Medical Professionals Version - National Cancer Centre Singapore

Issue No. 05 • MICA (P) 207/10/2008
AN NCCS BI-MONTHLY PUBLICATION
July / August 2009
...HELPING READERS TO ACHIEVE GOOD HEALTH
Salubris is a Latin word which means healthy, in good condition (body) and wholesome.
NCCS TEAM IS GETTING
THE ANSWERS FOR
LIVER CANCER

PAGE A2
In Other Words
FOR THE LOVE OF SCIENCE
SALUBRIS
July / August 2009
DANIEL TAN speaks about his passion for science which
led him to his research into how targeted drug works
in nasopharyngeal cancer. CAROL ANG reports.
Recently, the Department of Medical Oncology welcomed back two doctors.
Amongst them is Dr Daniel Tan, who had been away for a nine-month
fellowship programme in the UK. He is the second doctor to return from
overseas, the first this year being Dr Ng Quan Sing. Five other doctors,
namely, Dr Lynette Ngo, Dr John Chia, Dr Richard Quek, Dr Wong Nan Soon
and Dr Ang Mei-Kim are still overseas and not due to return till 2010.
Dr Tan is the first oncologist
from Singapore to be conferred
the Young Investigator Award
from the American Society of Clinical
Oncology (ASCO) Cancer Foundation.
This award provides funding to promising
investigators planning an investigative
career in clinical oncology.
Recalling fondly his stint overseas,
Dr Tan revealed, “In my second year
of study at St Bartholomew’s and
The Royal London Hospital, we had
8-week elective projects – ranging from
library-based to lab-based ones – and
out of curiosity, I picked the latter and
ended up in the then Imperial Cancer
Research Fund at Lincoln’s Inn Fields.
I was fortunate to have a very good
mentor who showed me how research
can challenge scientific dogma, with
the aim of making a difference in
patient care.” Dr Tan’s enthusiasm for
knowledge was so great that he even
took a year out to do an intercalated
BSc degree in tumour biology.
It is precisely this investigative spirit
and an avid interest in making new
discoveries that has brought Dr Tan
to his current vocation as oncologist
and clinician-scientist at the NCCS.
Nursing a passion for Science
since he was a child, Dr Tan knew
his dream job would be one that
allows him to apply knowledge in a
practical meaningful way. “Medicine
provided the right mix of human
interaction and applied science,”
he said. And, at the age of 16, Dr Tan
started medical school in London
and now holds BSc (Hons), MBBS
and MRCP qualifications.
He returned in 2002 to be enrolled into national service where he spent a year in the Diving
Medicine Section. In 2004, Dr Tan joined SingHealth, and undertook the rotations through
various departments as a medical officer at the Singapore General Hospital. Three years
later, he began his career in oncology but took off again shortly on a National Medical
Research Council Fellowship to the Drug Development Unit of The Royal Marsden Hospital,
a leading cancer centre in the UK, with full support and encouragement from the NCCS.
For this, he gratefully acknowledges the medical oncology department for creating a highly
conducive environment for personal development, where peers and seniors work towards a
common goal to deliver better care and treatment options to patients – and early phase trials
may be a way forward.
“During my nine months there, I learnt how to innovate the design of Phase I trials, care for
participating patients, as well as interact with pharmaceutical companies and collaborating
overseas Phase I units in Europe and US. It was also quite an experience prescribing novel
drugs available at the unit, knowing well that some of them might become the standard of
care in the next five to 10 years.” He further recounted that some patients could be seen to
benefit even in the context of Phase I trials, which are traditionally regarded as dose titration
experimental studies. “In the era of targeted therapy, and non-invasive molecular platforms,
there is now scope to rationally improve the chances of patient benefit from novel drugs, as
well as gain insight to basic tumour biology.”

PAGE A3
In Other Words
SALUBRIS
July / August 2009
“Despite the slew of
exciting drugs coming
through, we remain
cautiously optimistic,
and at the end of the day,
patient care and safety
remains the priority.“
Dr Daniel Tan
However, beyond the high tech
translational science, he added “I
would say I still derived the greatest
satisfaction treating patients and seeing
them get better. Some of the patients I
met at the hospital were also refreshingly
enlightened. They participated in trials
with the hope of helping others even
though there was a chance that it would
not benefit them,” he added.
