A Urologist Addresses the More Controversial Aspects of Prostate Cancer Screening

WORDS PROFESSOR DATO’ SETIA DR TAN HUI MENG

FEATURED EXPERT
PROFESSOR DATO’ SETIA DR TAN HUI MENG
Consultant Urologist
Subang Jaya Medical Centre (SJMC)

Prostate cancer is the third most common cancer among the male population in Malaysia after colorectal and lung cancer.

However, despite these staggering numbers, compared to breast cancer, prostate cancer screening appears to be a very controversial topic in medicine.

THE UNCERTAINTIES SURROUNDING PROSTATE CANCER

To date, most health professionals and the public at large are still lost and uncertain on how to go about preventive measures and the treatment of prostate cancer.

Sometimes, early prostate cancers are localized and contained within the prostate. The cancer grows very slowly and may not cause problems for years or may not even become advanced cancer. In cases like these, patients do not need to be treated.

THE RECOMMENDATION FOR PROSTATE CANCER SCREENING

In the United States, the Preventive Services Taskforce (USPSTF) gave a Grade C recommendation on screening for prostate cancer, which means individuals do not necessarily need to screen for prostate cancer unless they have concerns, and they should discuss their concerns with their physicians.

This recommendation came about to reduce the overdiagnosis and overtreatment of prostate cancers.

This decision, however, has resulted in an increasing trend of prostate cancer mortality and morbidity, causing much suffering and compromising the quality of life for patients.

THE CHALLENGE THAT WE FACE TODAY

The challenge today is to come up with a strategy to screen the right population and find lethal prostate cancers.

Equally important, we will also need new treatments that are less invasive and cause less morbidity in individuals.

IMPROVING SCREENING ACCURACY WITH mpMRI SCREENING

For more than 30 years, the medical profession did not make headway with regard to the diagnosis and management of prostate, other than developing robotic techniques and better radiotherapy to remove the tumours.

The Problem with the ‘Old System’

The diagnosis using systematic non-targeted transrectal ultrasound scan (TRUS) guided biopsy is highly inaccurate as it has high false negative rate. This is dangerous as it misses at least 50% of cancer.

The Development of mpMRI and Its Advantages

The transformative advancement in the diagnosis and treatment of prostate cancer was the development of multiparametric MRI (mpMRI) of the prostate.

Using mpMRI as a triage can spare significant number of men from undergoing unnecessary prostatic biopsies and avoiding both physical and psychological trauma and morbidity, especially if TRUS biopsies are performed.

Many studies have confirmed that mpMRI is highly reliable in identifying more than 90% of men with clinically significant and lethal prostate cancer.

This method was reported to be much more sensitive (93%) in detecting prostate cancers compared to TRUS biopsies (48%).

MpMRI as a triage also detects much fewer clinically unimportant prostate cancer (54% fewer) compared to using the traditional TRUS biopsy.

In other words, mpMRI reduces overdiagnosis of clinically unimportant prostate cancer and improves the detection of clinically significant and deadly prostate cancer.

HENCE, TO SCREEN OR NOT TO SCREEN?

Many screening studies have shown that for men diagnosed with prostate cancers, whether they are treated or not, their survival outcome is generally over 10 years or so.

This shows that a majority of the men with prostate cancer detected by screening do not benefit from treatment.

Instead, they suffer the consequences of treatment, like losing potency and experiencing urinary or rectal symptoms with occasional incontinence!

However, long-term studies show the benefits of screening are observed after consistent follow-ups for 12 years or more.

The Goteborg Randomised Cancer Prostate Screening Trial, done in Sweden, revealed that for men who have undergone over 14 years of follow-up and completed the screening, there was a 66% decrease in advanced prostate cancer in the screened population compared to the population of men who were randomized to the non-screening arm.

Therefore, one can conclude that men who have serial PSA screening and then treated if prostate cancer is detected have a 66% less chance of developing advanced prostate cancer—which often results in very painful bone metastases.

There was also a 56% lower mortality rate in the screened population.

Extrapolating from this result, in the Swedish population, PSA screening can save 5,700 out of 1 million screened men from dying of prostate cancer.

THE BEST WAY FORWARD

In summary, prostate cancer is still a significant life-threatening disease.

Early detection and early prediction of the disease are crucial, whereas screening in men with long life expectancies is beneficial.

Overdiagnosis and overtreatment issues can be addressed with targeted screening and biopsy only for at-risk patients. This aims for early detection & diagnosis of localized lethal prostate cancer, which is fully curable.

If diagnosed with non-lethal prostate cancer (especially low-grade cancer), individuals only require good active surveillance with a follow-up mpMRI. They should also repeat a biopsy of the prostate if necessary.

