THE GIFT OF LIFE - National Cancer Centre Singapore
THE GIFT OF LIFE - National Cancer Centre Singapore THE GIFT OF LIFE - National Cancer Centre Singapore
Issue No. 19 • MICA (P) 061/10/2010 an nccs bi-monthly publication November / December 2011 ...helping readers to achieve good health Salubris is a Latin word which means healthy, in good condition (body) and wholesome. THE GIFT OF LIFE
- Page 2 and 3: Page A2 In Other Words THE GIFT OF
- Page 4 and 5: Page A4 In Focus SALUBRIS November
- Page 6 and 7: Page B2 Looking Forward SALUBRIS No
- Page 8 and 9: Page B4 Tender Care SALUBRIS Novemb
- Page 10 and 11: Page B6 往 前 看 SALUBRIS Novemb
- Page 12 and 13: Page B8 Outreach SALUBRIS November
- Page 14 and 15: Page A6 Community SALUBRIS November
- Page 16: Page A8 Community SALUBRIS November
Issue No. 19 • MICA (P) 061/10/2010<br />
an nccs bi-monthly publication<br />
November / December 2011<br />
...helping readers to achieve good health<br />
Salubris is a Latin word which means healthy, in good condition (body) and wholesome.<br />
<strong>THE</strong> <strong>GIFT</strong> <strong>OF</strong> <strong>LIFE</strong>
Page A2<br />
In Other Words<br />
<strong>THE</strong> <strong>GIFT</strong> <strong>OF</strong> <strong>LIFE</strong><br />
SALUBRIS<br />
November / December 2011<br />
At age 39, Mr Yue Keng Siang<br />
was practically at the peak<br />
of his life. He was just into<br />
the third year of his marriage<br />
and has two children, aged<br />
three and one. However, all<br />
these came crashing when<br />
he was diagnosed with liver<br />
cancer. That was in 1999.<br />
CHARISSA ENG reports.<br />
Sports and travelling are the interests<br />
of Mr Yue Keng Siang. He teaches<br />
Physical Education in a local<br />
institution and the outdoors are a part<br />
of his daily routine. To him, the greatest<br />
takeaway from sports is how it hones<br />
his fighting spirit. And, indeed, little<br />
did he realise that someday this spirit<br />
would be called into play when he was<br />
unexpectedly diagnosed with liver cancer<br />
at the prime of his life.<br />
Back in 1999, he was bringing his young<br />
daughter for her screening at Queenstown<br />
Polyclinic. While waiting, he decided on<br />
a whim to go for a blood test. Doctors<br />
had been nagging Mr Yue’s family to<br />
go for screenings since his mother was<br />
diagnosed with liver cirrhosis. He had<br />
been pushing it to the back of his mind,<br />
but this time he thought he might as well<br />
take the opportunity to go for a test. After<br />
all, he was already at the clinic. Since<br />
then, there was no turning back.<br />
He was overseas when he received the<br />
call from his doctor on his test results.<br />
When he returned from his trip, the<br />
doctor broke the news to him that he was<br />
suffering from stage one liver cancer.<br />
Mr Yue said, “At that time, I really could not believe it.<br />
I have not expected this at all. My thoughts were racing<br />
through my mind and all I could think of was the fact that<br />
I exercise regularly, I do not smoke and am not an alcoholic.<br />
How could this happen to me?”
Page A3<br />
In Other Words<br />
SALUBRIS<br />
November / December 2011<br />
It was also a shock to his family and friends. For him and his family, it was their most<br />
trying period. Just into the third year of marriage, with two young kids in tow, what would<br />
the future have in store for them now? If anything happens, what will his wife do?<br />
Not one to surrender easily, Mr Yue said, “I know I have got to face it so I started getting<br />
more positive about it.”<br />
With a chuckle, he recalled telling his wife: “At least I know this is how I may die and<br />
I can plan before I go. I just have to take it easy.”<br />
Mr Yue started his treatment shortly after. He went to various specialists to have more tests<br />
done and was advised to go for surgery to remove the cancer in his liver. He also started on six<br />
cycles of chemotherapy. The main cause of his cancer was due to Hepatitis B from his mother.<br />
Prior to that, Mr Yue had not known much about Hepatitis B and had no clue that it can lead<br />
to liver cancer. Fortunately, his cancer was detected early and it had not spread to other parts<br />
of his body. “From the day of my surgery, my lifestyle habits took a drastic change. I went<br />
on a strict diet of just vegetables and I do not take any red or white meat, with the exception<br />
of fish. I started adopting a healthy lifestyle like cutting down on my intake of fried food,” he<br />
said. “After the cancer cells were destroyed, I quickly went into remission.”<br />
“Six years later, I suffered a relapse. I was really disappointed. I had been very disciplined in<br />
my lifestyle choices,” said Mr Yue. He went for a second surgery in 2005 and restarted the<br />
entire process of keeping healthy. Barely less than 10 months later, he suffered from a second<br />
relapse. “Doctors told me the cancer is now growing on the other side of my liver. I also had<br />
signs of liver cirrhosis and they suggested that I get a transplant. Otherwise, my cancer will<br />
