Cancer - not necessarily a death sentence

by Samangie WETTIMUNY

[email protected]
 

Few months ago, I visited yet another cancer patient, father of one of my close friends and batch mates at his home. His fragile and weak appearance evoked remorse and eerie feelings in me as I sensed the overhanging tragedy. His only satisfaction was his caring daughter who was always by his side treating him with undiminished love, care and dignity until his death.

Almost all of us have someone known to us either in our immediate family, among friends or neighbourhood who had to succumb to this deadly dicease finally losing a desperate battle. If there is a decease that could shrink everyone in fear, cancer stand only one step behind AIDS. From a total of 58 million deaths worldwide in 2005, cancer accounts for 7.6 million (13%) of all deaths. Unfortunately the deaths from cancer in the world are estimated to continue to rise, with an estimated 9 million dying from cancer in 2015 and 11.4 million dying in 2030. So just as the World Health Organization says cancer is a public health problem worldwide which affects all people: the young and old, the rich and poor, men, women and children.

Scientists are still fighting to find a type of treatment that would be able to conquer cancer fully. However, though most of the people shrink even at the mere mention of the word cancer, with the massive advancements in cancer treatments, those affected can be always courageous knowing that they can be successfully cured if detected at the very early stage, and can be controlled to a great extent even if detected at a later stage.

As the Medical Director and the Senior Consultant Medical Oncologist of the Parkway Cancer Centre, Singapore, Dr. Ang Peng Tiam states “Diagnosis is very critical because it determines the most accurate treatment for the patient. Identifying the stage is also critical. The earlier it is detected, the greater the possibility of healing.”

The medical staff of the Parkway Cancer Centre (PCC), Gleneagles Hospital, Singapore also include Dr. Khoo Kei Siong Deputy Medical Director, Senior Consultant Medical Oncologist and Physician, Dr. Teo Cheng Peng, Senior Consultant Haematologist and Physician, Dr. Lim Hong Liang Senior Consultant Medical Oncologist and Physician, Dr. Foo Kian Fong Senior Consultant Medical Oncologist and Physician, Dr. See Hui Ti Consultant Medical Oncologist and Physician, Dr. Lee Kim Shang Senior Consultant Radiation Oncologist, Dr. Yang Tuck Loong Edward Senior Consultant Radiation Oncologist, and Dr. Anselm Lee Consultant Paediatric Haematologist and Oncologist. Deputy Division, Vice president of PCC is Lion Luai.

Talking to journalists at the PCC auditorium at a press briefing which had the participation of most of the medical staff of the PCC, Dr. Khoo Kei Siong said, out of the several cancer types, lung, stomach, liver, breast and colorectal are the top five most common killers.

“Regular screening is important especially for those who are considered high-risk., so one should know whether he/she is considered normal risk or high risk. One of the most important factors in determining one’s risk of getting cancer is that person’s family history of the disease.”

“Screening and early detection of cancer can increase the chances for successful treatment of cancer. Screening refers to the use of simple tests to identify individuals who have the disease but do not yet have the symptoms. Mammography, pap smear are some of the common screening tests.”

As emphasized by all the panellists recognising early signs and symtoms of cancer and taking prompt action leads to early diagnosis. Some of the early signs and symptoms of cancer include:

* Lumps

* sores that fail to heal

* Abnormal bleeding or discharge

* Persistent indigestion

* Chronic hoarseness of voice

* Changes in bowel habits

* Changes in moles or warts

* Onset of impaired hearing, with persistent noise in the same ear.

“Anyway it should be noted that these signs do not always mean cancer, but if they continue, it is highly advisable to consult a doctor at once.”

When asked whether breast cancer is hereditary, Dr. See Hui Ti said that though it is true that women with a family history of breast cancer have a greater risk of getting the disease, they account for just 15 to 20 percent of all breast cancer cases.

As Dr. See further explained , the vast majority of women suffering from breast cancer do not come from “breast cancer families” (families with two or more close relatives, whether from the mother or father’s side, with a history of breast cancer). So it is always wise to stay alert against the disease. Practise breast self-examination (BSE) every month and go for a mammogram at least once a year. “The patients from breast cancer families, however may need more than BSE or mammograms.”

In fact clinical trials are now looking into the [possibility of using magnetic resonance imaging (MRI) to scan women below 40 years for more effective breast screening. According to Dr. See, though there has been no direct link between heavy consumption of fast food and colorectal cancer, high consumption of fat does lead to obesity in the long run. Most of the fast food types include large quantities of fat to a large extent. Obesity along with physical inactivity has been known to raise the risk of cancer.

Mainly there are three types of treatments for cancer-medical oncology, surgical oncology and radiation oncology.(See Box1) Chemotherapy comes under medical oncology. At the PCC chemotherapy is applied in several ways. * Up front or induction chemotherapy is used to shrink the tumour size before going into definite local treatment with surgery or radiotherapy.