It is crucial for those with intermediate-grade prostate cancer (ISUP 2) or large volume low-grade prostate cancer (> 6mm core cancer tissue) to receive careful active surveillance paired with good clinical judgement and a follow-up mpMRI as well.

Men with localized lethal prostate cancer will need ablative treatment with surgery, radiotherapy or occasionally brachytherapy. Counselling for adverse events like erectile dysfunction and occasional urinary incontinence following ablative treatments should also be given.

MpMRI has greatly improved the diagnosis of clinically important prostate cancer, and better genomics will help predict the prognosis of the disease. Transperineal mpMRI – ultrasound fusion prostatic biopsy is the way forward. Focal therapy like HIFU, irreversible electrophoresis or targeted ablation will probably play an increasing role, especially for patients with favourable intermediate-risk or low-grade large-volume prostate cancer.

An Oncologist Spotlights the Newest & The Latest in Stereotactic Radiosurgery Technology

WORDS DR AMINUDIN RAHMAN MOHD MYDIN

FEATURED EXPERT
DR AMINUDIN RAHMAN MOHD MYDIN
Consultant Clinical Oncologist
KPJ Damansara Specialist Hospital

It’s an undeniable fact that cancer is one of the leading causes of death both in Malaysia and worldwide.

HOWEVER, CANCER NEED NOT NECESSARILY BE A DEATH SENTENCE THESE DAYS

There are numerous developments in the technology behind cancer screening that allows more precise cancer treatment and hence a greater potential for better treatment outcome.

Many exciting developments have taken place in the field of radiation therapy, also called radiotherapy.

Radiation therapy involves the use of high-powered X-rays and other types of radiation to disrupt the growth of a tumour.

As a result, the tumour will eventually start to shrink.

Depending on the type and severity of cancer, it can be used as a single form of cancer treatment.

It can also be used alongside chemotherapy and other forms of cancer treatments. For example, after a surgery to remove a tumour, the patient may receive radiation therapy to eliminate any leftover cancer cells in their body.

One significant development in radiation therapy is stereotactic radiosurgery, which is available in Malaysia.

WHAT IS STEREOTACTIC RADIOSURGERY (SRS)?

Click on the image for a larger, clearer version.

  • This is a very precise form of radiation therapy.
  • It can be used on both cancerous and non-cancerous or benign tumours.
The advantage of SRS over older radiotherapy systems
  • Delivers high doses of radiation in tiny, precise beams that target the tumour(s) while minimizing damage to surrounding tissues.
  • Its high precision allows for treatment of very small tumours as well as tumours located close to important organs.
  • High doses of radiation allow for more effective treatment of tumours.
  • Less damage to surrounding healthy tissues means fewer potential side effects compared to older systems.

Stereotactic radiosurgery is commonly used to treat the following:

  • Abnormalities in the brain and spine, including cancer.
  • Benign or non-cancerous tumours.
  • Epilepsy.
  • Trigeminal neuralgia, a rare and very painful chronic disease that affects the trigerminal nerve in the brain.
  • Abnormal connections between arteries and veins, or arteriovenous malformations.
THE DIFFERENT TYPES OF STEREOTACTIC RADIOSURGERY
Gamma knife
  • Commonly used to treat tumours and lesions in the brain.
  • No actual knives are involved here—the ‘knife’ here is a highly focused beam of radiation!
  • The beam is typically delivered under the control of a computer-guided treatment.
  • The use of artificial intelligence or AI shows promise in optimizing delivery route of the radiation beam to the targeted areas of treatment.
Stereotactic body radiation therapy (SBRT)
  • Commonly used on cancers that are still confined to a small area of the body and have not yet spread into nearby tissues.
  • SBRT is used for tumours and cancers outside the brain, commonly those in the head and neck, lung, liver, pancreas, kidney, prostate, and spine regions.
  • This treatment method delivers high doses of radiation to the targeted area over a matter of days. (Conventional radiation therapy may take place over a matter of weeks.)
  • While highly concentrated radiation is applied, don’t worry—the treatment isn’t painful.

Proton therapy

  • Commonly used to treat both cancerous and non-cancerous tumours that are located near important organs such as brain and spinal cord. It is also frequently used to treat cancer in children.
  • This is a pretty complicated treatment, as the oncologist and their colleagues would need to first determine the specific location, size, and dimension of the tumour. This is often done via imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI).
  • Once these details are obtained, the radiation oncologist will direct high-energy proton beams onto the tumour.