just keep coming back, given that I am a Hepatitis B carrier,” he said.<br />
“I decided to opt for transplant, despite the high risk involved with the transplant surgery.<br />
It was a chance for me to lead a ‘normal’ life,” said Mr Yue.<br />
He was glad to be in touch with a few patients to share with one another their<br />
experiences, to offer support and to learn more on liver cancer and the process of<br />
transplant itself. He explained, “The sharing sessions helped me a lot back then. My wife<br />
was reluctant for me to undergo the surgery as she was worried for me. At the sharing<br />
sessions, I became better-informed about liver transplant and its risks and it made me<br />
more confident to want to go for it.”<br />
“If there was a support group back then, it would have been very helpful. Fellow patients<br />
can meet and share experiences and offer one another some moral support. In times like this,<br />
knowing somebody who understands what you are going through can make a big difference<br />
to accepting the disease,” he explained. After an eight-month wait, a match from a donor was<br />
found and he underwent a liver transplant.<br />
Today, 11 years on after the first surgery, Mr Yue is a refreshed man. He said,<br />
“If you look at me today, you would not know that I have had cancer. Life is certainly<br />
different now as it is no longer so uncertain like in the past. I am a lucky man. I<br />
discovered my cancer early and I got a match for my liver. I also had an understanding<br />
superior who understands my need to go for treatment and checkups in the early stage.”<br />
In fact, Mr Yue feels so much better after<br />
the transplant that he is back to doing<br />
the things he loves. Just last month,<br />
he took part in the World Transplant<br />
Day in Sweden. This international<br />
event had a sporting element where<br />
transplant patients all over the world<br />
come together to compete in various<br />
sports. He was there competing in table<br />
tennis, track and field, and badminton<br />
and even won a silver medal in the<br />
badminton doubles event.<br />
On how cancer has changed his<br />
perspective on life, he said, “When you<br />
have cancer, your mindset and attitude<br />
towards it are very important. I faced a lot<br />
of things when I had cancer but when I<br />
began to accept the illness, I start to take<br />
it as part of my learning process.”<br />
“I am so grateful to be<br />
given the gift of life,<br />
I will really treasure<br />
this. I think in life, we<br />
should take it easy<br />
and not neglect the<br />
ones important to us.<br />
I nearly missed the<br />
chance to be able to<br />
spend time with my<br />
family. Now all I want<br />
is to spend more time<br />
with them.”
Page A4<br />
In Focus<br />
SALUBRIS<br />
November / December 2011<br />
IT’S <strong>THE</strong> SEASON TO BE MERRY:<br />
PLAYING SANTA CLAUS TO<br />
PATIENTS’ CHILDREN<br />
For the past seven years, come year end and<br />
the Department of Medical Oncology (DMO) in<br />
NCCS will be buzzing with activities that are<br />
not quite related to their clinical responsibilities.<br />
It is the time when staffs are reined in to do their<br />
bit to bring joy to the children of cancer patients.<br />
CHARISSA ENG finds out what is in store for this<br />
year’s festive season.<br />
It is as early as September when<br />
preparation for the year-end festive<br />
season will begin for the staff of<br />
DMO as part of their annual community<br />
project. The work begins with raising<br />
funds to buy presents for children of<br />
cancer patients in the spirit of Christmas.<br />
A few of these children are themselves<br />
suffering from cancer.<br />
A/Prof Koo Wen Hsin, Deputy Director<br />
of NCCS, first thought of this initiative<br />
in 2004. He felt that the patients need<br />
more than just medication to help them<br />
in their recovery. Equally important is<br />
the patients’ psychological health. They<br />
need moral support from their family,<br />
friends and the community. And, what<br />
better time to provide this support than<br />
by showing the patients that they are not<br />
forgotten amid all the hustle and bustle<br />
at the year’s end?<br />
From then on, DMO has been continuing<br />
the project and never looked back.<br />
Department secretary Ms Ang Hui Lan,<br />
who was involved since its onset in 2004<br />
explained that the project was divided<br />
into a few stages, namely, the fund<br />
raising, recruiting of volunteers, shopping<br />
for presents and later, the gift wrapping<br />
and distribution to the children.<br />
Good team work helped as everyone<br />
chipped in to volunteer their services<br />
including driving to various locations in<br />
the heartlands to distribute the gifts.<br />
A/Prof Koo even roped in his friend, an<br />
insurance agent, to mobilise his fellow<br />
agents to help out.<br />
This year hopefully, the workload may be<br />
lighter as a church group from the Church<br />
of the Holy Family has offered to collaborate<br />
