May/June 2013

IN THIS ISSUE: Treating colon cancer | PCC roadshows | 千万不要掉以轻心

Stories ofHOPE

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Taking a shower one day, Ms Trinh Thi Tuyet Suong, 46, discovered a lump on her left breast. As a pharmacist and owner of one of the largest

medical supplies stores in Pleiku City, Vietnam, she immediately thought, “Breast cancer.”

Suong placed her trust, and her life, into the hands of professionals. Vietnamese doctors recommended lumpectomy and thereafter oral Tamoxifen. After the surgery, it was back to her punishing schedule of opening her shop at six in the morning and closing up only after 11 at night, seven days a week.

She went back to normal life, and never gave a second thought to her brush with cancer. After all, the doctors did not request for follow up reviews.

In 2007, after 15 cancer-free years, she developed headaches and vomiting. It was back to the hospital. A few months and many tests later, doctors maintained that her symptoms were not cancer-related.

After some research and advice, Suong flew to Singapore and consulted with oncologist Dr Khoo Kei Siong of Parkway Cancer Centre.

Assessments showed that she had a large tumour in the brain that was causing swelling of the surrounding brain and obstructing the flow of cerebrospinal fluid. The mystery of her headaches was solved.

Dr Khoo recalls Suong’s initial visits to his clinic. “When she first came to us, she was very unwell with persistent headaches, neck ache and vomiting. She was anxious and worried. Our assessment revealed many tumours in her brain.”

Neurosurgeon Dr Timothy Lee of Gleneagles Hospital was recommended to see her. He performed a resection on the largest of these tumours in Suong’s cerebellum. A stent was also inserted into the brain to relieve the hydrocephalus (accumulation of cerebrospinal fluid).

For the first time in months, Suong started to feel better.

In the assessments, Dr Khoo also found a large tumour in the pancreas obstructing the bile duct. Thus, Suong learned that not only did she have brain cancer, she also had pancreatic cancer. She underwent surgery in Vietnam to bypass the bile duct.

Meanwhile, her Singapore healthcare team was

Trinh Thi Tuyet Suong was treated successfully for breast cancer 18 years ago, but 15 years later, she discovered that its shadow remained

Never let your guard down

HealthNewsInspiring and informative stories for patients MCI (P) 040/01/2013

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Stories of Hope

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faced with a new mystery – what was the origin of the tumours in her cerebellum?

“Breast and pancreatic cancer are treated differently, using different types of drugs,” Dr Khoo explained the challenge. “So we had to know where the tumours come from. This was one reason why we decided to remove one of the brain metastasis – to send it for tests. While it would seem that the brain metastasis had come from the pancreas, it turned out to be from the breast cancer she had 18 years ago.”

It was a sobering lesson for Suong – that she should never let down her guard when it comes to cancer. Not for the first few years, and not even after 18 years.

Suong had radiotherapy for the brain cancer and started on chemotherapy. She was also given oral hormonal therapy for the breast cancer that she thought was a closed case for more than a decade.

All the tumours responded well to treatment and, by the beginning of 2009, Suong finally felt confident that she was emerging from the end of a long, dark

千万不要掉以轻心癌症生还者郑氏雪棠(右)18年前成功战胜乳癌。15年后，她一直以为自己过着没有癌症的正常生活，但棠后来发现，肿瘤的阴影一直都没有离开她

一天，46岁的 郑氏雪棠在洗澡时发现左边乳房有个肿块。身为药剂师兼越南嘉莱省最大药剂品店的老板，“乳癌”两个字马上出现在她的脑海。

棠把自己的生命交给了专业医生，完全信任他们。越南当地的医生建议她接受肿瘤切除手术，随后服用荷尔蒙治疗药物Tamoxifen。手术后，棠继续过着以往忙碌的生活，每天早上六点就开门做生意，一直到晚上11点才关店，每个星期七天无休假。

就这样，她回到了正常的生活轨道，再也没有想起自己跟癌症曾经多么接近。毕竟，医生并没有要求她回去复诊。

2007年，她过着不受癌症困扰的生活15年后，棠又出现了头痛、呕吐的症状。她回到医院接受治疗，但几个月后，即使她接受了无数检验，医生还是坚持这些症状和癌症无关。

棠在他人的建议下搜集资料，决定飞往新加坡向百汇癌症中心的内科肿瘤高级顾问邱继祥医生寻求专业咨询。检测显示，棠的脑部有个大肿瘤，导致肿瘤周围的脑组织肿大，阻碍脑脊髓液体的流通。她终于知道自己为什么会头疼了。