As the Young Investigator Award is given
to applicants during their transition
from a fellowship programme to a
faculty appointment, it was shortly
before he returned to Singapore that he
received this honour.
“I am glad that the proposal came
through the peer-review process and was
selected for funding by a highly regarded
international scientific body. The most
satisfying part is to have articulated an
idea in the proposal and have someone
take it seriously to the extent of providing
funding, all in good faith,” he said.
The grant from the award would go into
his research on ‘Delineating Clinically
Relevant Targets of Anti-Angiogenic
Small Molecule Tyrosine Kinase Inhibitors
in Nasopharyngeal Carcinoma’.
“To put that simply, I am trying to
understand why resistance develops in
drugs targeting blood vessels, as well as
find out how they work in nasopharyngeal
cancer which affects about 400
Singaporeans each year,” he explained.
Now that Dr Tan is back, the clinicianscientist
has to divide his time between the
NCCS-VARI Laboratory, where he works
with his mentor Prof Teh Bin Tean, and
the clinic where he sees patients suffering
from a range of different tumour types.
Dr Tan was upfront about his role as an
oncologist. “At first, I had reservations
about a lifelong career in oncology.
But I soon found it to be both a
privilege and an extremely fulfilling
undertaking to care for cancer patients.”
Indeed for someone who is developing
new drugs in oncology, Dr Tan remains
circumspect on the role of a physician.
“Despite the slew of exciting drugs
coming through, we remain cautiously
optimistic, and at the end of the day,
patient care and safety remains the
priority. Hopefully, our research efforts
will shed some light to the current gaps
in understanding cancer, and ultimately
translate to improved care for patients.”
Off work, this 31-year-old is on a constant
quest to discover new gastronomic highs.
He regularly goes for runs, waxes lyrical
about wine together with good friends,
and challenges himself to a therapeutic
game of golf, when time avails.
By Carol Ang

PAGE A4
In Focus
SALUBRIS
July / August 2009
NCCS TEAM IS GETTING THE
ANSWERS FOR LIVER CANCER
The NCCS team has come up with a modality to test drug
combinations in laboratories and today their work has found
its way to the patients who are on clinical trials. At the onset
of this trial, a biopsy of the tumour from the patient was first
taken and implanted into a mouse. The mouse underwent
treatment with the use of one drug and its progress was
monitored. Subsequently, other drugs were administered
until the desired result was obtained.
Thus far, the team has tested a combination of two drugs, both of which are produced by two different giant pharmaceutical companies, for liver
cancer. The combination of two drugs was found to be more effective than the use of one drug. Based on this discovery, a Phase I clinical trial
testing on liver cancer patients for this two-drug combination was conducted. Twenty-seven patients participated in this trial and the results were
encouraging, with complete shrinkage of the tumour in a few patients. A Phase II trial will be launched on some 59 patients later this year.
The team behind this timely
discovery comprises of Adjunct
Professor Huynh Hung from
the NCCS Humphrey Oei Institute of
Cancer research (Division of Cellular
and Molecular Research) and clinician
investigators Dr Toh Han Chong, Head
of the Department of Medical Oncology
and Dr Choo Su Pin, Consultant for the
Department of Medical Oncology.
Professor Hui Kam Man, Director, Division
of Cellular and Molecular Research at
NCCS said: “We could not have achieved
this without the financial support from the
Singapore Millennium Fund, the National
Medical Research Fund and the Singapore
Cancer Syndicate. They could see the
significance of our project and gave us the
necessary funding to make this a reality.”
The team’s success has prompted more
drug companies to come together and
use NCCS as a platform to best their drug
combinations. More clinical trials are in
the works.
However, exemplary treatment
methods are futile if patients are late
in seeking medical attention. Majority
of liver cancer fatalities could have
been prevented with early detection.