with the DMO. The group spokesperson<br />
said, “We believe in the importance of the<br />
work of NCCS and it seems to us that some<br />
of its patients face some of the sternest<br />
challenges life can throw at one – especially<br />
those who are also labouring under the<br />
financial burden that the costs of cancer<br />
treatment can present.”<br />
“We feel that their children should<br />
not be forgotten at this time, and<br />
we want to share with them some of<br />
the joy and hope of the Christmas<br />
season, and to remind them that<br />
there is light even in the dark<br />
periods of our lives. We got in touch<br />
with a medical social worker from<br />
NCCS and are now working on this<br />
project for Christmas 2011.”<br />
The church group is raising funds to buy<br />
the gifts for the children. They hope to<br />
raise about $1500 so that 30 children can<br />
smile during the festive season. The DMO<br />
will support them by playing Santa Claus<br />
wherever needed, to bring the Christmas<br />
mood to the children.<br />
From past year’s experience, the children<br />
have mostly very simple wishes, such<br />
as new school shoes and socks, book<br />
vouchers, bicycles, toys etc. To expedite<br />
shopping and delivery, the volunteers will<br />
be divided into three teams – one team<br />
to do the shopping, another team to wrap<br />
and label the presents and the third to<br />
deliver the presents.<br />
For Ms Ang and her colleagues, seeing the<br />
smiles on the young children is the best thing<br />
they have gained from being involved. She<br />
said, “It made the whole process very worth it.<br />
We probably caught lots of children by surprise<br />
that when we talked to them, some of them<br />
even muttered ‘Santa Claus, Santa Claus’.”<br />
Ms Ang hopes that everyone who has<br />
participated will enjoy the process and<br />
see for themselves how their role has<br />
helped and benefited the children. Her<br />
Christmas wish this year is for the project<br />
to keep moving ahead… ho, ho, ho!
GYNaeCOLOGICaL <strong>Cancer</strong>s:<br />
TreatmeNT and ScreeNING II<br />
Page B1<br />
Looking Forward<br />
SALUBRIS<br />
November / December 2011<br />
<strong>Cancer</strong> of the Uterus<br />
Commonly referred to as cancer of the uterine lining<br />
also known as endometrial cancer, it is now the most<br />
common gynaecological cancer affecting <strong>Singapore</strong><br />
women, especially postmenopausal women in their<br />
50s and 60s. In KK Gynaecological <strong>Cancer</strong> <strong>Centre</strong>,<br />
we see an average of 180 new cases per year and the<br />
incidence is increasing.<br />
By Dr Chia Yin Nin<br />
Head & Consultant,<br />
Gynaecological <strong>Cancer</strong> Unit,<br />
KK Women’s and Children’s Hospital<br />
Adjunct Assistant Professor,<br />
Duke’s Medical School, <strong>Singapore</strong><br />
Visiting Consultant,<br />
<strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> <strong>Singapore</strong><br />
The exact cause of this cancer is unknown. However, certain women are at higher risk<br />
than others:<br />
• Obese or overweight women<br />
• Women who never have children or have few children<br />
• Women who are sub-fertile<br />
• Women who started menses early and started menopause late<br />
• Women who have diabetes, high cholesterol or high blood pressure<br />
• Women with a history of irregular menses or have polycystic ovarian syndrome<br />
• Women with a strong family history of cancer of the uterus or cancer of the colon or<br />
known family history of LYNCH II syndrome<br />
• Breast cancer patients on Tamoxifen therapy<br />
The majority (80%) of cases present early with some form of abnormal bleeding:<br />
• Bleeding after menopause<br />
• Bleeding in between menses<br />
• Prolonged spotting after menses<br />
Anyone with the above symptoms should seek medical<br />
attention. The initial evaluation includes an ultrasound scan<br />
and endometrial biopsy (usually a D&C). Once the cancer is<br />
confirmed, the definitive treatment is a staging surgery<br />
(to assess the extent/spread of the cancer) and removal of<br />
the uterus. More advanced cancers may require additional<br />
treatment like radiotherapy, hormonal therapy and<br />
chemotherapy after the initial surgery.<br />
As the majority of cases present early in<br />
stages, the overall outlook for endometrial<br />
cancer is good with five year survival of<br />
approximately 80 percent.<br />
One can prevent endometrial cancer by<br />
having more children, by ensuring regular<br />
menses and by keeping an ideal body<br />
weight through a healthy diet and regular<br />
exercise. Prolonged usage of Combined<br />
Contraceptive Pill (COCs) and medicated<br />
IUD called Mirena can also reduce one’s<br />
risk of endometrial cancer.<br />
There is no effective screening tool<br />
for endometrial cancer. Screening is<br />
often deemed not cost effective as<br />
majority of the cases present early and<br />
can be relatively easily treated with<br />
good outcome.<br />
Continued on page B2.