邱医生回想起棠初次来到诊所的情景。他说：“当她第一次来到我们的诊所时，身体状况很差，头一直疼，颈部也痛，还呕吐。她也心急想知道自己发生什么事，也很担心自己的健康状况。我们的诊断显示她的脑部有多个肿瘤。”

她被介绍给鹰阁医院的脑外科医生Dr Timothy Lee。医生为棠切除了她的小脑内最大的肿瘤。医生也在脑内植入支架，舒缓脑水肿（脑脊髓液体累积）的情况。那几个月来，棠第一次感觉比较舒服一些。

邱医生为棠进行的检测也显示，她的胰脏部位有一个大肿瘤，导致胆管阻塞。这表示棠不止有脑癌，她也有胰脏癌。她在越南动了胆管绕道手术。

与此同时，她在新加坡的医疗团队面对着另一个疑问 - 是什么导致她的小脑长瘤？

邱医生解释难题所在：“治疗乳癌和胰脏癌的药有所不同。所以找出肿瘤的源头非常重要。这也是我们决定切除脑瘤的原因之一。我们希望把被切除的组织送往化验后，可以找出答案。虽然乍看之下脑瘤病变是原自胰脏肿瘤，但检验发现原来元凶是她18年前的乳癌。”

这对棠而言是一个沉重的教训 - 她不应该对任何疾病掉以轻心，尤其是癌症。乳癌切除手术后的前几年她应该更加谨慎，即使是过了18年后，她也应该维持警觉。

棠开始接受放疗治疗脑癌，她也开始接受化疗。针对她已经不再复发的乳癌，她也开始接受口服荷尔蒙治疗。

棠所有的肿瘤都对治疗呈现良好的反应。2009年初，她终于见到一些曙光，有信心自己可以走出这条漫长又阴暗的隧道。

那些年里，棠都住在胡志民市，方便她往返医院及到机场飞往新加坡接受治疗。

虽然不太愿意，她还是得把自己一手创办的生意交给她的儿科医生女儿打理。虽然如此，这位药剂师还是时时挂念着同乡的医疗需要。其中，一位邻居给她的印象最深刻。有一天，这位陈小姐哭着打电话给棠，说道：“我刚看了医生，他说我必须切除两边的乳房。”

陈小姐被诊断出两个乳房都有肿瘤，但她实在无法面对双乳房切除手术。棠安抚她，并建议她到

tunnel. All this while, she had been staying in Ho Chi

Minh City, so that she could be nearer the hospital and the airport, as she was making frequent trips to Singapore for treatment.

With reluctance, she had put her cherished business, Trang Pharmacy, into the capable hands of her daughter, who is a paediatrician. However, the pharmacist in her still cared deeply for the health needs of her fellow Pleiku City residents.

She remembered one neighbour in particular. Ms Hien had called Suong one day, crying. “I just saw the doctor and he says I need to have both breasts removed!”

Cancer had been detected in both Ms Hien’s breasts. She could not face up to double mastectomy. Suong calmed her down and suggested that she visit Dr Khoo in Singapore.

After some persuasion, Ms Hien did as Suong recommended. The visit was more than she could hope for. After careful analysis, Dr Khoo said that she need not have mastectomy and recommended another course of treatment. She is well and without

希望的故事

千万不要掉以轻心

cancer. Suong gave a quiet smile of satisfaction at the recollection. “To this day, she would thank me profusely every time she sees me, because, in a way, I helped to save her breasts!”

Suong remained well till April 2012 when cancer was detected again, and that was when she started chemotherapy.

Throughout her treatment, Dr Khoo observed this about Suong: “It’s natural for a patient to worry and become anxious when symptoms worsen. However, Suong has been very cooperative with regard to her treatment, no matter how unpleasant they are.”