Thus, for NCCS’s 2nd Liver Cancer
Awareness Campaign in September
this year, great emphasis was placed
on raising public awareness and
encouraging more people to do
health screenings.
To reach out to more households,
public forums will be held at the Paya
Lebar Kovan Community Centre on 12
and 13 September 2009. The forums
will be presented in English and
Mandarin. All attendees are entitled
to free goodie bags and vouchers for
free Hepatitis screenings at SingHealth
Polyclinics. Madam Cynthia Phua,
MP for Aljunied GRC, who will be
launching the LiCAM campaign urged
the public to go for regular medical
screenings, their best defense against
the disease.
The campaign will focus on information
on the latest treatment methods and
care for liver cancer patients, the risk of
Hepatitis and how to avoid contracting
fatty liver. Fatty liver is a condition that is
likely to become more common among
affluent Singaporeans.
It is expedited when fat accumulates in
Hepatocytes, or tiny sacs of liver cells.
Although fatty liver is a benign condition,
it can give rise to a wide spectrum of
liver diseases, lead to inflammation and
scarring of the liver and eventually, liver
cancer if left undetected. The campaign is
sponsored by Bayer Healthcare.
Dr Tan Yu Meng, Deputy Head and Senior
Consultant, Department of Surgical
Oncology, NCCS and Surgical Director,
Liver Transplant Programme, SGH, who
spearheads the Liver Cancer Awareness
Month Committee said, “Early detection
is the best solution for liver cancer
as often by the time the patients are
brought to our attention it is too late for
treatment. Hence, we hope to raise public
awareness so that they will come forward
and take advantage of the free screening.”
With greater public
awareness and improved
cancer treatments, liver
cancer patients may
look ahead with lighter
hearts as NCCS brings its
research work from the
bench to the bedside.

ADVANCES IN RADIOTHERAPY
IN THE MANAGEMENT OF
EARLY PROSTATE CANCER
PAGE C1
Under The Microscope
SALUBRIS
July / August 2009
INTRODUCTION
Prostate cancer is a cancer whose incidence has been
steadily increasing over the last 35 years. It is typically
found in men older than 50 years but its incidence
varies greatly around the world. In Singapore, it is
now the 3rd most common male cancer.
By Dr Terence Tan
Sr Consultant Radiation Oncologist,
Dept of Radiation Oncology,
NCCS
Early prostate cancer refers to cancer confined to the prostate (stage I & II) and these may be managed
by surgery, radiotherapy or active surveillance. Locally advanced prostate cancer on the other hand is
best treated by a combination of androgen suppression therapy and radiotherapy.
This article looks at advances in the use of radiotherapy in the management of localised prostate cancer.
DOSE
It is now generally accepted that there is a doseresponse
curve for prostate above the conventionally
given 66 Gy. Studies from the Memorial Sloan-
Kettering Cancer Center and M.D. Anderson Cancer
Center have shown that patients have improved
relapse-free survivals when given doses above 70
Gy. While studies into the delivery of even higher
doses are on-going, the current recommendation is
for doses of at least 74 Gy (minimum tumour dose)
to be delivered.
Dose escalation studies began in the era of 3-D
conformal radiotherapy and it was noted that
while increases in the total dose delivered to the
tumour improved disease-free survival, rectal and
bladder morbidity rates also increased. That was
until the advent of Intensity Modulated Radiation
Therapy (IMRT).
IMRT
Intensity modulated radiotherapy is a very sophisticated form of radiation where
the cross-sectional exposure of each treatment beam is not uniform as in the
past but is varied by computer control (intensity-modulated) such that parts of
the beam passing through sensitive normal structures have reduced exposure
rates while parts which pass through tumour and not normal tissues have higher
exposure rates.
In this way, when a number of such treatment beams are arrayed around the
patient, the high-dose treatment volume can be made to envelope the tumour
target volume very conformably while sparing the surrounding normal tissues to
a degree even greater than the previously used 3-D conformal techniques.
