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We hear from four cancer specialists

Four specialists in different medical fields – enthusiastic about the medical and scientific progress that’s been achieved in recent times, they gave us their take on the latest treatments – and, importantly, some advice on what you can do to protect yourself from these and other diseases in the first place.

#1 MELANOMA AND MORE

DR DENNIS LIM is a general surgeon with subspecialty expertise in head and neck surgery and surgical oncology. As a surgical oncologist, he is consulted when someone is diagnosed with cancer anywhere in the body – including a significant number of patients with malignant melanoma – that requires surgery as either its main or secondary treatment.

In surgical oncology, he says, there is no average patient – every person and their cancer is different. “My main role,” he says, “is to educate the patient on the various treatments available, and to personalise a treatment plan that is effective and efficient.”

Cancer Singapore
“New immunotherapy medications are being approved every year – especially for melanoma, potentially the deadliest of skin cancers”

Immunotherapy

For Dr Lim, immunotherapy has been the biggest breakthrough in recent times. Also called biologic therapy, it’s a type of treatment that boosts the body’s natural immune response with substances made by the body or in a lab, so as to overcome the cancer. New immunotherapy medications are being approved every year, he says – especially for melanoma, potentially the deadliest of skin cancers.

“The good news is that the body is quite good at fighting melanoma itself: in fact, we do see rare cases where a biopsy-diagnosed tumour spontaneously regresses,” says Dr Lim.

Until quite recently, the diagnosis of a melanoma that had metastasised – spreading beyond its original skin location into other organs of the body – was more or less a death sentence. “Now,” he says, “we can look forward to effective immunotherapy, even for Stage IV patients.”

One especially exciting thing about the immunotherapy approach, he adds, is that it essentially boosts your immunity against any cancer. “What’s more, some of the new orally active treatments are being found to be effective against more than one type of cancer, rather like the way aspirin can treat a wide range of diseases and conditions.” The ultimate treatment, he says, would be a daily pill to control cancer.

Prevention

Dr Lim recommends taking special care to avoid the midday sun in particular. He advises sunscreen lotions are not always enough, especially when the sun is at its peak, or when you’re unavoidably exposed to it for extended periods – while cycling, playing sport or sightseeing, for example. “It’s a good idea to wear a hat, or clothing with long sleeves, to provide a physical barrier against solar radiation,” he says.

While there is disagreement in the medical community as to whether or not stress is a risk factor for cancer, Dr Lim says that when it comes to cancer care, stress management is “more important than it is generally given credit for.” Having a good de-stressing programme is as essential part of the treatment process.

Dennis Lim Surgery
#11-09 Mount Elizabeth Medical Centre
6386 5167 | dennislim.com.sg

#2 BREASTING THE CHANGES

Breast and general surgeon DR GEORGETTE CHAN has published widely in the field of breast surgery and surgical oncology. She sees patients who are concerned about lumps or pain in their breasts, or an unusual discharge from their nipples; she also sees patients who feel no symptoms but have had abnormal findings on their mammograms and breast ultrasound scans.

“My initial aim is to allay my patient’s fears while we ascertain whether any of the symptoms or abnormal scans could be due to breast cancer. If breast cancer is indeed an issue,” she explains, “I will then perform diagnostic biopsies as well as carry out the curative surgeries.”

Breakthroughs

As most women diagnosed with breast cancer require surgery – and with the incidence of breast cancer increasing throughout the developed world – any new breakthroughs in the field are critical. Dr Chan cites three major areas where advancements have been made.

Firstly, in surgical techniques that minimise disfigurement, for example the nipple-sparing mastectomy. The nippleareolar complex is a challenging area for the plastic surgeon to reconstruct, she explains, so it’s ideal if it can be saved.

“In my opinion,” she says, “a nipple-sparing mastectomy is the best form of reconstruction that we can do for a patient with breast cancer, and is such a boon for women who are good candidates for it.” She’s been performing this procedure for the past decade.

Cancer Singapore

Secondly, in newer chemotherapy treatments for metastatic disease (where the cancer has spread from its original site) patients survive for longer. For example, targeted therapy can be used for specific mutation-related breast tumours.

“For locally advanced breast cancers, after doing a biopsy we work with the medical oncologist to tailor a chemotherapy regime that will shrink the tumour to a more manageable size. In the space of three to four months, after four rounds of chemo, some tumours may shrink to half their size, or even less. This can mean converting the surgical treatment from a full mastectomy to breast-conserving surgery.”

Thirdly, in advances in radiation therapy. Usually, radiation would be applied to the whole chest wall in small doses, every day for a month. “But now, for selected cases – often older patients with less aggressive tumours – the radiation can be done during the surgery itself, and that will be the only radiation that’s required.” The beauty of this, she says, is that it focuses exactly on the affected location, thus sparing other areas from the effects of radiation.

Prevention

Dr Chan has three succinct pieces of advice for women wanting to lower their chances of cancer. “Limit your exposure to oestrogen,” she says. “Maintain a lean body with little fat by following a sensible diet and exercising at least three times a week.” And, finally, “Have babies, and nurse them for as long as you can.”

Georgette Chan Consultancy
#11-09 Mount Elizabeth Medical Centre
6386 5167 | georgettechan.com.sg

#3 GUT FEELING

Consultant gastroenterologist DR ANDREA RAJNAKOVA sees patients with gastrointestinal problems that range from abdominal pain, reflux, indigestion and bloating to constipation, diarrhoea, fatty liver and more. She also offers colonoscopy screening – a vital tool in the prevention of colon cancer.