新加坡找邱医生。经过几番劝说后，陈小姐照棠的意思来到了新加坡。在那次的医疗咨询里，邱医生告诉她她不需要切除乳房，并建议她接受另一个疗程。现在，她的癌症没有了。这是她预期不到的。

想到这里，棠脸上浮起淡淡的微笑说：“到今天，她每次看到我都会不停地向我道谢，因为她总认为我有份帮她保住了她的乳房！”

2012年之前，棠的健康情况良好。但在那一年，她又再被检测出癌症复发，并需要接受化疗。在棠的治疗过程中，邱医生有这样的观察：“当病情的症状恶化时，她们很自然会开始担心，变得焦虑。但无论治疗有多么难受，棠都非常地合作。”

他进一步解释：“一般上，无论是患有因为乳癌或其他癌症扩散而导致的脑癌，病人的情况一般都不乐观。更何况棠不但需要面对多个脑瘤，还需要对抗两个部位的癌症。在这样的情况下，她的复原可以说是令人赞叹的。有效的疗程和她本身坚强的意志力都是让她可以继续生活下去的原动力。”

在2013年一月的最后一次检测中，棠已经完全没有任何症状，她的癌症已经受到控制。

“It’s natural for a patient to worry and become anxious when symptoms worsen. However, Suong has been very cooperative with regard to her treatment, no matter how unpleasant they are.”

Dr Khoo, on Suong

“当病情的症状恶化时，她们很自然会开始担心，变得焦虑。但无论治疗有多么难受，棠都非常地合作。”

邱医生

He explained further, “Patients with secondary brain tumours, whether from breast or other cancers, generally do not fare well. Moreover, Suong not only had to face multiple brain secondaries, she had to battle two cancers. In that context, her recovery is nothing less than remarkable. Effective treatment and her strong will to live have kept her going all these years.”

During her last assessment in January 2013, she was found to be entirely asymptomatic and her cancer is under control.

Community Outreach

Left: “I am Cancer Warrior” roadshow at Chinatown Point from 18 to 24 March. Below: Some of the works produced by members of the public using “Draw for Courage” drawing kits.

Cancer may be one of the top killers in Singapore, but many cancer patients have survived the disease and have encouraging

stories to tell. In March, Parkway Cancer Centre (PCC) brought

its “I am Cancer Warrior” campaign to the public at two events, as part of its efforts to raise awareness of cancer and highlight the importance of health screening.

On 12 March, PCC introduced the campaign at Hewlett-Packard’s “Power of Prevention” education fair, which was organised for employees to find out more about the various types of cancer and how to prevent it.

From 18 to 24 March, PCC also held a “I am Cancer Warrior” roadshow at Chinatown Point, where members of the public could find out about how people fought and conquered cancer.

Launched in 2011, the “I am Cancer Warrior” campaign celebrates the victories of former cancer patients and provides a platform for them, along with cancer experts, to share their experiences on how they battled the odds to beat the disease.

Since then, several roadshows have been held, and PCC has taken part in public and corporate events to raise awareness of how cancer can be prevented, detected early and treated.

At PCC’s booth at the Hewlett-Packard event, for instance, visitors got to see the cancer centre’s resources in fighting cancer, including newsletters such as Health News and Hopelink, and a unique cookbook featuring recipes for Asian cancer patients.

The cookbook, “Awakening the appetite”, costs $49.90, with nett sales proceeds going to the Singapore Cancer Society (SCS).

Some visitors also took part in “Draw for Courage”, where they bought $5 drawing kits to express their idea of what a cancer warrior can be like. Sales proceeds from the kits were also donated to SCS.

Sharing stories of hope

Community Outreach

Top: At Hewlett-Packard’s “Power of Prevention” education fair, PCC staff were on hand to share information and materials on cancer, as well as speak about the Cancer Warrior campaign. Above: Senior counsellor Benson Soh also gave practical tips on how to cope with cancer.

Health Carnival by health magazines “Health No.1” and “Wellness No.1”PCC medical oncologist Dr See Hui Ti (right) answers questions after her talk on eating right to prevent cancer.

National Kidney Foundation’s “Care for your health” talkPCC medical oncologist Dr Foo Kian Fong speaks about the prevention, screening and treatment of colon cancer.

NTUC’s carnival to celebrate International Women’s Day PCC senior dietitian Fahma Sunarja shares tips on healthy eating.