Even within the treatment volume, it is possible to vary the dose (dose-paint),
giving for example a radical dose to the tumour proper while delivering a lesser
prophylactic dose to the draining lymphatics, all within the same treatment
session. The availability of this technology has made dose escalation to very high
levels possible with even less side-effects. IMRT has been in use at the National
Cancer Centre Singapore (NCCS) since 2001.
Continued on page C2.

PAGE C2
Under The Microscope
SALUBRIS
July / August 2009
ADVANCES IN RADIOTHERAPY
IN THE MANAGEMENT OF
EARLY PROSTATE CANCER
Continued from page C1.
IMAGE GUIDED RADIOTHERAPY
The prostate is a very mobile organ. Its position varies from day to day depending
on the contents in the rectum and bladder. In the past, the uncertainty of the
prostate’s position was dealt with by using larger treatment volumes. But this
would mean a greater volume of normal tissue being irradiated. However, if the
position of the prostate can be determined before each treatment, then smaller
margins can be applied in the treatment volume. Methods of prostate localisation
include ultrasound and the use of fiducial markers implanted within the prostate.
In the latter method, images taken using the treatment machine’s on-board
imaging device are compared with the images obtained during treatment planning.
If the prostate is found to have shifted, then adjustments are made to align the
radiation beam with the organ. This procedure is critical to IMRT as it helps ensure
that the high-dose volume is accurately delivered to the prostate while the smaller
margins required helps reduce the side-effects even when high doses are given.
The most accurate method currently available is Dynamic Targeting Image Guided
Radiotherapy where treatment machines are equipped with an on-board CT
facility which is used to do scans of patients each day before treatment.
These scanned images are the most accurate representation of the shape and
position of a patient’s tumour or involved organ at the time of treatment.
Adjustments based on these images help maximise the dose to the targeted organ
while minimising the damage to the surrounding normal tissues.
Gold fiducial markers have been used in the treatment of prostate cancer here
since 2004 and NCCS installed its first dynamic targeting IGRT machine in 2007.
HORMONES
Prostate cancer is generally a hormone-responsive disease and there is much
experience in the use of hormones in the treatment of advanced or metastatic
disease. There is now also evidence to show that in selected patients the addition
of androgen suppression therapy to radiotherapy improves disease-free survival
and possibly even overall survival.
BRACHYTHERAPY
Brachytherapy is a method of radiation where radioactive seeds are implanted
into the prostate to effect treatment from within. In the past, its use was limited by
the inability to properly implant these radioactive sources into the prostate. With
improvement in technology, we now have good imaging equipment to plan as well
as monitor the placement of the seeds and modern devices which facilitates very
good implantation transperineally with the use of needles.
The advantage of this method of treatment is that much higher radiation doses can
be concentrated in the prostate while sparing the surrounding tissue.
THE FUTURE – CHARGED
PARTICLE IRRADIATION?
Charged particles such as protons
or carbon ions can be focused
even much more highly compared
to photons and have the potential
for even greater relative sparing
of the surrounding normal tissues.
Their biological effectiveness is also
higher than the usual x-rays used in
radiotherapy.
This makes dose escalation to even
higher doses feasible with even
lesser morbidity to surrounding
normal tissues. They, however,
require very expensive facilities
and are available in only very
few research centres around the
world. With the accumulation of
experience from these centres and
hopefully with technology becoming
more affordable with time, it is
hoped that such treatment would
become more widely available for
the treatment of prostate as well as
other cancers in the future.

RATIONAL APPROACH TO
TESTICULAR SWELLING
PAGE C3
Spotlight
SALUBRIS
July / August 2009
Conditions of the scrotum and its contents often worry the
individual enough to seek medical attention. Most scrotal
conditions are benign and self-limiting, but it is important
to diagnose the odd testicular malignancy that is potentially
fatal if missed. The clinician evaluating should differentiate
benign from malignant diseases, pursue a cost-effective
diagnostic evaluation, and initiate appropriate urological
referral when indicated.
By Dr Lee Fang Jaan
Registrar,
Dept of Urology
Dr Tan Yeh Hong
Consultant,
Director of Endourology,
Director of Laparoscopy,
Dept of Urology
Singapore General Hospital
Patients with a palpable mass in the
testis should be suspected of having
testicular cancer; especially if there
is a previous history of undescended
testis, even if surgically repaired.