Linear accelerator (LINAC)

  • Commonly used to treat cancers of the prostate, lung, breast, oesophagus, stomach, rectum, uterus, bladder, liver, and more.
  • This is a high-definition dynamic radiosurgery (HDRS) treatment that allows for accurate delivery to small areas of the body.
  • It can target areas accurately, thereby minimizing exposure to healthy cells and hence side effects.
  • It is also capable of delivering high-dosage radiation beams. This usually means that the patient’s radiotherapy sessions will take less time, and they will also require fewer sessions compared older radiotherapy systems.

A Breath of Fresh Hope For Women Against Lung Cancer

A panel discussion titled ‘A Breath of Fresh Hope’ was held on 7 December 2023. This was a collaboration between the pharmaceutical division of Roche (Malaysia) Sdn Bhd and the Lung Cancer Network Malaysia (LCNM).

This panel discussion highlighted the alarming prevalence of lung cancer in non-smoking Malaysian women, the related medical implications of this prevalence, and the social stigma surrounding this cancer.

“Over 2.2 million lung cancer cases were reported in 2020 globally, and more than 770,000 of them were in women. Lung cancer is the third top malignancies seen in the global female population, after breast and colorectal cancers,” said Ms Deepti Saraf.

SHIFTING PUBLIC PERCEPTION OF LUNG CANCER
FEATURED EXPERT
DR ANAND SACHITHANANDAN
Consultant Cardiothoracic Surgeon and Co-Founder of Lung Cancer Network
Malaysia

“The majority of lung cancer cases affect smokers. Having said that, we are now starting to see increasing numbers of cases of lung cancer in non-smokers, of whom women are overrepresented,” said Dr Anand.

Lung cancer does not affect smokers only; there are other risk factors that could put one could be at risk.

Dr Anand Sachithanadan revealed that fewer than 2% of Malaysian women smoke, but lung cancer is one of the main cancers that affect women in Malaysia.

Thus, contrary to popular perception, lung cancer does affect people that do not smoke, as outlined below.

Common lung cancer risk factors. Click on the image for a larger, clearer version.

BE AWARE OF THE SYMPTOMS OF LUNG CANCER—EVEN IF YOU DO NOT SMOKE
FEATURED EXPERT
DR JENNIFER LEONG
Consultant Clinical Oncologist
Sunway Medical Centre

Dr Jennifer Leong told us, “Many women harbour the preconceived notion that because they don’t smoke, they are not at risk of lung cancer. At times, even when displaying typical symptoms, they can easily miss out on these symptoms and do not get the required medical attention in the earlier stages of disease, affecting their chances at longer survival.”

“While I wouldn’t say that lung cancer is preventable, it’s very much a curable disease provided that you can detect it early on,” she added.

On the other hand, ignoring or overlooking the early symptoms of lung cancer would lead one to seek medical treatment only when the cancer has advanced to a late stage, during which the chances of a positive outcome are far more diminished.

Dr Anand concurred with Dr Jennifer’s statement. He stated: “Lung cancer care has been revolutionized in the last four or five years, leading to significantly better outcomes for our patients as well as overall survival. Despite all these tremendous promises, the fact remains most patients are still being diagnosed late in stage.”

Common symptoms of lung cancer. Click on the image for a larger, clearer version.

WOMEN SHOULD PRIORITISE THEIR OWN HEALTH AS WELL AS THAT OF THEIR LOVED ONES
FEATURED EXPERT
ASSOCIATE PROFESSOR DR CARYN CHAN MEI HSIEN
Consultant Health Psychologist
Faculty of Health Sciences
Universiti Kebangsaan Malaysia

“Many women are expected to and are taught to prioritise the health of family, sometimes at the expense of their own health. Consequently, some women would ignore or dismiss their symptoms, or feel guilty when their medical treatments become a significant expense to the family,” said Associate Professor Dr Caryn Chan.

One unfortunate consequence of women putting the needs and well-being of others over their own is that they often neglect their own health.

Often, Associate Professor Dr Caryn Chan pointed out, they overlooked symptoms such as those of lung cancer, and seek medical attention only when their illness had deteriorated to an advanced stage.

This attitude on both the parts of women and society need to change. “Taking care of your health does not mean you are burdening the rest of the family,” Dr Caryn stated.

She also called for the family to come together to distribute caregiving and support responsibilities, typically delegated to a woman, across all capable family members. This way, a woman would have ample opportunity to also tend to her own needs and well-being.

BE MORE PROACTIVE IN DETECTING LUNG CANCER EARLY!
FEATURED EXPERT
MS. DEEPTI SARAF
General Manager
Roche Malaysia Sdn Bhd

“All of us have a part to play in raising awareness of lung cancer,” Ms Deepti Saraf reiterated while closing the panel discussion.

Be alert for symptoms.

If you, your loved ones, or your friends have symptoms, seek medical help.