March was a busy month for Parkway Cancer Centre, which held a series of community outreach events to raise awareness about cancer screening, prevention and treatment

Sharing stories of hope Talks and other events

Find out moreFind out more about “I am Cancer Warrior” at its Facebook page at https://www.facebook.com/IamCancerWarrior

Cancer Warriors will also be telling their stories in a documentary series on Channel NewsAsia. Get more details on the telecast dates and times at http://parkwaycancercentre.com/stories-of-hope/c-n-a/cancer-warriors-2/

Serving You

‘Even in suffering, she keeps giving’ I first met May*, who is now in her 50s, 12 years

ago when her father was seeing Dr Freddy Teo Cheng Peng (Senior Consultant, Haematology)

for a marrow disorder. She was always well groomed, elegant and

refined, and back then, as she cared for her father and coped with his illness, I got to know her well and we kept in touch even after her dad passed away.

In October 2011, she came to us complaining of a swollen jaw. She had consulted other doctors but her aches and pains were earlier diagnosed as the normal signs of ageing.

We knew immediately that something was wrong and sent her for further tests. When the diagnosis of Stage IV lung cancer, which had already spread to the bones, was given, I was devastated.

May, however, was quick to accept her condition. She cried initially, of course, but she quickly came to terms with the diagnosis. With calm and grace, she simply wanted to know as much as she could about her cancer and the treatment options.

Being too close to May personally, Dr Teo felt it was best to refer her to his colleague – Dr Foo Kian Fong (Senior Consultant, Medical Oncology).

And, with her quick acceptance and trust in the doctors, treatment began almost immediately. Without going into the details, May, who is married with two grown-up sons, fought hard, remained positive and upbeat and successfully beat the cancer into remission.

However, soon after celebrating the good news, she had another blow. In May 2012, her mother was diagnosed with cancer of the pancreas.

Again, despite her own health not fully recovered yet, May jumped into the role of caregiver without hesitation, caring for her 70-something mother, just as she had her father over a decade ago.

Due to her advanced age, May’s mother passed away just five months from the diagnosis.

Perhaps it was the physical and emotional toll of those months that contributed to the relapse as May’s cancer returned not long after her mother passed away. Now she is back in hospital herself seeking treatment for her relapse.

Again, what was beautiful about her was how gracefully she accepted the latest setback.

I have met many cancer patients but few as calm, wise and giving as her. Sure, she cries but she never dwells, choosing to move ahead positively.

Through the emotional roller coaster and in spite of her physical pain, she takes the effort to understand the details and is always organised and in control of her treatment and medication.

In the midst of all this, she also never stops giving and has already made plans for her family, from her husband and two sons, to her sister. Knowing that her disease is terminal, she has even decided how she will spend her last days, vowing to fight as long as she can but also ready to let go when the time comes.

Nursing manager Sister Tay Sok Har (right) has given many patients strength over the years. But she has also drawn inspiration from some of them. She remembers one in particular Insisting that because her household is made up

of all boys who “won’t be able to cope with caring for her at home”, she wants to spend her last days in hospital. And, not forgetting her unmarried sister, she has made her sons promise to take care of not just their father but also their aunt after she is gone.

Her indomitable spirit won’t allow even the thought of death get her down, sharing with me how she looks forward to first seeing her daddy, then her mummy, in Heaven.

As I share this with you, she had spent her last three weeks in hospital, battling an infection yet determined to get better to spend Chinese New Year at home with her family. And, even when I visit her in the ward at the end of my work day, she never fails to worry about me as well, telling me to go home early as I must be tired, too.

I don’t know how long May will remain with us, but she has given herself a good run, never allowing the disease to get her down, to stop thinking of others or lose faith.

She has again successfully battled her latest infection, and has gone home for Chinese New Year.

She has inspired me in many ways by taking charge of her life, putting others’ hearts above her own, loving others unlimitedly and selflessly. I am witnessing a well-fulfilled life, someone who continues to touch the lives of many others even when she is unwell.

She is just an amazing lady, my beloved sister and my special best friend.

*Not her real name

Fighting Cancer

Treating colon cancer

CanHOPE CanHOPE is a non-profit cancer counselling and support service provided by Parkway Cancer Centre. As part of its continued efforts to help cancer patients and their caregivers in their journey, it organises a host of support programmes from counselling, patient support groups to talks and workshops on a wide range of cancer topics.