Differential causes of testicular
swelling include torsion and
infection. When the swelling can
be felt separate from the testis,
differential diagnoses to consider
include incarcerated hernia,
spermatocele and varicocele. Acute
pain in the testis suggests torsion.
Painful enlargement may be due to
scrotal abscess. Pain and tenderness
adjacent to the testis may be due to
epididymitis or a varicocele. Tenderness
of the testis itself may reflect orchitis.
However, an underlying neoplasm
should always be considered.
Accurate diagnosis requires a careful
history and structured physical
examination, including urinalysis.
Radiological studies such as scrotal
ultrasound and Doppler blood flow
are performed in selected patients
with uncertain diagnosis.
Examination of the scrotum is best
performed with patient standing.
A warm room and warm examining
hands helps as cold temperature
causes contraction of the dartos and
cremasteric muscle and elevation
of the testis toward the external
inguinal ring. The left testis usually
lies lower than the right and the
scrotal sac is hypoplastic when its
gonad is absent.
Palpation is carried out by
systematically examining the testis,
epididymis, and cord for size and
consistency. The exact nature and
location of scrotal mass should be
determined. When transilluminated,
fluid filled structures (e.g. hydrocele)
radiate a reddish glow.
Testicular pain should always be
considered an emergency. Evaluation
should not be delayed if testicular
damage from torsion of the spermatic
cord and subsequent ischemia are to
be avoided. Differentiation between
testicular torsion and epididymitis is
usually possible on the basis of the
presentation and physical findings.
Testicular pain should
always be considered an
emergency. Evaluation
should not be delayed if
testicular damage from
torsion of the spermatic
cord and subsequent
ischemia are to be avoided.
Continued on page C4.

PAGE C4
Spotlight
SALUBRIS
July / August 2009
RATIONAL APPROACH TO
TESTICULAR SWELLING
Continued from page C3.
Some 90% of testicular torsions occur in
men younger than 30 years old. A teenager
with sudden onset scrotal pain and a normal
urinalysis most likely has testicular torsion.
Unrelieved torsion (longer than six hours)
leads to testicular ischemia and atrophy. A
delay in diagnosis longer than 12 hours will
result in irreversible damage.
Testicular torsion can be confirmed by
Doppler ultrasound (greater than 90%
sensitivity, 70% specificity). However, if in
doubt, scrotal exploration and detorsion
should always be performed. The common
anatomical defect is high “investment” of the
tunica vaginalis – the so called bell-clapper
deformity. This inherent defect is usually
bilateral, and detorsion should always be
followed by testicular fixation (orchiopexy)
of both gonads.
If epididymitis or epididymo-orchitis is
diagnosed especially with the finding of
pus cells and bacteria on urine microscopy,
the patient can be treated with a course of
bactrim and doxycycline for two weeks. The
etiology is commonly bacterial infection of
the urinary tract.
In sexually active young adults especially
when associated with urethritis, chlamydial
and neisseria gonorrhoeae infection must be
considered. It is prudent to review the patients
after treatment for resolution of symptoms
and signs. If in doubt, an ultrasound scrotum
should be ordered. An underlying testicular
malignancy must still be a consideration.
Testicular cancer is the most frequent cancer
in young men (15 to 35 years of age).
Cryptorchidism is a well-known risk factor
even after orchiopexy. Testicular tumours
usually present as painless lumps, but some
men (20-25%) develop scrotal pain as a result
of bleeding caused by rapid tumour growth
and necrosis. Most tumours are discovered
as hard testicular lumps detected on self
examination. Reactive hydrocele may make
appreciation of a testicular lesion difficult.
Scrotal ultrasound is an excellent modality for the assessment of testicular
mass. Testicular cancers are typically non-homogenous with hypoechoic
areas. Testicular microcalcifications are associated with a high propensity for
developing seminomas and warrants regular ultrasound surveillance.