If you are at high risk of lung cancer, consult your doctor.

The doctor can arrange for you to undergo regular screening to detect early the presence of cancer or other issues with your lungs.

This is an educational article brought to you by

Can the World Truly Be Free of Fear of Cancer in the Next 25 Years? Experts Believe So

WORDS LIM TECK CHOON

On 5 September 2023, Siemens Healthineers hosted Creating a World Without Fear of Cancer: A Critical Dialogue, a panel discussion for local healthcare experts and leaders to share their thoughts on whether the world can indeed be free of fear of cancer within the next 25 years.

This may seem odd at the surface as cancer cases continue to rise—indeed, the number of cases in Malaysia is projected to double by 2040!

However, we are also seeing a rise in technological innovations that allow for more precise and earlier detection of cancer, as well as more effective forms of treatment through customized therapy that capitalizes on recent breakthroughs in genetics, immunotherapy, and more.

Hence, it is possible that, over the next 2 decades, we will see a shift from cancer as a ‘death sentence’ to a manageable long-term or chronic disease with higher survival rates. In other words, a world without fear of cancer.

We managed to get a front row seat at this panel discussion, and we’re pleased to share the highlights with you.

WHO’S AT THE PANEL DISCUSSION?
  • Fabrice Leguet, Managing Director of Siemens Healthineers Southeast Asia
  • YB Dr Kelvin Yii, Special Advisor to the Health Minister
  • Serena Yong, CEO of Regency Specialist Hospital
  • Professor Ricky Sharma, Global Head of Clinical Affairs at Varian
  • Ranjit Kaur, former President and current board member of Reach to Recovery International (RRI)
HIGHLIGHTS OF THE PANEL DISCUSSION
FEATURED EXPERT
YB DR KELVIN YII LEE WUEN
Special Advisor to the Minister of Health
  • “The National Strategic Plan for Cancer Control aims to make cancer prevention, management, and control accessible and affordable through partnerships with stakeholders,” says YB Dr Kelvin Yii. “The goal is to reduce the cancer burden, promote understanding of cancer, encourage prevention and early diagnosis to alleviate patient fears.”
  • The backbone to this effort is the Public Private Partnerships (PPPs) that involve strategic partnerships between government and private hospitals.
  • Current, most of the medical innovations for cancer diagnosis and management are centred around private hospitals, thus putting them out of reach of many Malaysians, especially those in the B40 group.
  • Through PPP, efforts such as government hospital patients getting follow-up treatments at private hospitals can be made possible while still at a reasonable cost partly funded by the Ministry of Health Malaysia.
  • Dr Kelvin admits that funding is a significant challenge at the moment.
FEATURED EXPERT
PROFESSOR RICKY SHARMA
Global Head of Clinical Affairs
Varian Medical Systems
  • “Cancer is a disease that can evolve and mutate to evade treatments,” Professor Ricky Sharma states. “The importance of patient data cannot be understated, as well as patient experiences of treatment from country to country.”
  • He underscores the importance of using patient data to deliver a personalized patient experience. “It has to be from a holistic point of view,” he elaborates. “We need to be asking important questions from the patients’ perspective: ‘Is treatment accessible? Are patients being treated with the respect they deserve? How and where are clinical decisions being made and the treatments being administered?'”
  • In light of the objectives set by the Ministry of Health Malaysia, such as the digitalization of all their healthcare facilities by 2030, Professor Ricky Sharma believes that this would allow for more accessible healthcare to people of all economic status, regardless of location.
  • For example, he cites the use of a virtual cockpit, which allows a healthcare professional to deploy customized treatment plans, analyze and provide results of imaging tests, etc to multiple hospitals without having to physically travel to those places. This would save time and improve productivity and efficiency.
  • Furthermore, digitalization of the medical workplace would allow for more flexible work hours for the staff, which is an effective way to reduce burnout. He and Ranjit Kaur bring out the fact that the medical profession has one of the highest suicide rates in the world, and this move to digitalization would help reduce the prevalence of burnout and mental issues that could help reduce such tragedy.
FEATURED EXPERT
FABRICE LEGUET
Managing Director
Siemens Healthineers Southeast Asia
  • Fabrice Leguet believes the next step in comprehensive cancer care will be to move beyond today’s fragmented cancer care landscape towards a more integrated approach.
  • He cites the shift of cancer screening from tertiary hospitals to general practitioners’ clinic as an example of such an approach. Having screening services available to clinics, especially at more rural areas of Malaysia, would go a long way in increasing the number of cancer cases detected at an early stage and, hence, the chances of better treatment outcomes and fewer deaths.
  • “By partnering with healthcare providers, we accelerate the transfer of knowledge in oncology across clinical, technical and managerial fields and fast-track the adoption of integrated innovative technologies across the continuum of cancer care,” he says.
  • “While we leverage our access to global best practices and the latest technological innovations, we take a ‘fit for purpose’ approach, where solutions are adapted to the local context in close collaboration with our partners in the region,” he adds.
  • He further says, “Every strategic partnership, every technological innovation, and every collaboration with policy makers will bring us one step closer to creating a world without fear of cancer.”
FEATURED EXPERT
SERENA YONG
Chief Executive Officer
Regency Specialist Hospital
  • Serena Yong shares that the private medical healthcare sector welcomes the partnership with the Ministry of Health via PPP programmes.
  • “By integrating insights from different fields, we can achieve more diverse and effective outcomes,” she states.
  • “Patient well-being at the heart of our mission,” she goes on to add, “so this partnership expedites the integration of connected health solutions, ensuring swifter access to care. Moreover, it facilitates the expansion of teleconsultation services and the implementation of predictive analytics on a broader scale, ultimately contributing significantly to our patients’ journey toward improved health outcomes.”
FEATURED EXPERT
RANJIT KAUR
Former President and Current Board Member
Reach to Recovery International (RRI)
  • In spite of technological advances, Ranjit Kaur reiterates the importance of community support and holistic approaches that emphasizes the patient’s emotional well-being alongside their medical treatments.
  • “In a world where technology drives improvement in various aspects of our lives, we must also prioritize empathy, timely care access and comprehensive support systems for patients, not only in Malaysia but worldwide,” she says. “Each patient journey is often daunting and worrisome, but by paying greater attention to these details, we can help individuals look beyond their diagnosis and find confidence in their ability to overcome cancer.”
  • Given that the oncologists in Malaysia are still concentrated in urban areas such as the Klang Valley, Ranjit highlights the efforts of the Ministry of Women, Family and Community Development to provide very affordable lodging for families that have to travel to these urban areas for a family member’s cancer treatments. She calls for the Malaysian government to look into providing more similar assistance and services to enable Malaysians from outside of urban areas that are traveling long distances for cancer treatments.
  • She and YB Dr Kelvin Yii agree that the government of Malaysia should prioritize the Ministry of Health in the yearly budget. Ideally, the Ministry of Health should be getting the most, if not the lion’s share of, the annual budget to allow PPP programmes to make healthcare treatments, especially for cancer, accessible to all Malaysians regardless of race, gender, and socioeconomic status.