For more information, contact CanHOPE at:Cancer Counselling and Hotline: (65) 6738 9333Email: enquiry@canhope.orgWebsite: www.canhope.com.sg

Singapore’s No.1 cancer can be treated and potentially be cured if it is detected early

Picture ©iStockphoto.com/Health_News

The most common cancer in Singapore, it is treatable and potentially curable especially when detected early. Present day treatment is more effective, safer, less invasive and associated with fewer side effects.

Family history and lifestyle factors can increase the risk of getting colon cancer.

Symptoms include bleeding on moving bowels, abdominal discomfort or pain, and a change in bowel

habits. Look out for persistent symptoms. Patients with persistent symptoms should be investigated, preferably by colonoscopy, if colon cancer is suspected, on advice of a doctor.

Recommended screening

tests for average-risk asymptomatic individuals include stool tests starting from age 40, and colonoscopy at age 50.

High-risk individuals, like those with a family history of colonl cancer, should be screened by colonoscopy.

Colorectal cancer, or colon cancer, is the most common cancer in Singapore. The risk of getting it rises sharply at age 50 to 55 and

doubles with each passing 10 years of age, peaking at age 75. However, people younger than 50 are also at risk.

Colon cancer has been linked to several factors such as genes, diets and other environmental factors. In present day, colorectal cancer can be treated and potentially cured, especially if it is detected early.

Participants got to hear more about Singapore’s No.1 cancer at a recent event organised by CanHOPE, a non-profit cancer counselling and support service provided by Parkway Cancer Centre.

The talk was part of CanHOPE’s continued efforts to help cancer patients and their caregivers in their journey, along with many other support programmes including counselling, patient support groups and workshops on a wide range of topics, from prevention and treatment of cancer to managing its side effects and nutrition.

At the talk held at Mount Elizabeth Hospital, Consultant Colorectal Surgeon Dr Teoh Tiong Ann was invited to speak on various aspects of colorectal cancer, from prevention and screening to treatment.

On its causes, Dr Teoh said that while genes affect the possibility of getting colorectal cancer, other factors can contribute significantly. Diets high in animal fats and low in fibre – also known as the “Rich Man’s Diet” – for example, can increase the risk of colon cancer. Other environmental factors such as smoking, obesity and a sedentary lifestyle also add to the risk of contracting this cancer.

However, Dr Teoh noted that there are many precautions that can be taken to reduce this risk. He also assured his audience that colon cancer can be treated and potentially be cured if detected early.

He also spoke about the symptoms. These include: Bleeding on moving bowels, abdominal discomfort or pain, and a change in bowel habits.

Such symptoms are shared by many other ailments, and should not necessarily be a cause for alarm. But people in high-risk categories – such as those with a personal or family history of colorectal cancer and those with persistent symptoms – should see a doctor. He noted that the risk of getting colon cancer increases with the number of first-degree relatives who have the disease.

During the question-and-answer session that followed his talk, Dr Teoh was asked about the most common symptom. “Bleeding is most common, but 95 per cent of people with bleeding have no cancer. So it’s still hard to tell,” he replied. “But if it persists, then go for a check-up. Let your doctor advise you if you need further investigations.”

In his talk, Dr Teoh also shared about how

colorectal cancer is detected. This includes the stool test, barium enema test, CT colonography, and colonoscopy. Colonoscopy, he stressed, is the best test for detecting the cancer, and when done correctly, is almost painless and relatively safe. He recommended that those 40 years old and above go for a stool test every year, and follow up with a colonoscopy if there are any abnormal results. He also recommended that normal average-risk individuals should go for a colonoscopy at the age of 50 as part of health-screening. People experiencing persistent, unexplained symptoms at any age should also go for a colonoscopy on advice of a doctor, he said.

Later, when asked about how soon one should do a colonoscopy after observing symptoms, he said: “We should take a balanced view. You should consult a doctor. The doctor will assess your symptoms and risk-factors and advise.”

Dr Teoh also spoke about the treatment options for colon cancer. “The primary treatment is surgery and removal of the cancer. Traditional open surgery with large incisions has given way to laparoscopic surgery with much smaller incisions in many instances. Laparoscopy, also known as keyhole surgery, is minimally invasive, less painful and allows the patient to recover faster. Although the incisions are smaller in laparoscopic surgery, the actual surgery performed and clearance of the cancer is the same as what is performed in traditional open surgery with larger incisions.”