Page B2<br />
Looking Forward<br />
SALUBRIS<br />
November / December 2011<br />
Gynaecological <strong>Cancer</strong>s:<br />
Treatment and Screening II<br />
Continued from page B1.<br />
Ovarian cancer is often referred to as a silent killer. In the early stages, there are<br />
often no symptoms. By the time symptoms arise, the cancer is often in the advanced<br />
stages. Furthermore, symptoms of ovarian cancers are often vague and are often<br />
confused with gastritis, gallbladder disease or colorectal conditions.<br />
Common symptoms include:<br />
• Abdominal bloatedness and distension<br />
• Indigestion or ‘wind’<br />
• Sensation of fullness after a meal<br />
• Palpable abdominal mass<br />
• Urinary symptoms e.g. frequency of urination<br />
• Bowel symptoms e.g. constipation<br />
• Unilateral leg swelling<br />
It is hence important that women around the perimenopausal age group do not<br />
ignore such symptoms. If unsure, do seek medical advice early.<br />
<strong>Cancer</strong> of the Ovary<br />
Ovarian <strong>Cancer</strong>, though less common compared<br />
to endometrial cancer, is the most deadly.<br />
The majority of cases present late in advanced<br />
stages. In <strong>Singapore</strong>, the incidence rate is<br />
about 15.2 per 100,000 per year. It mostly<br />
affects women aged between 40 and 60.<br />
In KK Gynaecological <strong>Cancer</strong> <strong>Centre</strong>, we see<br />
an average of 120 new cases per year.<br />
Again, like endometrial cancer, the exact cause<br />
of it is unknown. Certain women are, however,<br />
at higher risk than others:<br />
• Women who never have any children<br />
• Women who are sub-fertile<br />
• Women who started menses early and<br />
started menopause late<br />
• Women with a strong family history of<br />
breast and/or ovarian cancer or known<br />
family history of BRCA syndrome or<br />
LYNCH II syndrome<br />
Once ovarian cancer is suspected, the patient will be referred to a gynaecologic<br />
oncologist or medical oncologist and further investigations will be done. These<br />
often include CT scans and/or ultrasound scans to look for tumour growth(s) in the<br />
ovary(ies) and a blood test called ovarian tumour markers e.g. CA 125. The results of<br />
the investigations will indicate to the doctor the likelihood of the growth in the ovary<br />
becoming cancerous or not. Finally, surgery has to be done to remove the growth<br />
to confirm the diagnosis of cancer. Once cancer is confirmed, surgical staging (to<br />
determine the spread/extent of the cancer) is carried out at the same setting. If the<br />
cancer is found to be advanced at the time of surgery, attempts will be made to<br />
remove as much cancer as possible at the same setting. Occasionally, if the cancer<br />
is deemed too advanced, chemotherapy may be given first prior to surgery. Except<br />
for very early stage ovarian cancers, almost all ovarian cancers have to be treated<br />
with a two-pronged approach: A combination of surgery and chemotherapy.<br />
The outlook for ovarian cancer depends on the stage in which the cancer is at.<br />
Overall, the outlook is poor with five year survival of about an average of 50% as<br />
the majority of cases present late in advanced stages.<br />
At present, there is no effective screening tool for ovarian cancer. Neither routine<br />
ultrasound scan nor ovarian tumour markers blood tests are specific enough to<br />
detect ovarian cancer early.<br />
Ovarian cancer can be prevented by taking the COCs. Prolonged usage over three to<br />
five years can halve one’s risk of ovarian cancer. Alternatively, having more children<br />
and breast feeding can also help lower one’s risk.<br />
Gynaecological cancers are common. Cervical cancer can be prevented by<br />
vaccination and Pap smear screening. Although endometrial cancer cannot be<br />
prevented effectively and screened, it often presents with abnormal bleeding<br />
early. Hence, it is important not to ignore these early warning signs and to seek<br />
medical attention early. Ovarian cancer remains a silent killer, so be aware<br />
of the vague symptoms of presentation. Do seek medical attention if unsure.<br />
Taking the COCs can reduce one’s risk of ovarian and endometrial cancers.
