General Surgery

Colorectal cancer currently ranks second in terms of cancer incidence and cancer related death in Hong Kong. More than 5,000 new cases of colorectal cancers were diagnosed every year. In 2019, more than 2,000 people died of colorectal cancer. Echoed with the increase in public awareness and acceptance of large bowel screening program, increasing number of early colorectal neoplasms have been detected over the past few years. 

Though majority of the benign neoplasms detected during colonoscopy can be removed by simple endoscopic methods, some lesions have to be treated by more advanced endoscopic techniques like endoscopic submucosal dissection or transanal endoscopic microsurgery. Rarely, surgical resection is needed for benign neoplasms.

Before formulating the most appropriate treatment plan, timely imaging for staging is essential. In order to gather more information about the relationship of the primary tumour with adjacent structures and to exclude distant metastases, CT scan or PET-CT scan are commonly used. For rectal cancers, MRI pelvis is the standard modality as it helps to recognise lesions which are not suitable for upfront surgical resection. Neoadjuvant chemo-irradiation or radiotherapy will be the treatment of choice in order to achieve down staging effect on the tumour prior to definitive resection. 

In CUHK Medical Centre, patients with colorectal cancers are cared by a dedicated multi-disciplinary team (MDT) of colorectal surgeons, liver surgeons, oncologists, radiologists and pathologists, who work as a team to assure that patients’ needs are all addressed throughout the treatment. 

For patients with localised colorectal cancers, curative intent resection in the form of minimally invasive surgery is the mainstay of treatment, which enhances postoperative recovery. Nowadays, colorectal resections are performed using the minimally invasive approach whenever possible unless patients’ or tumours’ factors make this approach unsafe. Occasionally, conventional open surgeries still need to be carried out for locally advance disease. Most rectal cancers can nowadays be removed by sphincter preserving surgery. In fact, the need for permanent stoma has markedly decreased over the past two decades. All resected specimens are sent for histological evaluation. For patients having nodal metastases or adverse histological features identified by the pathologist, adjuvant treatment will be formulated by our oncologist.

Adjuvant treatment is an anti-cancer treatment given after the curative surgery. The role of adjuvant treatment is to reduce the chance of cancer recurrences. For colorectal cancer, adjuvant chemotherapy or chemo-irradiation (for rectal cancer) would be needed for patients with significant recurrent risks. Nowadays adjuvant therapy often carries out in an ambulatory fashion that doesn’t involve hospitalisation. The side effects of treatments could be largely minimised via tailored medical treatment plans and advanced radiotherapy technologies.

Some colorectal cancers have distant metastases at time of diagnosis. Treatment options of these stage IV tumours need to be individualised, based on the patients’ general condition, symptoms / complications related to the primary tumour, the biological (molecular) characteristics of the tumor and the load of metastatic disease. Close collaboration among muti-disciplinary team members will facilitate these patients to have the best treatment option formulated in a timely fashion. Any change in condition, necessitating change in treatment plan can also be achieved in an efficient manner.