Until she was 39 years old, Madam Norasmah Eunos had never been warded in hospital. Then one day in February 2005, she noticed blood in her stools.

Somewhat embarrassed, she dragged herself to see her company doctor at SIA Engineering, where she is a senior officer.

She was shocked to learn that she had cancer.

'Within two weeks, I was referred to Changi General Hospital where they found that I had stage four colorectal cancer,' Madam Norasmah, 43, said.

She was immediately admitted for surgery, and 12cm of her colon was removed.

The mother of three children aged 13, 18 and 19 was deeply shocked at the diagnosis.

'I couldn't accept it,' she said. 'Nobody in my family for nearly three generations had ever had cancer. I thought 'I am a good and helpful person with no bad habits. Why did God do this to me?''

There was more bad news.

After the colon surgery, doctors found that cancer cells had spread to her liver and she would need another operation to remove the tumour there. However, Madam Norasmah was too weak for another operation and the tumour needed to shrink before doctors could operate.

There was an option - join a clinical trial at the National Cancer Centre for an experimental chemotherapy drug, Erbitux, that can shrink tumours over time so that they become more easily operable.

Disheartened

'At that point, I was very disheartened and did not think I could survive,' she said.

However, support from her husband, Mr Mohd Nahadi, 46, and her children and friends kept her going.

'When I looked at the faces of my children, I knew I had to fight this and hold on for another 10 or 20 years at least,' she said.

She agreed to enrol in the trial and underwent chemotherapy for two months.

At first her husband accompanied her. But later she told him she could go on her own. This feeling of independence meant a lot to her.

She suffered from side effects such as rashes on her face and upper body, and blisters on her fingertips and toes.

But the doctor told her it was a good sign as it showed that the drugs were working.

'I was so shy to go to work because of the rashes. But I decided to be strong and think positive, and went back to work as usual,' she said.

Her employers were supportive and she continued to work throughout her treatment, getting medical certificates but going back to work after the chemotherapy.

The facial rash also made people ask her what was wrong.

'I would tell them that I had been diagnosed with cancer and was undergoing treatment. It helped them understand why I looked the way I did,' she said.

Finally, in February 2006, Madam Norasmah's tumour had shrunk enough. It was removed and it took her a month to recover. She went for a second cycle of chemotherapy that lasted three months. There was no need for Erbitux this time.

The good news was that her cancer went into remission, her rash disappeared and she began to feel better. She maintains a healthy lifestyle by exercising three times a week in the gym, and also by doing light exercises with her husband.

More importantly, her diet has changed. She avoids spicy food and has given up red meat, eats more vegetables and doesn't take seafood as she is allergic to it.

Madam Norasmah still does the housework but her husband and children help with house-cleaning and the laundry.

Doctors recently found that some cancer cells remain and she is due for another round of chemotherapy next month. 'This time, it will be a light dose,' she said.

'I am not scared of a relapse as it has happened before. I don't want to think about the past. I think about the future,' she asserted.

Madam Norasmah is glad she went for the experimental drug. She said: 'Some people are scared to enrol in clinical trials. They think they will be guinea pigs but it's really not like that.'

She saw the experimental drug as a chance to live her life and see her children grow up. Her experience has also brought the family closer. 'We can now talk about any problem together,' she said.

The experience changed her in other ways too.

'I used to be very hot-tempered. I have learnt to let things go and not worry about or carry problems over to the next day.

'People say that I look well and healthy. If you see me in person, you won't think that I'm a cancer patient.'

Battling cancer with chemotherapy drug Erbitux

The experimental chemotherapy drug Erbitux, which doctors treated Madam Norasmah with, was introduced here in July 2004.

Dr Elizabeth Au, a consultant medical oncologist and physician at Mount Elizabeth Medical Centre, explained that Erbitux is added to the usual chemotherapy drugs such as Oxaliplatin and Irinotecan.

Erbitux acts to increase the efficacy of the chemotherapy agents. In some circumstances, it increases the patient's survival.

Used for colorectal cancer and head and neck cancers, the drug interferes with the growth of cancer tumours and cells.

In Madam Norasmah's case, Erbitux helped to shrink her tumour such that it became operable. Doctors were able to remove it safely.

Colorectal cancer is the commonest cancer in Singapore for both men and women, with nearly 800 new cases diagnosed every year.

Statistics show that one in 20 Singaporeans will contract colorectal cancer, with more than 85 per cent occurring in adults aged 50 and above. The risk gets higher with age.

Dr Simon Ong, senior oncologist at the National Cancer Centre, said that the known risk factors for colorectal cancer include age, obesity, lack of exercise, smoking, alcohol, chronic inflammation of the large bowel and hereditary factors.

'A diet rich in animal fat and red meat is also suspected to increase the risk,' he said.

Dr Ong added that 75 per cent of colorectal cancers are preventable. 'Engaging in an active lifestyle, staying lean, and avoiding a high fat diet, smoking and alcohol can prevent colorectal and other cancers.'

The Singapore Cancer Society is organising its Colorectal Cancer Awareness Month next month to encourage people to go for regular screenings to detect cancer early.

Free colorectal cancer screenings will be available for citizens above the age of 50.

This article was first published in Mind Your Body, The Straits Times on Mar 5, 2008.