Pancreatic Cancer 101: How Early Detection Can Make a Crucial Difference

WORDS LIM TECK CHOON

FEATURED EXPERT
DR TAN CHIH KIANG
Consultant Clinical Oncologist
Thomson Hospital Kota Damansara
PANCREATIC CANCER AT A GLANCE
An overview of pancreatic cancer. Click for a clearer, larger image.
  • “Pancreatic cancer is a type of cancer that originates from the pancreas, a vital organ located between the stomach and liver,” Dr Tan Chih Kiang tells us. “It occurs when abnormal cells in the pancreas multiply uncontrollably, forming a tumour.”
  • It’s the 12th most common cancers diagnosed worldwide.
  • It’s one of the deadliest cancers, with a 5-year survival rate of just 5–10%.
  • According to Dr Tan, this low survival rate is mainly the result of many pancreatic cancer cases being detected and diagnosed only when the cancer has reached an advanced stage. “At this stage, treatment options are limited, and surgery is no longer an option,” he says.
YOU ARE MORE LIKELY AT RISK OF PANCREATIC CANCER IF YOU…
  • Are obese. People with body mass index or BMI of 30 and higher face up to 20% increased risk.
  • Smoke. 25% of pancreatic cancer cases involve tobacco smokers.
  • Have diabetes. The link between diabetes and pancreatic cancer is still unclear, however.
  • Have chronic pancreatitis or long-term inflammation of the pancreas. Heavy smoking and drinking of alcohol can lead to chronic pancreatitis.
  • Have a genetic mutation that leaves you more likely to develop this cancer.
  • Are older. Dr Tan shares that the average age of the people diagnosed with this cancer is 70.

Aside for the last 2 risk factors, the other risk factors can be managed through lifestyle modifications—losing weight through healthy, balanced diet and regular physical activity, for example—and good control of existing health conditions. You can consult your doctor for more information.

HOW TO TELL THAT YOU MAY HAVE PANCREATIC CANCER
  • Upper abdominal pain and discomfort. The pain may radiate to the back.
  • Jaundice, which is the yellowing of the skin and the white of the eyes, and/or very itchy skin.
  • Indigestion that does not respond to conventional medications.
  • Fatigue—feeling exhausted all the time.
  • Unexplained weight loss.