* In concurrent chemo-radiation, drugs are used as radio-sensitisers to improve the effectiveness of radiotherapy.

* In adjuvant chemotherapy, drugs are given after surgery or radiotherapy to treat invisible micrometastases and improve chances of cure. Curative chemotherapy is for very chemo-sensitive cancers like lymphoma, germ cell tumour and leukaemia. Palliative chemotherapy which is for advanced cancers kills cancer cells, controls disease, preserves quality of life and prolongs survival.High dose chemotherapy and stem-cell rescue is another type.

When it comes to surgery, PCC offers advanced surgical methods including radical surgery for advanced cancers, conservative surgery, minimal access surgery and reconstructive surgery. PCC has surgical oncologists who have specialized in Breast surgery, Colorectal surgery,Thoracic surgery, Head and Neck surgery, Gynaecological surgery,Neurosurgery,Orthopaedic surgery,- Urological surgery, Gastrointestinal and Hepatic surgery,Reconstructive surgery,and General surgery

A team of anaesthetists, intensivists, and physiotherapy and rehabilitation team is there to provide the necessary pre and post-operative care to ensure safe and speedy recovery.

The greatest challenge of radiation therapy is to achieve the highest probability of curing with the least side effects. PCC which offers radiation treatment for cancers and benign tumours either alone or together with chemotherapy or surgery include the types of radiation treatments such as intensity Modulated Radiation therapy (IMRT), Image-Guided Radiation Therapy (IGRT), 3D Conformal Radiation Therapy, Stereotactic radiation therapy, Conventional radiation therapy, radiosurgery, brachytherapy and implants.

In fact Parkway Health is the first in South East Asia to to provide Tomotherapy (type of image-guided radiation therapy) using a Tomo Therapy HI-ART system. This system delivers painless and precise treatment doses to the tumour with minimum radiation deposited in healthy tissue. Gamma Knife radiosurgery is also available at the Parkway Health Gamma Knife Centre since June 2008.

PCC was established in December, 2006 with the aim of providing comprehensive and holistic treatment of cancers in a safe and comfortable environment employing the latest technologies.

It offers comprehensive cancer treatment with a highly skilled, multi-disciplinary team comprising medical specialists, nurses, counselors and other para-medical professionals to meet the special needs of cancer patients.As the Medical Dirctor, Ang Peng Tiam states their primary focus is patient care. Research is only of importance if it has immedeiate relevance to the patient.

All the treatment wards are highly comfortable. The physical surroundings would never make patients feel that they are cornered. As the Medical director states “PCC aim is to cure those that can be cured. To control the dicease, preserve the quality of life, and prolong life for those with advanced cancer, and always remembering to treat every cancer patient with dignity.

Paediatric Oncology

Treatment of cancers in children (under age 18 ), include leukaemias, brain cancers, lymphomas, neuroblastomas (cancers of the adrenal gland), Wilms tumours (cancers of the kidney), rhabdomyosaromas (cancers of the skeletal muscles) and other sarcomas, germ cell tumours (cancers of the testis, ovaries and related organs), bone cancers, liver cancers, retinoblastomas (cancers of the eye), and other tumours.

Bone marrow transplantation in children, for cancers including leukaemias, and non-malignant diseases like thalassaemia, immunodeficiencies, metabolic diseases, acquired or congenital bone marrow failure syndromes (e.g. aplastic anaemia, Fanconi anaemia,Diamond-Blackfan syndrome, etc), and autoimmune disorders (e.g. SLE).

Treatment of other blood diseases in children, including thalassaemia, haemophilias, thrombotic disorders, idiopathic thrombocytopenic purpura (ITP), histiocytic disorders like Langerhans cell histiocytosis (LCH) and haemophagocytic lymphohistiocytosis (HLH),immunodeficiencies, and pyrexia of unknown origin.

Through Parkway Health’s CanHOPE which is a non-profit cancer counselling service both patients and the general public receives accurate cancer information, its related screening tests, treatment and other services. Necessary emotional and psychosocial support is always given through counselling. In addition up-to-date cancer information, referrals to appropriate cancer services, resources for further rehabilitation and support services, professional advice on side effects of cancer treatment and coping strategies, diet and nutrition and ‘meet and greet’ services to help first-time patients adapt to the hospital environment are provided.

In addition to its hospitals and Clinical programmes, Parkway cancer Centre of the Parkway Health Group also operate a 24 hour International Patient Assistant Centre (IPAC) in Singapore.

Also, more than 43 International patient assistance centres are situated worldwide. In Sri Lanka, Parkway Health Care, International Assistance Centre is situated in Polhengoda under the guidance of its Country Manager Shuvo Hridayesh.

According to the WHO, 40% of cancer cases can be prevented. Noone is helpless against cancer. The best way to get rid of is to be alert always as emphasized by all the medical experts.