Hormone Replacement<br />
Therapy and <strong>Cancer</strong><br />
Page B3<br />
Tender Care<br />
SALUBRIS<br />
November / December 2011<br />
Introduction<br />
to Hormone<br />
Replacement Therapy<br />
Hormone Replacement Therapy (HRT)<br />
can be prescribed in various<br />
combinations and schedules. It can be<br />
prescribed as either unopposed estrogen,<br />
known as Estrogen Replacement Therapy<br />
(ERT) or combined with progestogen,<br />
known as Combined HRT. There are<br />
various ways of administering oral HRT,<br />
ranging from cyclical to continuous.<br />
HRT was first introduced in the 1940s<br />
to treat menopausal symptoms.<br />
It was portrayed to be the “cure all”<br />
for symptoms such as hot flushes,<br />
insomnia, mood swings and night<br />
sweats experienced by postmenopausal<br />
women due to estrogen deficiency.<br />
Other promises of HRT include cardio<br />
protective effects and the improvement<br />
of bone health.<br />
In the 1970s, it was reported that the use<br />
of ERT in postmenopausal women with<br />
an intact uterus resulted in significantly<br />
higher rates of endometrial cancer. This was<br />
subsequently overcome when progestogen<br />
was used in combination with estrogen in<br />
this group of women.<br />
To date, HRT remains the most<br />
effective in treating symptoms<br />
due to menopause. It is currently<br />
approved for the treatment of<br />
moderate-to-severe vasomotor<br />
symptoms and the prevention<br />
of osteoporosis.<br />
There are potential side effects with<br />
HRT. They include breast tenderness,<br />
cramping, fluid retention and blood clots<br />
(thrombosis) in veins or lungs. However,<br />
probably the most controversial and of<br />
concern would be the association of HRT<br />
use with cancer.<br />
Evidence from Literature<br />
Breast <strong>Cancer</strong><br />
Based on evidence from published literature such as Collaborative Study 1 , the Women’s<br />
Health Initiative (WHI) 2-3 and the Million Women Study (MWS) 4 , causality between HRT<br />
and breast cancer has been established.<br />
(1) Collaborative Study<br />
Recent but not past use of HRT, as well as the duration of HRT usage, is a risk factor for<br />
breast cancer and risk is reduced upon discontinuation of therapy. There is an increased<br />
risk of breast cancer by 2.3 percent with each additional year of HRT use.<br />
(2) WHI<br />
This was a landmark randomised and placebo-controlled trial to ascertain HRT use in the<br />
prevention of heart disease and breast cancer in postmenopausal women. In 2002, the WHI<br />
study was terminated early due to increasing rates of heart disease 5 and breast cancer.<br />
Event<br />
Increase in number of cases for every<br />
10,000 women receiving HRT yearly<br />
Breast <strong>Cancer</strong> 8<br />
Dementia (>65 years) 23<br />
Heart Attacks 8<br />
Strokes 8<br />
Venous Thrombolic Events 18<br />
The increased risk of breast cancer was evident at the second year of HRT use and its risk<br />
dissipated within two years upon discontinuation of therapy. However, no increased risk<br />
of breast cancer was reported in the ERT arm. 6<br />
Continued on page B4.
Page B4<br />
Tender Care<br />
SALUBRIS<br />
November / December 2011<br />
Hormone Replacement<br />
Therapy and <strong>Cancer</strong><br />
Continued from page B3.<br />
In the eleventh year follow-up WHI 7 study<br />
that was recently published, women who<br />
received combined HRT compared to<br />
placebo had a two-fold relative increase<br />
in mortality due to breast cancer. Hence,<br />
combined HRT was not only associated<br />
with increased risk of breast cancer but<br />
also mortality.<br />
(3) MWS<br />
This was a large prospective observational<br />
trial. In postmenopausal women taking<br />
combined HRT, their risk of breast cancer<br />
was twice of that compared to non-users<br />
of HRT. Similarly, the risk of breast cancer<br />
increases with duration of use.<br />
In summary, there is an increased<br />
risk of breast cancer with HRT use<br />
(higher with combined HRT than ERT)<br />
and risk increases with duration of<br />
HRT. Nonetheless, this increased risk<br />
would dissipate within two years upon<br />
discontinuation of therapy.<br />
Endometrial cancer<br />
Based on data from WHI and the Heart<br />
and Estrogen/Progestin Replacement<br />
Study follow up (HERS II), combined HRT<br />
has not been shown to increase risk of<br />
endometrial cancer. 2,8<br />
Ovarian cancer<br />
From a meta-analysis of observational<br />
studies 9 , the association of ovarian cancer<br />
with HRT seems to be stronger in ERT<br />