Cancer Singapore

New Developments

Diagnostic and therapeutic techniques for colorectal cancer have improved significantly over the past decade, says Dr Rajnakova. This includes technological advances in the equipment and devices used for performing gastrointestinal endoscopies, including advances in image resolution and magnification.

Prevention

Follow a healthy diet, lead a healthy lifestyle – and go for the necessary colonoscopies. That’s it, in a nutshell.

“Colorectal cancer is the most common cancer in Singapore men,” the doctor warns, “and the average population risk for developing colorectal cancer here is among the highest in the world.” This is a preventable cancer, however, and screening is key. During colonoscopy, polyps can be nipped in the bud and endoscopically removed on the spot.

“Most colorectal cancers start off as fleshy little polyps, which take a good five to 10 years to grow before they undergo cancerous changes,” she explains.

You should have your first colon screening at the age of 40 if you have a family history of colorectal cancer, otherwise at 50. If you have a strong family history of colorectal cancer (or even cancers with associated genetic risk such as stomach, breast or uterine cancers), start screening 10 years younger than the age at which your relative was diagnosed with the disease.

Poor diet can play an important role in the development of colorectal cancer, particularly when it’s associated with weight gain, physical inactivity, smoking and drinking too much alcohol. “Of all the major cancers,” says the doctor, “colorectal cancer seems to have the closest links to diet. Multiple studies show that it might be prevented through changing what and how much we eat.”

Eat a well-balanced diet that includes all the necessary nutrients: small amounts of complex carbohydrates, along with good fats, proteins, and plants rich in minerals, vitamins, fibre and water. “Other factors count too – how your food is prepared, for example; how much you eat at a meal and how your food intake is distributed throughout the day.”

Avoid processed food as much as possible, she emphasises – it tends to be laced with artificial colourings, flavourings and other additives. And don’t think that eating one or two “superfoods” such as kale will somehow balance out an unhealthy diet that’s largely based on processed and deep-fried fast food. It won’t.

Andrea’s Digestive, Colon, Liver and Gallbladder Clinic
#12-10 Mount Elizabeth Medical Centre 3 Mount Elizabeth
6836 2776 | andrea-digestive-clinic.com

#4 THICKER THAN WATER

Did you know that cancer patients are at significantly higher risk of deep vein thrombosis, or DVT? Vascular surgeon DR CHENG SHIN CHUEN’s clinic is a one-stop service for the comprehensive diagnosis and treatment of blood vessel problems. That’s everything from injection sclerotherapy and endovenous laser ablation of unattractive spider and varicose veins on the legs, to stenting procedures for life-threatening aortic aneurysms – and DVT.

A potentially fatal disorder that most of us associate with long periods of immobility, especially on long, cramped plane journeys, DVT happens when a blood clot forms in one of the deep veins in the lower legs, thighs or pelvis, explains Dr Cheng.

What are the symptoms? “The affected area might be swollen, red and warm to the touch, or the skin could have a bluish, whitish or even purplish discoloration. It often becomes gradually more painful.”

Time is of the essence, because of the life-threatening consequences of a clot reaching the lung (pulmonary embolism); so, if you suspect you have DVT, seek medical help immediately.

Cancer Singapore
“Time is of the essence; if you suspect you have DVT, seek medical help immediately.”

DVT and Cancer

Deeply unfair as it seems, having cancer increases vulnerability to DVT. There are various reasons for this, as Dr Cheng explains.

Some tumours in the abdomen or the pelvis actually exert pressure on major veins, increasing the clot-formation risk “downstream”. What’s more, patients with severely painful bone tumours, or tumours that are pressing on nerves, tend to be more immobile, which of course increases their risk of DVT.

To make things worse, cancer treatments – be it surgery, chemotherapy or hormone therapy – make the body more likely to form harmful clots, and here’s why:

  • Any surgery holds the risk of blood clots, because the body has to form clots to heal incisions. The risk is simply greater for cancer patients. Importantly, the risk continues well beyond the surgery itself, and clots can develop even weeks later.
  • In chemotherapy, the destruction of cancerous cells causes them to release substances that increase blood-clotting. In addition, chemotherapy can inflame and damage the walls of blood vessels, making the patient more susceptible to DVT.
  • In targeted therapy, anti-angiogenic drugs destroy tumours by restricting the growth of blood vessels to the tumour. Unfortunately, they also affect blood vessels outside the tumour, increasing the risk of DVT.
  • Hormone therapy with Tamoxifen, a drug that blocks the effects of oestrogen, causes metabolic changes that thicken the blood and affect its flow, again increasing the risk of DVT.

Prevention

Apart from taking anticoagulant medications, cancer patients can decrease their DVT risk with a few simple measures, says Dr Cheng.

Firstly, stay as mobile and as active as possible, so as to promote healthy blood-flow. Go for walks if that’s an option. Secondly, stay well hydrated by drinking plenty of water.

Thirdly, keep your veins massaged by wearing compression stockings up to the thighs, all the time or as much as possible – but only if the circulation in your arteries is good. Diabetic patients have a higher likelihood of blocked leg arteries, warns Dr Cheng.

“In summary,” he says, “cancer increases the risk of DVT, but there are simple measures that can be taken to lower the risk.”

Pacific Vein & Endovascular Centre
#12-01 Paragon 290 Orchard Road
6238 2966 | pacificvein.com.sg

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This article first appeared in the August 2017 edition of Expat Living. You can purchase a copy or subscribe so you never miss an issue!

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