More than 95% of testicular tumours originate from germ cells. Germ cell
tumours can be seminomas or nonseminomatous germ cell tumours. Seminomas
are more likely to be confined to the testis (stage I) and are exquisitely
radiosensitive. Nonseminomatous germ cell tumours consist of embryonal cell
carcinomas, yolk sac tumours, or teratomas, alone or mixed with other elements.
Sertoli cell tumours, Leydig cell tumours, and lymphomas are the most-common
non-germ cell tumours. In men older than 60 years, most tumours are non-
Hodgkin’s lymphoma, with a predilection for bilateral involvement.
Tumour markers are helpful in the diagnosis, staging and management of malignant
testicular tumours. α-fetoprotein (AFP) is often associated with embryonal
carcinoma, whereas β-subunit of human chorionic gonadotropin (β-hCG)
elevations occur with choriocarcinomas. However, many testicular cancers are
mixed germ cell in origin and tumour marker elevation is variable. Persistent
elevation of tumour markers post orchiectomy suggests the presence of metastatic
disease. However, there is a 25% false-negative marker elevation rate.
Avoidance of scrotal skin violation is mandatory when obtaining histological
diagnosis. The lymphatics of the testes drain primarily into the retroperitoneal
para-aortic and inter-aortocaval lymph nodes while the scrotal skin lymphatics
drain into the inguinal nodes. Trans-scrotal needle biopsy or orchiectomy is
therefore contraindicated. Suspected testicular tumours should be explored via
an inguinal incision with early control of the spermatic cord to prevent vascular
or lymphatic dissemination.
Further treatment is based on histological
assessment of the tumour and staging
consisting of computed tomography (CT)
scanning and chest x-ray. A false-negative
rate on 20 to 25% occurs in the presence
of non-enlarged (smaller than 1.5cm) but
microscopically involved retroperitoneal
lymph nodes. Treatment modalities include
retroperitoneal lymphadenectomy, external
beam radiation to the retroperitoneum and
chemotherapy, alone or in combination.

40th SMA National Medical Convention
BREAKING THE MYTHS
ABOUT CANCER
PAGE A5
Community
SALUBRIS
July / August 2009
In recent years, the number of cancer patients and
high-risk groups have been on the rise. Consequently,
more cancer prevention methods are finding their way
to the media, having evolved from a wide variety of
sources ranging from official cancer research centres
to the good neighbour next door.
While it is good to have choices, the same cannot be
said for making flawed choices, which are a waste of
time and money better spent on prevention methods
that are actually effective.
To dispel mistaken notions about cancer prevention, the 40th SMA National
Medical Convention based its theme on “Cancer Prevention – Breaking the
Myths”. The National Cancer Centre Singapore (NCCS) was one of the few
institutions to collaborate with the Singapore Medical Association to organise this
event. Madam Halimah Yacob, MP for Jurong GRC, was the Guest-Of-Honour to the
event held at Suntec City Convention Centre on 11 July 2009.
As cancer is the
principal cause of
death in Singapore,
the convention sought
to provide objective
insights on cancer
prevention, with the
consequential goal of
reducing the number
of cancer patients and
cancer-related deaths
in the long run.
To expand its outreach to the general public, the morning public seminar was held
in three concurrent sessions in English, Malay and Mandarin. Dr Wong Zee Wan,
Senior Consultant from the Department of Medical Oncology, was one of the speakers
representing NCCS.
The afternoon session began with a lunchtime seminar, followed by the medical
symposium for healthcare professionals. Dr T. Agasthian, Senior Consultant from the
Department of Surgical Oncology, spoke on behalf of NCCS.
A wide variety of topics was
covered during the convention:
PUBLIC SEMINAR
• Does altering your eating habits
change the risk of cancer?
• Getting a friend to stop smoking
• New cancer screening techniques
LUNCH SYMPOSIUM
• HPV Vaccination for Cervical Cancer
Prevention in Singapore –
Are we a leader or a lagger?
• Cancer vaccines of the Past,
Present and Future
MEDICAL SYMPOSIUM
• Cervival Cancer: to vaccinate
or not to vaccinate?