users compared to combined HRT users.<br />
Risk increases with increased duration<br />
of use. Based on MWS, prolonged use of<br />
HRT increases ovarian cancer risk that is<br />
translated to four per 10,000 HRT users<br />
over five years. 10<br />
Can HRT be used in<br />
<strong>Cancer</strong> Survivors?<br />
At present, there is insufficient data to<br />
make recommendations on HRT use for<br />
cancer survivors.<br />
Despite the fact that hormones are not<br />
able to directly cause DNA damage, they<br />
are able to stimulate cell proliferation and<br />
affect tumour growth. Hence, HRT use is<br />
generally contraindicated in this group<br />
of patients.<br />
Conclusion<br />
Post-WHI era, HRT is not used for the<br />
prevention of chronic diseases such as<br />
CVD and is no longer recommended to<br />
be used to relieve menopausal symptoms<br />
in postmenopausal women. Nonetheless,<br />
the benefits of HRT may outweigh their<br />
risks when used as a short term therapy<br />
for moderate to severe vasomotor<br />
symptoms and to prevent osteoporosis<br />
in women younger than 60 years and in<br />
early menopause.<br />
Guidelines from the American Association<br />
of Clinical Endocrinologists (AACE) 11<br />
and the North American Menopause<br />
Society (NAMS) 12 concur that HRT may<br />
still be appropriate albeit for a selected<br />
group of women. In addition, the<br />
American Congress of Obstetricians and<br />
Gynecologists (ACOG) recommends that<br />
the lowest effective dose of HRT be used<br />
and for the shortest time possible to treat<br />
menopausal symptoms.<br />
Individualised patient assessment<br />
on menopausal symptoms<br />
experienced have to be conducted<br />
prior to HRT use. At the same<br />
time, patients have to be informed<br />
of associated risks versus benefits<br />
of HRT, have treatment options<br />
discussed and to undergo<br />
appropriate monitoring if HRT is<br />
being prescribed.<br />
By Vivianne Shih Lee Chuen<br />
Principal Clinical Pharmacist<br />
Oncology Pharmacy<br />
NCCS<br />
References<br />
1. Collaborative Group on Hormonal Factors in<br />
Breast <strong>Cancer</strong>. Breast cancer and hormone<br />
replacement therapy: collaborative reanalysis<br />
of data from 51 epidemiological studies of<br />
52 705 women with breast cancer and 108<br />
411 women without breast cancer.<br />
Lancet 1997;350:1047-59.<br />
2. Writing Group for the Women’s Health<br />
Initiative Investigators. Risks and benefits<br />
of estrogen plus progestin in healthy<br />
postmenopausal women. Principal<br />
results from the Women’s Health<br />
Initiative randomized controlled trial.<br />
JAMA 2002;288:321-33.<br />
3. Chlebowski RT, Hendrix SL, Langer RD et<br />
al. Influence of estrogen plus progestin on<br />
breast cancer and mammography in healthy<br />
postmenopausal women: the Women’s<br />
Health Initiative Randomized Trial.<br />
JAMA 2003;289:3243-53.<br />
4. Million Women Study Collaborators.<br />
Breast cancer and hormone replacement<br />
therapy in the Million Women Study.<br />
Lancet 2003;362:419-27.<br />
5. Manson JE, Hsia J, Johnson KC et al. Estrogen<br />
plus progestin and the risk of coronary heart<br />
disease. N Engl J Med 2003;349:523-34.<br />
6. Women’s Health Initiative Steering<br />
Committee. Effects of conjugated equine<br />
estrogen in postmenopausal women with<br />
hysterectomy: the Women’s Health<br />
Initiative randomized controlled trial.<br />
JAMA 2004;291;1701-12.<br />
7. Chlebowski RT, Anderson GL, Gass M et al.<br />
Estrogen plus progestin and breast cancer<br />
incidence and mortality in postmenopausal<br />
women. JAMA 2010;304:1684-92.<br />
8. Hulley S, Furberg C, Barrett-Connor E et<br />
al. Noncardiovascular disease outcomes<br />
during 6.8 years of hormone therapy: Heart<br />
& Estrogen / progestin Replacement Study<br />
follow-up. (HERS II). JAMA 2002;288:5866.<br />
9. Zhou B, Sun Q, Cong R et al. Hormone<br />
replacement therapy and ovarian cancer<br />
risk: a meta-analysis. Gynecol Oncol<br />
2008.;108:641-51.<br />
10. Neves-E-Castro M. An analysis of ovarian<br />
cancer in the Million Women Study. Gynecol<br />
Endocrinol 2007;23:410-3.<br />
11. Cobin RH, Futterweit W, Ginzburg SB<br />
et al. American Association of Clinical<br />
Endocrinologists medical guidelines for<br />
clinical practice for the diagnosis and<br />
treatment of menopause. Endocr Pract<br />
2006;12:315-7.<br />
12. North American Menopause Society.<br />
Estrogen and progestogen use in<br />
postmenopausal women: 2010 position<br />
statement of the North American Menopause<br />
Society. Menopause 2010;17:242-55.