He also talked about how chemotherapy is important as additional therapy to increase chances of cure, and anti-cancer drugs being developed are increasingly tolerable, reducing the severity of side effects.

The Doctor Is In

Picture ©iStockphoto.com/Health_News

Breast cancer:

You can never tellContrary to popular belief, patients who are

found be in the advanced stages of cancer at the time of diagnosis, are not necessarily

elderly, uneducated or have a low income. Sometimes, you just don’t know why you are not feeling well, and the symptoms may be too vague to pin-point the disease.

Headaches, tiredness, loss in weight, gain in weight, aches and pains – are they just signs of stress, normal ageing or cancer?

“I have been having these aches and pains in my bones for some months. But, I always thought that they were part and parcel of the ageing process,” Madam Chua said.

As it turned out, she had Stage IV breast cancer.

The 50-year-o ld banker had stopped work some time ago. She was well-dressed and conversed eloquently in English. On each of her clinic visits, she was always accompanied by her husband, who was clearly concerned and cared very much for her.

She started having aches for almost a year prior to seeing me. She had consulted several doctors, who have been prescribing anti-inflammatory drugs to ease the pain and discomfort. She had also been to the physiotherapist and been taught stretching exercises. She exercised regularly in the gym to keep fit.

Then she started feeling bloated and lost her appetite. She also read an article that said that these symptoms suggested something could be wrong with her ovaries, stomach or colon. So she saw her gynaecologist for a routine check-up. He detected a lump in her left breast and immediately referred her to a general surgeon.

The surgeon carried out a biopsy of the breast lump and arranged for her to have a series of investigations to determine if the cancer had spread. A PET scan showed that the cancer had spread to the bones, the lymph nodes and almost replaced her entire liver. The abdomen was swollen because of the large liver mass and water in the abdomen.

Most patients with breast cancer are diagnosed reasonably early, that is, before there is evidence of spread to other parts of the body. In these patients, surgery to remove the whole breast (total mastectomy) or part of the breast where the cancer is sited (partial mastectomy) is often needed.

However, in the case of Madam Chua, although the tumour in the breast was quite small, there was evidence that the cancer had spread to many part of her body.

It is puzzling why some cancer patients can have

Sometimes, it can be hard to pin down the tumour and the extent of its growth

big tumours, which are relatively contained, while others who have relatively small tumours, may have cancers that have escaped beyond the breast to other organs.

This could be due partly to the biological behaviour of the cancer. Some cancer cells tend to be more aggressive and have a higher propensity to spread.

The grade of Madam Chua’s breast cancer was scored grade 3 out of 3 – which means it is highly aggressive.

The g r ade o f a cancer is different from the stage of a cancer. Simplistically, the grade of the cancer refers to the appearance of the cancer cell. The more similar the cancer cell is to the normal cell of that body part, the lower the grade.

Conversely, the more distorted and strange looking the cell is, the higher the grade of the cancer cell. As a general rule, the higher the grade of the cancer cells, the more aggressive the cancer is.

This may partly explain why Madam Chua’s cancer was diagnosed at such a late stage.

The bad news is that Madam Chua’s breast cancer cell contained a cancer gene called HER2 (also called c-erbB2). This gene is associated with the cell being more aggressive.

The good news is that there is a monoclonal antibody called Herceptin® (Trastuzumab), which is extremely effective in treating HER2 positive breast cancer. This targeted agent, like several others for other cancers, has made the job of medical oncologists so much easier.

By combining a cocktail of chemotherapy drugs with Herceptin, her cancer responded marvellously as expected.

Madam Chua’s PET-CT scan, done after four cycles of chemotherapy, showed that the cancer in most of the diseased sites had improved significantly or resolved completely.

I would not recommend that we live life under a cloud of fear that this or that minor symptom is a signal of cancer. What we need is to pay attention to our bodies and a strong dose of common sense.

Early detection is best but even at late stage discovery, medical treatment can make a difference.

For Madam Chua, it was a combination of her alertness and general medical knowledge, as well as her discipline in going for check-ups, which led to this relatively successful outcome.

Dr Ang Peng Tiam