Most of these symptoms often go undetected, or are assumed to be trivial, hence the cancer is allowed to progress to an advanced stage unchecked.

Dr Tan advises us to see a doctor should we experience these symptoms. Better safe than sorry, as early detection allows for a higher chance of better treatment outcome!

Asia Pacific Women’s Cancer Coalition Releases Important Data on Women’s Cancers

WORDS LIM TECK CHOON

The Asia-Pacific Women’s Cancer Coalition recently launched a report called Impact and Opportunity: The Case for Investing in Women’s Cancers in Asia Pacific.

WHAT’S IN THE REPORT?

Published by the Economist Impact and supported by the pharmaceutical company Roche, this report presents a detailed examination of the burden of women’s cancer, specifically breast and cervical cancer, in 6 countries in the Asia Pacific region: India, Indonesia, Malaysia, the Philippines, Thailand, and Vietnam.

The report includes detailed snapshots of the breast and cervical cancer burden, incidence, and mortality in each of the 6 countries mentioned above. Readers will access the following information:

  • Current cancer care capacity status
  • Existing policies and planning
  • Prevention and screening measures
  • Diagnosis and resource capacity
  • Quality of treatment and access
  • Levels of awareness and education about breast and cervical cancer

The report furthermore identifies the gaps and opportunities for relevant stakeholders to improve the provision of assistance to women dying from these cancers every year in Asia Pacific.

THE MALAYSIAN SNAPSHOT

The full-size images may not display properly on certain desktop devices due to technical limitations.

If you experience this issue, to get the full-size image (warning: these images are huge), click on each thumbnail and then save the image or open it in a new tab.

THE REPORT IS ONLINE—READ IT HERE!
Click here for the full report at the Asia-Pacific Women’s Cancer Coalition website. The link leads to a PDF file.

Seeking the Light at the End of a Cancer Treatment Journey

WORDS LIM TECK CHOON

Khariza Abdul Khalid has a blessed life. At 47, she is the Executive Director of Gamuda Land and a mother of 3 precious children.

However, it was not always rosy for Khariza, for in 2012, the discovery of an unusual bulging on her left stomach led to a diagnosis of stage 3 non-Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma is a type of cancer that starts in the lymphatic system—a network comprising our lymphatic vessels, lymph nodes, lymphoid organs, lymphoid tissues, and lymph fluid. When one develops this cancer, their white blood cells grow in an abnormal manner, forming tumours throughout the body.
A SHOCK, THEN COMES DETERMINATION

“I was scared, worried, nervous,” recalls Khariza, “but I was informed that I would have to go through chemotherapy.”

Fortunately, her husband and parents were very supportive, acting as the rock for her to stay strong and supported throughout her cancer treatment journey.

Her parents even stepped in to care for her children during the period.

A LONG JOURNEY

“I had to go for 6 cycles of chemotherapy and a bone marrow transplant,” Khariza shares with us.

Each cycle took place in a month, and she would, depending on her health condition, have 2 weeks of rest or staying in the ward for 3 to 4 days.

During this period, she took a year leave from work.

“I’m grateful for the support from not only my family, but also my employer and colleagues,” she tells us.

Additionally, she is also grateful for the compassionate care, understanding, and support she received from the doctors, nurses, and other hospital staff during her treatment journey.

“Don’t worry too much,” Khariza advises others that are embarking on their cancer treatment journey. “It is not an easy road, but you will get through this!”

A HOPEFUL FUTURE

By the end of the 6th cycle, Khariza received the news that she had been hoping to hear: her cancer cells had been eliminated.

She would undergo immediate bone marrow transplant, to replace bone marrow damaged during chemotherapy and to regenerate her immune system.

These days, Khariza is feeling more like her old self.

“I am blessed,” she says. “I am feeling heathier and more energetic too, as I have added exercises and workouts into my daily routine.

Not taking life for granted anymore, she also devotes more time to bond with her family and friends.

A Cancer Expert Explains What You Should Know About Wilms Tumour

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ENI JURAIDA ABDUL RAHMAN
Consultant Paediatrician, Paediatric Haematologist, and Paediatric Oncologist
Sunway Medical Centre

“Wilms tumour is the most common type of kidney cancer affecting children, usually those that are under 5 years old,” says Dr Eni Juraida Abdul Rahman.

FACTS ABOUT WILMS TUMOUR
  • It is also called Wilms’ tumor or nephroblastoma. The name Wilms came from Max Wilms, a German surgeon that first described this cancer.
  • The tumour is the result of mutations of genetic materials in kidney cells, which typically occur after birth.
  • Usually only one kidney is affected, but in 5% to 7% of cases, it can be found in both kidneys.
WHAT CAUSES WILM TUMOUR?