妇 科 癌 症 : 治 疗 与 筛 检 II<br />
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子 宫 癌<br />
一 般 被 称 为 “ 子 宫 内 壁 癌 ” 或 “ 子 宫 内 膜 癌 ”。 它 目<br />
前 是 新 加 坡 最 常 见 的 妇 科 癌 症 , 患 者 通 常 是 50 岁 至<br />
60 岁 左 右 , 停 经 后 的 妇 女 。 在 竹 脚 妇 科 癌 症 中 心 ,<br />
每 年 平 均 有 180 起 新 病 例 , 而 且 发 病 率 不 断 提 高 。<br />
谢 燕 妮 医 生<br />
竹 脚 妇 幼 医 院 妇 科 癌 症 部 门 主 任 兼 顾 问<br />
新 加 坡 杜 克 - 国 大 医 学 研 究 院 兼 职 助 理 教 授<br />
新 加 坡 国 立 癌 症 中 心 客 卿 顾 问<br />
这 种 癌 症 的 确 切 病 因 不 明 。 不 过 , 某 些 女 性 的 患 癌 风 险 比 其 他 人 高 :<br />
• 肥 胖 或 超 重 的 女 性<br />
• 不 曾 生 育 或 育 有 较 少 孩 子 的 女 性<br />
• 患 有 不 育 症 的 女 性<br />
• 较 早 进 入 生 理 期 和 较 迟 步 入 更 年 期 的 女 性<br />
• 患 有 糖 尿 病 、 高 胆 固 醇 或 高 血 压 的 女 性<br />
• 有 月 经 失 调 或 多 囊 卵 巢 综 合 征 病 史 的 女 性<br />
• 有 子 宫 癌 或 、 大 肠 癌 或 林 奇 二 型 (LYNCH II)<br />
综 合 征 家 族 病 史 的 女 性<br />
• 接 受 泰 莫 昔 芬 (Tamoxifen) 治 疗 的 乳 癌 患 者<br />
大 多 数 病 例 (80%) 在 初 期 阶 段 会 出 现 一 些 异 常 出 血 的 情 况 :<br />
• 更 年 期 后 出 血<br />
• 月 经 间 期 出 血<br />
• 长 期 经 漏 不 止<br />
任 何 人 如 果 出 现 以 上 症 状 , 应 寻 求 治 疗 。 初 步 检 查 包 括 超 声 波 扫<br />
描 和 子 宫 内 膜 活 体 组 织 检 查 ( 一 般 采 用 子 宫 扩 张 刮 除 术 )。 一 旦<br />
确 诊 患 癌 , 最 佳 的 治 疗 方 法 是 进 行 分 期 手 术 ( 以 评 估 癌 症 的 范 围 /<br />
扩 散 程 度 ) 和 切 除 子 宫 。 晚 期 癌 症 患 者 可 能 需 要 在 进 行 手 术 后 接<br />
受 额 外 治 疗 , 如 放 射 治 疗 、 荷 尔 蒙 疗 法 和 化 疗 。<br />
( 子 宫 内 膜 癌 )<br />
由 于 大 多 数 病 例 在 初 期 阶 段 就 被 发<br />
现 , 因 此 整 体 而 言 , 子 宫 内 膜 癌 患 者 的<br />
五 年 存 活 率 高 达 80%。<br />
多 生 育 、 确 保 生 理 期 正 常 , 以 及 通 过 健<br />
康 饮 食 和 定 期 运 动 来 维 持 理 想 体 重 ,<br />
都 是 预 防 子 宫 内 膜 癌 的 方 法 。 长 期 使 用<br />
复 合 避 孕 药 (COCs) 和 一 种 称 为 “ 曼 月<br />
乐 ”(Mirena) 的 含 药 宫 内 节 育 器 , 也 可<br />
以 降 低 患 子 宫 内 膜 癌 的 风 险 。<br />
目 前 , 医 学 界 并 没 有 检 验 子 宫 内 膜 癌 的<br />
有 效 筛 检 法 。 筛 检 常 被 认 为 不 符 合 成<br />
本 效 益 , 因 为 大 多 数 病 例 能 及 早 发 现 ,<br />
而 且 比 较 容 易 治 疗 和 痊 愈 。
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妇 科 癌 症 : 治 疗 与 筛 检 II<br />
( 子 宫 ) ( 韧 带 )<br />
( 输 卵 管 )<br />
卵 巢 癌 通 常 被 称 为 “ 无 声 杀 手 ”。 初 期 阶 段 通 常 没 有 任 何 症 状 。 等 到 症 状 出 现<br />
时 , 病 情 已 进 入 晚 期 。 此 外 , 卵 巢 癌 的 症 状 非 常 模 糊 , 也 经 常 同 胃 炎 、 胆 囊 疾<br />
病 或 结 肠 直 肠 病 况 混 淆 。<br />
常 见 症 状 包 括 :<br />
• 腹 部 胀 气 和 鼓 胀<br />
• 消 化 不 良 或 胀 风<br />
• 饭 后 有 饱 足 感<br />
( 卵 巢 恶 瘤 ) ( 健 康 卵 巢 )<br />
• 腹 部 明 显 有 肿 块<br />
• 泌 尿 系 统 症 状 , 如 频 尿<br />
