Colorectal Cancer

At a glance

Colorectal cancer is a malignant tumor that forms in the large intestine (the colon and the rectum).

Its most important feature is that in the early stage there are usually no symptoms at all.
The National Cancer Information Center explains that "by the time symptoms appear, it has often already progressed a fair way."

So with colorectal cancer, finding it early through regular screening matters more than waiting for symptoms.

This page is a summary of official sources, for reference only.
Always talk with a healthcare professional about diagnosis and treatment.

If changes like the ones below continue, get checked.
These are the main symptoms of colorectal cancer listed by the National Cancer Information Center.

• A change in bowel habits (diarrhea or constipation that is new or keeps coming back)
• Blood or mucus in the stool
• Stools becoming thinner
• Feeling you have not finished after a bowel movement (tenesmus)
• Discomfort in the abdomen
• Unexplained weight loss, loss of strength, tiredness
• Poor appetite, indigestion, nausea and vomiting
• A lump you can feel in the abdomen

That said, these symptoms also come from causes other than colorectal cancer.
Having them does not mean it is cancer, and having none does not mean you can relax either.
Tests are what decide.

Where to go first

If you have symptoms, or a screening test came back abnormal, start at gastroenterology (소화기내과).
If a place does colonoscopies, you can be tested at a local clinic as well.

After a diagnosis

• Colorectal surgery (대장항문외과) / general surgery (외과) — when surgery is needed
• Hematology-oncology (혈액종양내과) — when you have chemotherapy
• Radiation oncology (방사선종양학과) — when you have radiation therapy

Once colorectal cancer is diagnosed, several departments often set the treatment plan together.

Should I go to a bigger hospital

If cancer is confirmed or strongly suspected, you will go to a general hospital or a tertiary hospital.
A tertiary hospital needs a referral letter (진료의뢰서) for national health insurance (건강보험) to apply,
so it is best to get one from a local clinic or hospital first.

You can look for both local clinics and larger hospitals on the map.

Screening stage

1. Faecal occult blood test — checks whether there is blood in the stool that you cannot see. It is done in the national cancer screening program (국가암검진).
2. If the finding is abnormal, you have a colonoscopy.

Changes to the eligible ages and the test methods of the national cancer screening program are under discussion.
To find out whether you are due for screening this year and which test you get,
check with the National Health Insurance Service (국민건강보험공단).

Diagnosis stage

• Colonoscopy — looks inside the colon directly and takes tissue from any suspicious area.
• Biopsy — the tissue taken is checked under a microscope for the final answer on whether it is cancer.
• CT · MRI · PET — check how far the cancer has spread (the stage).
• Blood test — tumor markers such as CEA are checked as well.

What finally confirms whether it is cancer or not is the biopsy.

Treatment for colorectal cancer depends on where the cancer is, the stage, and your general condition.
The National Cancer Information Center describes the following treatments.

Surgery

The affected part of the colon is removed together with the nearby lymph nodes.
This is the basic method in colorectal cancer treatment.

Chemotherapy

Treatment that uses drugs to destroy cancer cells.
It is sometimes given before surgery to shrink the tumor, and sometimes after surgery to prevent it coming back.

Radiation therapy

Radiation destroys cancer cells. It is used fairly often in rectal cancer.

Interventional treatment

A method that treats using thin tubes and similar tools while watching on imaging equipment.

Which treatments you have, and in what order, differs from person to person.
Talk it through fully with your doctor before deciding.

It varies with the hospital and the patient's condition, but the flow is usually like this.

1. Pre-operative tests — blood tests, an electrocardiogram, a chest X-ray and so on check whether you can withstand surgery.
2. Bowel preparation — the day before surgery you take medicine to empty the bowel.
3. Surgery
4. Recovery — once you pass gas and the bowel starts moving, you begin with thin rice porridge, a little at a time.
5. After discharge — the biopsy result decides whether further treatment is needed.

Good things to bring

• Your referral letter, ID, and health insurance card (건강보험증)
• Test results and imaging from your previous hospital (on CD and the like)
• A list of the medicines you take (blood thinners in particular must be reported in advance)

The length of stay and the procedures differ from hospital to hospital.
Get the exact details from the hospital where you will have surgery.

The special cost-sharing program (산정특례)

If you are diagnosed with cancer, you can apply for the special cost-sharing program for serious illness.
Once registered, your out-of-pocket rate for care related to that cancer drops sharply,
and it applies for a set period.

The application is usually made for you by the hospital that issued the medical certificate.
If you do it yourself, you submit a registration form to the National Health Insurance Service.

Other points

• If it was found through the national cancer screening program, you may get help with the screening cost.
• Depending on your income level, you may qualify for the cancer patient medical cost support scheme.

Programmes and out-of-pocket rates change.
What follows is a summary as of the reference date, so before applying always check the latest rules with the
National Health Insurance Service.