Just like with most cancers, we still haven’t found the exact causes for this cancer.

However, Dr Eni Juraida points out that there are certain genetic disorders that can increase a child’s risk of developing Wilms tumour, such as:

  • Aniridia, or the abnormal development of the iris of the eye due to genetic mutation, usually along chromosome 11 that led to deleted genes and hence missing genetic information.
  • Hemihypertrophy or hemihyperplasia, a condition in which one side of the body or a part of one side of the body is larger than the other in an extent that is greater than what is considered normal.

“Patients with WAGR syndrome have a 45% to 60% chance of developing Wilms tumour,” says Dr Eni Juraida.  WAGR stands for: Wilms tumour, aniridia, genitourinary malformation, and range of developmental delays.

SYMPTOMS TO WATCH OUT FOR IN A CHILD
  • Painless swelling in the abdomen, occasionally noted by parents while bathing the child; the tumour may cause discomfort
  • Haematuria, or blood in urine
  • Hypertension or high blood pressure
  • Fever
  • Unusual loss of appetite, resulting in weight loss
  • Pain in the abdomen
  • Generally feeling unwell
  • Cough and shortness of breath
HOW IS WILMS TUMOUR TREATED?

Treatment options will depend on the stage of the tumour.

Surgery

The mainstay treatment, usually done upfront for stage I and II tumours and sometimes delayed for stage III, is a surgical procedure called nephrectomy. This surgery removes the affected kidney and hence the tumour from the child’s body.

In the rare cases when tumours are present in both kidneys, partial nephrectomy removing only the parts affected by the tumour will be performed to preserve as much of the kidneys as possible.

Chemotherapy

“Chemotherapy are medications that are given to kill cancer cells,” Dr Eni Juraida explains.

For stage I and II tumours, these medications can be given after a nephrectomy, to kill off any remaining cancer cells.

However, stage III tumours are much larger in size compared to stage I and II ones, and chemotherapy will be prescribed before a surgery to first shrink the tumour. This will allow the surgery to be carried out more safely.

Radiotherapy

This may be prescribed in some cases, usually for tumours that has spread to other organs such as the lungs or are not completely resolved via chemotherapy.

CAN WE HELP PREVENT THE DEVELOPMENT OF WILMS TUMOUR IN OUR CHILD?

“Since we don’t know the cause, it is difficult to have any preventive measure,” Dr Eni Juraida points out.

However, for children with WAGR syndrome, having them undergo a surveillance ultrasound of the abdomen on a periodic basis—such as every 6 months—can help detect Wilms tumour.

Not Sure What Immunotherapy Is? Get Your Answers From an Oncologist!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HAFIZAH ZAHARAH AHMAD
Consultant Clinical Oncologist
Sunway Medical Centre Velocity
IMMUNOTHERAPY IS A NEWER APPROACH TO TREAT CANCER, BUT WHAT EXACTLY IS IT?

According to Dr Hafizah Zaharah, immunotherapy is a pretty unique way to treat cancer, in that it uses the body’s own immune system to attack cancer cells.

“The immune system is like the police force of our bodies,” she says. “It is designed to protect the body against infections, illnesses, and diseases.”

The cells that make up our immune system. Click on the image for a larger, clearer version.

When it comes to faulty or mutated cells in our body, the immune system identifies and eliminates these cells before these cells become a significant threat to our healty.

However, the cells of our immune system may not be strong enough to kill cancer cells, according to Dr Hafizah. Sometimes, the cancer cells are able to fool our immune system by resembling normal cells or hiding themselves.

THIS IS WHERE IMMUNOTHERAPY COMES INTO THE PICTURE

“Immunotherapy can boost or change how the immune system works, so it can recognize and kill cancer cells,” explains Dr Hafizah.

For example, cancer cells originate from normal cells, so the immune system may still mistake them for normal cells.

“These cancer cells can push a ‘brake’ button on the immune cells, so the immune system would not attack them,” Dr Hafizah adds.

Now, a type of immunotherapy called checkpoint inhibitors can take the ‘brakes’ off the immune system, allowing it to now recognize and attack the cancer cells!

There are other types of immunotherapy, of course, and these treatments can be used for various cancers.

CANCERS THAT CAN RESPOND TO IMMUNOTHERAPY
  • Non-small cell lung cancer
  • Triple negative breast cancer
  • Head and neck cancer
  • Cervical cancer
  • Gastric cancer
  • Oesophageal cancer
  • Bladder cancer
  • Melanoma
  • Liver cancer
  • Renal cell carcinoma
  • Endometrial cancer
  • Colon cancer
WHAT IS IMMUNOTHERAPY LIKE?