****************

Cancer treatment types

The three main types

1. Surgery

Surgery is more than a tissue removal witha knife or scalpel. It also includes the destruction of cancerous tissue though freezing (cryosurgery), electric currents(diathermy or electrosurgery), direct application of chemicals (chemosurgery), and laser (laser surgery).

Most of the times surgery is the first line of treatment for localised tumours that can be cut out before they spread and cause immediate life-threatening conditions such as blocking the colon.

Anyway not all cancers can be cut out. For example cancers that have spread through the system and cancers of the blood need alternative methods.

2. Radiotherapy

Radiotherapy is the controlled use of radiation to kill or slow the growth of cancer cells with minimal inuries to normal healthy cells.

It can attack cancers that are difficult or impossible to reach with surgery. The healthy cells almost always recover after treatment is over.

Radiotherapy treatment include X-rays, gamma rays and particle radiation. The radiation can be directed from a machine outside the body. injected into the blood or implant in the body.

The danger hee is that radiation itself can cause cancer. That is why doctor’s always try to use the least amount of radiation possible or refrain from it altogether against cancers in organs sensitive to radiation, such as the kidneys, lungs, liver, ovaries and testes.

3. Chemotherapy

Chemotherapy kills cancer cells with anticancer drugs administered orally or via injection. Cancers such as acute childhood leukaemia, Hodgkin’s and non-Hodgkin’s lymphoma, ovarian cancer and testicular cancer are particularly responsive.

Other treatments

Hormonal therapy

Hormones are chemicals produced by the body to regulate growth, metabolism and ovulation. Some of them impede certain cancers; others stimulate their growth. Doctors can control certain cancers like prostate cancer by introducing certain hormones or impeding them with drugs.

Bone marrow transpalntation

Bone marrow-the sponge like material inside bones- is responsible for producing the various types of blood cells. Bone marrow transpalntation is usuall applied to treat leukaemia and lymphoma.

Immunotherapy

Immunotherapy is a relatively new frontier in cancer research which involves harnessing the body’s immune system to fight cancer.

One research area focuses on a virus-fighting chemical in the body called interferon, which can slow the rate at which cells- including cancer cells - grow and multiply.

Hyperthermia

Another type of treatment that is under study, this involves exposing body tissue to high temperatures to enhance the effectiveness of other types of cancer therapy, sucha s radiotherapy and chemotherapy.

(courtesy: Making a Stand, A Parkway Health publication)

****************

How to reduce the risk of getting cancer

* Choose foods that are low in salt

A high salt diet has been linked to stomach cancer

* Exercise 30 minutes a day, at least five days a week.

Physical activity has been shown to offer protection against cancers of the colon, breast, prostate, lung and uterus.

* Limit consumption of cured meats

The nitrates and nitrites used to preserve them have been linked to stomach cancer.

* Don’t smoke

Tobacco use can greatly increase the frequency of lung,stomach, mouth, throat and bladder cancers.

* Get to, and stay at, a healthy weight

Obese people are more prone to getting cancer

* Reduce exposure to the Sun

Strong link exists between ultraviolet radiation and skin cancer. Avoid too much time outdoors on sunny days. If it is unavoidable, better to protect yourself with sunglasses, sunscreen, and clothes that keep you well covered.

* Avoid consuming overcooked barbecued food

The longer the meat stays on grill, the higher the possibility for the production of carcinogens that have been associated with cancer of the liver, colon, breast, skin, prostate and lung.

* Moderate your intake of alcohol

While alcohol on its own is not a strong carcinogen, alcohol combined with tobacco increases the frequency of tobacco-related cancers.

* Avoid high-fat foods such as fatty meats and fat-rich dairy products

High -fat foods appear to increase the risk of cancers of the breasty, colon and prostate.

* Steer clear of industrial materials such as asbestos, Vinyl chloride and benzene.

Asbestos is associated with lung cancer, vinyl chloride is associated with liver cancer and benzene with cancers of the blood. Take precautions if you are exposed to them in your job

* Eat five or more servings of a variety of vegetables and fruits every day.

- Fruits and vegetables are high in fibre, which can protect against bowel cancer

- Vitamin C, found in many fruits and vegetables, may prevent stomach cancer

- Vitamin A, which orange, yellow and dark green vegetables are rich in, defends against cancers of the lungs, oesophagus and larynx.

- Cruciferous vegetables such as brussels sprouts, broccoli, cauliflower and cabbage

- have been associated with reduces incidences of digestive and respiratory system cancers.

The key to being cured is early detection

According to the World Health Organization (WHO) , a third of cancers could be cured if detected early and treated adequately.

Spotting cancer in its early stages definitely gives one the best chance of beating it. Cancer experts say that many symptoms are mild and hardly noticeable, so we should look for them carefully.

1. Schedule self-checks

Women should examine their breast at least once a month for lumps, changes in skin texture or a discharge from the nipples. Men should check their testicles every month and take note of any abnormal lumps or swellings.

2. Go for cancer screening tests recommended for the person’s age group

Some Common types of screenings: