their numbers increase, cancer cells can invade nearby tissue and spread through the blood stream and lymphatic systems to other parts of the body.

Our current understanding of what causes cancer is not complete, as the majority of cancers occur sporadically and are not inherited.

Early detection is always the key to early treatment and a higher survival rate. This is why regular screening, which involves a compressive look at your medical history, physical examination and relevant tests, is crucial. Health screening helps us to detect signs of disease or determine your risk factors early, even before you have signs or symptoms.

Your risk of cancer can be decreased with by practicing a healthy lifestyle and receiving regular screenings.

The most common cancers in Singapore are:1

Men

  1. Colorectal
  2. Lung
  3. Prostate
  4. Liver
Women

  1. Breast
  2. Colorectal
  3. Lung
  4. Uterus

Colorectal cancer

Colorectal cancer (also known as colon cancer) is the most common cancer affecting Singaporean men and the second most common for women. It is primarily diagnosed in men in their 50s but cases have also been seen in younger men. Colorectal cancer may be prevented or successfully treated if discovered early.

In most people, colorectal cancer develops slowly over several years. It usually begins as a benign or non-cancerous polyp in the inner lining of the colon or rectum. A polyp may develop into cancer over time, but not all polyps turn into cancer.


Risk factors

We do not know the cause of colorectal cancer. However, there are some factors that increase your risk, such as:

  • Family history of colorectal cancer (and an even higher risk if your family member was diagnosed with colorectal cancer before age 45)
  • Being over 50-years-old
  • Previous history of polyps
  • History of ulcerative colitis or Crohn’s disease
  • Smoking (which has been shown to increase polyp formation)
  • A diet high in fats, red meats and low in fruits and vegetables

Signs and symptoms

Most cases of early colorectal cancer have hardly any symptoms, so they can be difficult to detect without regular screening.

In the later stages, common symptoms include:

  • Change in bowel habits or texture and shape of stools
  • Presence of blood in the stools
  • Persistent abdominal discomfort or lump felt in abdomen
  • Unexplained weight loss
  • Unexplained anaemia

How can it be detected early?

The survival rate for colorectal cancer is as high as 90% if discovered in the early stage. Early detection is the best protection against colorectal cancer.

Some methods for screening are:

Faecal immunological stool test (FIT) or faecal occult blood test (FOBT)

  • This is a simple test where a stool sample is collected, which is then sent to the lab to detect the presence of blood in the stool which cannot be seen by the naked eye
  • If the results are positive, a colonoscopy will be needed

Colonoscopy

  • This is the ‘gold standard’ for colorectal cancer screening
  • Colonoscopy detects both precancerous lesions (such as polyps) as well as cancerous lesions and tumours
  • This is recommended for men and women who have an average risk of colorectal cancer, do not show symptoms and are aged 50 and above
  • Colonoscopy may be conducted earlier for anyone with a higher risk or symptoms

As with any disease, general guidelines for screening may differ for individuals based on their medical condition and risk factors. You will need to discuss this with your doctor to ensure that appropriate tests and screening are done for you.

Lung cancer

Lung cancer is the second most common cancer in men and the third most common in women. It is the leading cause of cancer-related death in Singapore.


Risk factors

Some risk factors include:

  • Tobacco smoke from cigarettes, pipes or cigars containing harmful chemicals or carcinogens
  • Exposure to asbestos or other cancer-causing chemicals
  • Family history of lung cancer
  • Exposure to second hand smoke

Signs and symptoms

Lung cancer, especially at the early stages, often does not have any symptoms. As the condition worsens, symptoms include:

  • Persistent cough
  • Presence of blood when coughing
  • Shortness of breath or wheezing
  • Hoarse voice
  • Chest pain
  • Loss of appetite
  • Unexplained weight loss
  • Tiredness or weakness

It is important to consult your doctor if you experience any of the symptoms above.


Screening

Regular screening may help in the early detection and treatment of lung cancer. This includes:

  • Chest x-ray
  • Sputum (phlegm) testing
  • CT scans (computed tomography)

Prostate cancer

Prostate cancer is the third most common cancer in men in Singapore. Prostate cancer develops when cancer cells form in the prostate tissue. It is a slow progressive disease.


Risk factors

The causes of prostate cancer are not clear. However, it is mainly found in men above age 50.

Risk is also increased in:

  • Those with a family history of prostate cancer
  • Darker skin men
  • Those who have a diet high in fat
  • Obese men
  • Those with high testosterone levels (e.g. men who use testosterone therapy)

Signs and symptoms

Early prostate cancer is usually asymptomatic. In the later stages, as the tumour grows resulting in the urethra narrowing, some symptoms may include:

  • Frequent urination, especially at night
  • Difficulty in urinating or slow flow of urine
  • Pain or burning sensation during urination
  • Blood in the urine or semen

However, these symptoms are non-specific as they can also be caused by benign conditions like benign prostatic hyperplasia (BPH) and prostatitis. This is why it is important to discuss any symptoms with your doctor.


Screening

As most early prostate cancers do not cause symptoms, men who are concerned can speak to their doctors about testing. This is recommended for men who are aged 50 and above, or men that are younger if they have a family history of prostate cancer.

Several clinical examinations and laboratory tests that can help are:

  • DRE (digital rectal exam) to feel the prostate for lumps or abnormal areas
  • PSA test (prostate specific antigen) – a high level will warrant further investigations as it may also be high in infection, inflammation or enlarged non-cancerous gland
  • Ultrasound of the prostate (transrectal)

If there are any abnormalities in your results or you have any symptoms, you will be advised to consult with a urologist for further evaluation.

Take control of your health

It’s very important to keep a look out for any abnormal signs or symptoms and seek medical attention early.

Be alert if you have:

  • A lump (may not be painful) in the breast, neck, armpit, groin or anywhere else in body
  • A sore or ulcer anywhere in the body, including your mouth, which does not heal properly
  • Any recent changes in the size, shape or colour of a mole on your skin
  • Abnormal bleeding from your nose or any other part of the body
  • Blood in your stool
  • Problems that do not go away or get better like a persistent cough (with or without phlegm), hoarseness of voice, indigestion or discomfort, loss of weight for no reason or a change in bowel habits (like persistent diarrhoea or constipation)

Cancer treatment has evolved significantly over the years and consequently survival rates for patients have also improved. Improvements in screening for some common cancers have also led to early detection and therefore timely treatment.

We must be responsible for our own health and wellbeing. You can lower your risk of cancer by avoiding smoking, consuming alcohol in moderation, exercising regularly, and increasing intake of whole grains, fruits and vegetables. Prevention and early detection are key strategies in reducing your risk of cancer and ensuring treatment is successful.

References

For a full list of references, click here.
  1. Health Promotion Board. (2015). Singapore Cancer Registry Annual Registry Report 2015. Retrieved on 22 May 2020 from https://www.nrdo.gov.sg/docs/librariesprovider3/Publications-Cancer/cancer-registry-annual-report-2015_web.pdf?sfvrsn=10
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