• Screening Lung Cancer:
useful or harmful?
• Decision making in cancer
screening in the elderly
• The era of individualising
cancer management

PAGE A6
People
SALUBRIS
July / August 2009
10 YEAR DEVOTION WINS
SISTER CHIEW CHENG FONG
RECOGNITION
“Surprised, but an honour” were her first words when
Sister Chiew Cheng Fong learnt that she was among this
year’s National Day Awards recipients.
The National Day Awards are a means of recognising
various forms of merit and service to Singapore.
For her 30-year-long devotion to nursing, Cheng Fong
has been conferred the Efficiency Medal.
Instituted in 1969, the Efficiency
Medal may be awarded to any of the
following persons for exceptional
efficiency or exceptional devotion to
duty or for work of special significance:
• any public officer;
• any officer employed by any statutory
authority (other than a Town Council);
• any person in the service of any
organisation, association or body
rendering services in the field of
education; or
• any person employed in any company
which is wholly-owned by the
Government and which is carrying
on business mainly as an agent or
instrumentality of the Government.
With her years in nursing, Cheng Fong
has tended to countless patients and
touched the hearts of many. She believes
that a crucial ability of a nurse is
interpersonal interaction with patients.
Creating bonds and forming
relationships with patients enables
her to understand their feelings better
and hence help them soothe their
sufferings through effective ways apart
from medical attention. A model nurse
extends a helping hand or listening ear
to all patients whenever possible.
When asked what challenges nurses
face in today’s society, she said,
“Patients’ expectations are different
now compared to the past. They are
now smarter and more knowledgeable
thanks to the extensive amount of
information available.”
Her advice to patients however is:
“They need to sieve through it as
well as speak to their healthcare
professionals for clarification.”
Yet for someone who has
displayed such enthusiasm
towards an arduous career path,
her reason for taking up nursing
was unexpectedly casual.
“After finishing my ‘A’ Levels, the first job
that I saw in the papers was a nursing
one. Hence, I just applied for it,” came
her straightforward reply. No motivations,
no inspirational stories. Despite the
feeble attachment, she has never looked
back since that day and is now the senior
nurse clinician of the operating theatre /
endoscopy suite at NCCS.
Cheng Fong has been with NCCS since
1999 when the centre first opened its
doors. Recounting the early days, she
cited the establishment of the Ambulatory
Treatment Unit (ATU) as one of her most
memorable experiences.
As the person who commissioned the
ATU and the Operating Theatre (OT), she
had been under intense pressure, but the
outcome was worth all her trouble. “It was
a real challenge. Getting to know people,
equipments and liaising with vendors.”
Come November, she is due to receive her
medal. But nevertheless, she will not let the
recognition swell her ego and will continue
to dutifully offer her services to her patients.
By Joshua Tan

WHERE DID YOUR
FINGERPRINTS GO?
PAGE A7
People
SALUBRIS
July / August 2009
Most of us assume that our fingerprints are
permanent and unique. One can hardly
dispute this, considering that fingerprints
have always been regarded as the most
reliable method of identification.
Hence, the government agencies
would seek your fingerprint if
you want to apply for an identity
card, or a passport. Those who are
illiterate can use their fingerprint to open
a bank account. Not only that, convicted
criminals are fingerprinted so that they can
be tracked down for any future offences.
For most of us, the fingerprint is like our
shadow. It goes with you wherever you are.
But this was not to be for an Indonesian
travelling abroad to visit his relatives.
Mr S (as he chose to remain anonymous)
turned up at a United States airport with
no fingerprints when the border security
checked him to verify his identity.
The 62-year-old was detained for four hours
as he tried to explain his predicament.
Eventually he was released when the
authorities determined that he was not a
security threat.
Where did Mr S’s fingerprints go? His
doctor, Senior Consultant Dr Tan Eng
Huat of the Department of Medical
Oncology, National Cancer Centre
Singapore, shed light on this mystery.