According to Dr Hafizah, various immunotherapy agents are given as an infusion into a vein (a drip) typically once every few weeks.

These immunotherapy agents can be given to the patient all by itself, or in combination with targeted therapy or chemotherapy.

“For advanced stage cancer, immunotherapy treatment generally is given for 2 years, alongside close monitoring,” Dr Hafizah further says.

IS IT EFFECTIVE, THOUGH?

Although immunotherapy seems like the answer every person with cancer is looking for, Dr Hafizah warns that not all types of cancers will respond well to the treatment.

This is why, before embarking on immunotherapy, one will first undergo a specific biomarker test, such as the PD-L1 test, which will be carried out on a cancer specimen to ensure that the person will respond to the treatment.

ARE THERE ANY SIDE EFFECTS TO BE CONCERNED ABOUT?

“Generally, the treatment is well tolerated,” Dr Hafizah assures us.

However, just like with most types of treatments, side effects are possible. These include:

  • Feeling tired, skin rash, or muscle or joint pain
  • Rare side effects include allergic reactions such as dizziness, fast heart rate, face swelling, or breathing problems
  • Autoimmune reactions, which can lead to serious problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, etc

How Much Do You Know about Male Breast Cancer? Let’s Find Out!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR NIK MUHD ASLAN ABDULLAH
Clinical Oncologist
Sunway Medical Centre
BREAST CANCER AFFECTS MEN AS WELL AS WOMEN

Breast cancer in both men and women share many similar attributes.

The most common kinds of breast cancer in men are the same kinds that are present in women, namely:

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Ductal carcinoma in situ (or DCIS)

Dr Nik Muhd Aslan Abdullah says that breast cancer is, however, rare among men.

WARNING SIGNS

According to Dr Nik, many of the most pressing early warning signs of breast cancer in men are also similar to those found in women, such as:

  • Lumps in the breast tissue
  • Skin dimpling or puckering
  • Nipple retraction
  • Unusual discharge from the nipple
HORMONAL CHANGES CAN GIVE RISE TO BREAST CANCER

One reason why breast cancer is rare among men is that the hormone testosterone inhibit the growth of breast tissue, while oestrogen stimulates breast tissue growth.

While men and women have both hormones in their bodies, men have higher levels of testosterone compared to women. On the other hand, women have higher levels of oestrogen.

Some breast cancer cells have special structures at the surface, called hormone receptors. These cells are called hormone-receptor positive (HR positive for short). Oestrogen can bind to these receptors to cause the growth of these cells. Dr Nik explains that men have a higher possibility of developing breast cancer cells that are HR-positive, when compared to their female counterparts.

“Breast cancer cells in men are sensitive to hormonal imbalances,” Dr Nik explains, “so any factors or conditions that can lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”

What can cause the raise in oestrogen levels in men?
  • Klinefelter syndrome, a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens
  • Injury to the testicles
  • Use of androgen inhibitors
  • Liver cirrhosis (scarring of the liver)
  • Obesity 
Family history also plays a factor

About 1 out of 5 men with breast cancer is found to have had a family history of the disease.

This is because men can also inherit a mutation in the BRCA1 or BRCA2 genes or in other genes, such as CHEK2 and PALB2. These mutations will highly increase their risk for breast cancer.

“Unfortunately, we do not have a say in the types of genes we inherit,” Dr Nik says.

He recommends that men with a family history of cancer should consider seeking counsel from their doctors about going for genetic screening tests as soon as they can, especially those over the age of 50.

Genetic screening tests involves taking a blood sample for analysis. A genetic counsellor will then advise the person, based on the results given, on what the next best steps would be for him.

How to conduct self-breast examination for men. Click the image for a larger version.
MEN WITH HR-POSITIVE BREAST CANCER ARE MORE LIKELY TO RESPOND TO HORMONE TREATMENTS

Dr Nik explains that hormone therapy can be used to help lower the risk of the cancer cells spreading or treat cancer that has come back after treatment.

Why then do men with breast cancer have lower survival rate compared to their female counterpart?

“Through many of the studies that I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women,” Dr Nik says.

He attributes this to the fact that men with breast cancer are often diagnosed late.

“Men will sometimes wait too long to seek out a diagnosis for the symptoms they may be experiencing,” he explains, “or not recognize the warning signs of breast cancer in their bodies.”

As a result, they delay seeking help, and tend to do so only when the cancer has become advanced and spread to other parts of the body.

Dr Nik encourages men to seek a doctor’s opinion if they find themselves experiencing any of the mentioned symptoms related to breast cancer. “Breast cancer can be cured, and it is very treatable if detected early on,” he says.