Digestive cancers are a major health problem in Singapore, accounting for 3,000 new cases and 5 of the top 10 cancer deaths annually. Common digestive symptoms affect many adults but only 10% see a doctor. Serious symptoms requiring medical attention include those in people over age 45, weight loss, bleeding, and family history of cancer. Specialists perform colonoscopies and advanced endoscopy techniques to detect cancers and pre-cancerous growths early and remove them, but some lesions are still missed. New technologies allow for improved cancer screening and prevention.

1. Digestive Tract
Cancers
How to Prevent Them
Dr Jarrod Lee
Gastroenterologist &
Advanced Endoscopist
Mt Elizabeth Novena Hospital

2. Digestive Cancers in Singapore
• 3,000 new cases annually
• Top 10 cancer deaths: 5 of them
2

3. Digestive
Tract
3

4. Digestive Symptoms
• A common problem
• Affect 20-40% of
adults annually
• 50% self medicate
• 10% see a doctor
What is Serious???

5. Which Symptoms Are Serious?
Based on Common Advice
• Pain
• Cramping
• Bloating
• Flatulence
• Diarrhea
• Constipation
Based on Research
• Age > 45 years
• Weight loss
• Bleeding
• Family history

6. What will the
specialist do?

7. 7

8. Colonoscopy
8

13. 13

14. 14

15. 15

16. Missed Cancers
• Colorectal cancer: 5%
• Colorectal polyps: 22%
• Gastric cancer: 7-19%
• Esophageal cancer: 9%
Interval Cancers
Account for 10% of digestive tract cancers today
16

17. Reasons for Missing Cancers
• Lesion not seen
• Lesion seen but not biopsied
• Lesion seen but biopsy benign
17

18. 18

19. Gastric Cancer
19

20. Colorectal Cancer
20

21. ‘Next Generation’
Endoscopy

22. Advanced
Imaging

23. 23

24. 24

25. 25

26. 26

27. Polyps
27

30. Advanced
Polypectomy
30

31. 31

32. 32
Pancreas

33. 33
Endoscopic Ultrasound

34. Needle Sampling & Treatment
34

35. Pancreatic EUS
35

36. Raised
CA 19-9
• Normal Gastroscopy
• Normal Colonoscopy
• Normal CT
• Normal MRI
• Repeated again 9 mths
– Liver growth on MRI
– Offered surgery
36

37. 37

38. From Cancer
Screening
38

39. To Cancer
Prevention
39

40. Take Home Message
• ‘Next Generation’ endoscopy era is beginning
– A specialized field in its own right
– Offers the best chance of detecting cancerous and
pre-cancerous growths
– Growths can be removed with advanced techniques
• Digestive tract cancers
– We are moving from cancer screening to cancer
prevention
– Need to see the correct specialist
40

41. 41

42. Capsule Endoscopy
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43. 43

44. 44
Thank You
Questions to
drjarrodlee@gmail.com