For more than three years, Mr S,
who was diagnosed with Metastatic
Nasopharyngeal Carcinoma, has been
on a course of orally-administered
cytotoxic drug Capecitabine. The drug,
also known as Xeloda, is commonly
used for the treatment of metastatic
breast cancer and cancers of the colon,
head and neck and stomach.
The drug spawns some dermatological
damages such as blistering on the
hand and foot in up to 40 per cent of
the patients. More severe side effects
include peeling and bleeding on palms
and soles of feet. Over time, their
fingerprints vanish.
But this does not mean that patients
should refrain from travelling abroad.
Dr Tan has a simple remedy that will
ease some of the inconveniences
they would experience with security
authorities: carry a doctor’s letter on
oneself at all times, especially when
they are travelling.
The spin-off for the whole saga however
saw Dr Tan and his colleague Dr Choo
Su Pin in the centre of a media storm
when the news was reported in the
Annals of Oncology, a monthly journal
published on behalf of the European
Society for Medical Oncology.
From Colombia to the UK and
Europe, the world’s news media
hounded the two doctors for a story
for more than a week.
By Carol Ang
PROMOTIONS
NAME
Dr Yap Swee Peng
Dr Lim Soon Thye
Dr Toh Chee Keong
Dr Tham Chee Kian
TITLE
Radiation Oncology, Acting Director,
Public & Patient Education
Deputy Head, Medical Oncology
Senior Consultant, Medical Oncology
Associate Consultant, Medical Oncology

PAGE A8
NCC Foundation RUN FOR HOPE 2009
SALUBRIS
July / August 2009
22nd November, Sunday, East Coast Park, Angsana Green
Run For Hope (RFH) is
an annual charity leisure
run organised by the NCC
Foundation in conjunction
with the Four Seasons
Group (Four Seasons Hotel
and The Regent) in benefit
of the NCC Research Fund.
The press conference for RFH’09 took place
on 25th June at The Regent and was hosted
by the following panel of speakers:
• Prof. Soo Khee Chee, Director, National Cancer
Centre Singapore
• Eugene Sng, Programme Director, NCC
Foundation
• James Lee, Chairman, Run For Hope 2009;
Finance Director, The Regent
• Devin Otto Kimble, Managing Director, Brewerkz
• Ezzy Wang, Cancer Survivor, Run For Hope
Champion
For the first time, the microbrewery restaurant
Brewerkz crafted a special “Hope Beer” to help raise
funds for cancer research at NCCS. The malty tasteful
brew was unveiled at the press conference; for every
pint of Hope Beer sold at Brewerkz restaurants in
Singapore from June to November, one dollar will go
to the NCC Research Fund.
This year’s event also witnessed another first – the endorsement of Mr Ezzy
Wang as the champion ambassador. Ezzy is a cancer survivor at NCCS; with his
sunshine personality, positive attitude and active lifestyle, Ezzy’s involvement
provides a refreshing and humanistic perspective to Run For Hope.
We look forward to seeing you at the leisure run. Do come with
your family and friends to make a collective statement to fight
cancer with a joyful and hopeful spirit. Please visit our website
for more photos, registrations and donations details:
www.runforhopesingapore.org
Editorial Advisors
Dr Kon Oi Lian
Prof Soo Khee Chee
Executive Editors
Ms Carol Ang
Ms Veronica Lee
Mr Sunny Wee
Contributing Editor
Dr Wong Nan Soon
Members, Editorial Board
Ms Audrey-Anne Oei
Ms Sharon Leow
Ms Flora Yong
Medical Editor
Dr Tan Min-Han
Members, Medical Editorial Board
Ms Lita Chew
Dr Mohd Farid
Dr Melissa Teo
Dr Teo Tze Hern
Dr Deborah Watkinson
Dr Richard Yeo
is produced with you
SALUBRIS in mind. If there are other
topics related to cancer that you would like to read about
or if you would like to provide some feedback on the
articles covered, please email to salubris@nccs.com.sg.
NATIONAL CANCER CENTRE SINGAPORE
Reg No 199801562Z
11 Hospital Drive Singapore 169610
Tel: (65) 6436 8000 Fax: (65) 6225 6283
www.nccs.com.sg