• 排 便 症 状 , 如 便 秘<br />
• 一 条 腿 浮 肿<br />
( 健 康 卵 巢 )<br />
( 卵 巢 肿 瘤 )<br />
因 此 , 围 绝 经 期 年 龄 层 的 女 性 千 万 不 可 忽 视 这 些 症 状 。 如 果 不 确 定 , 应 及 早 向<br />
医 生 咨 询 。<br />
卵 巢 癌<br />
虽 然 卵 巢 癌 比 子 宫 内 膜 癌 较 少 见 , 但 它 是<br />
最 致 命 的 , 因 为 大 多 数 病 例 在 晚 期 阶 段 才<br />
被 发 现 。 在 新 加 坡 , 每 年 每 10 万 人 中 , 就<br />
有 大 约 15.2 人 患 卵 巢 癌 。 多 数 患 者 是 40<br />
岁 至 60 岁 的 女 性 。 在 竹 脚 妇 科 癌 症 中 心 ,<br />
每 年 平 均 有 120 起 新 病 例 。<br />
跟 子 宫 内 膜 癌 一 样 , 卵 巢 癌 的 确 切 病 因<br />
不 明 。 不 过 , 某 些 女 性 的 患 癌 风 险 比 其 他<br />
人 高 :<br />
• 不 曾 生 育 的 女 性<br />
• 患 有 不 孕 症 的 女 性<br />
• 较 早 进 入 生 理 期 和 较 迟 步 入 更 年 期 的<br />
女 性<br />
• 有 乳 癌 及 / 或 卵 巢 癌 或 乳 腺 癌 基 因<br />
(BRCA) 综 合 征 或 林 奇 二 型 综 合 征 家 族<br />
病 史 的 女 性<br />
如 果 怀 疑 患 上 卵 巢 癌 , 病 人 将 被 转 介 给 妇 科 肿 瘤 医 生 或 肿 瘤 内 科 医 生 , 进 一 步<br />
进 行 检 验 。 这 些 检 验 包 括 电 脑 断 层 扫 描 及 / 或 超 声 波 扫 描 , 以 检 测 卵 巢 是 否 有<br />
肿 瘤 , 以 及 一 种 称 为 “ 卵 巢 肿 瘤 标 记 物 ” 的 血 液 检 查 , 如 癌 抗 原 125 (CA125)。<br />
检 验 结 果 将 能 显 示 卵 巢 的 肿 瘤 演 变 成 恶 性 肿 瘤 的 可 能 性 。 最 后 , 医 生 必 须 动 手<br />
术 切 除 肿 瘤 , 以 确 定 诊 断 。 一 旦 确 诊 患 癌 , 医 生 会 同 步 进 行 分 期 手 术 ( 以 评 估<br />
癌 症 的 范 围 / 扩 散 程 度 )。 如 果 动 手 术 时 发 现 癌 症 已 进 入 晚 期 , 医 生 会 尽 量 切 除<br />
肿 瘤 。 有 时 候 , 如 果 癌 症 已 进 入 晚 期 , 医 生 可 能 会 让 病 人 先 接 受 化 疗 , 然 后 才<br />
进 行 手 术 。 除 了 非 常 初 期 阶 段 的 卵 巢 癌 外 , 几 乎 所 有 卵 巢 癌 都 必 须 采 用 双 管 齐<br />
下 的 方 法 —— 手 术 和 化 疗 。<br />
卵 巢 癌 的 痊 愈 情 况 , 须 视 癌 症 所 处 的 阶 段 而 定 。 由 于 大 多 数 病 例 到 了 晚 期 才 被<br />
发 现 , 因 此 整 体 而 言 , 患 者 的 五 年 存 活 率 平 均 约 为 50%。<br />
目 前 , 医 学 界 并 没 有 任 何 有 效 的 卵 巢 癌 筛 检 法 。 即 使 是 接 受 例 常 的 超 声 波 扫 描<br />
或 “ 卵 巢 肿 瘤 标 记 物 ” 血 液 检 查 , 都 无 法 及 早 发 现 卵 巢 癌 。<br />
卵 巢 癌 可 以 通 过 服 用 复 合 避 孕 药 来 预 防 。 长 期 使 用 三 至 五 年 , 可 使 患 卵 巢 癌 的<br />
风 险 减 半 。 此 外 , 多 生 育 和 母 乳 喂 养 也 有 助 于 降 低 患 癌 风 险 。<br />
妇 科 癌 症 很 常 见 。 子 宫 颈 癌 可 以 通 过 注 射 疫 苗 和 子 宫 颈 抹 片 检 查<br />
法 来 预 防 。 尽 管 子 宫 内 膜 癌 无 法 有 效 预 防 或 筛 检 , 但 患 者 通 常 会<br />
在 初 期 阶 段 出 现 异 常 出 血 情 况 。 所 以 , 千 万 不 要 忽 视 这 些 早 期 的<br />
警 告 信 号 , 而 且 要 及 早 寻 求 治 疗 。 卵 巢 癌 仍 是 “ 无 声 杀 手 ”, 所 以<br />
要 注 意 一 些 模 糊 症 状 。 如 果 不 确 定 , 应 向 医 生 咨 询 。 服 用 复 合 避 孕<br />
药 , 可 降 低 患 卵 巢 癌 和 子 宫 内 膜 癌 的 风 险 。
荷 尔 蒙 替 代 疗 法 与 癌 症<br />
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荷 尔 蒙 替 代 疗 法 简 介<br />
“ 荷 尔 蒙 替 代 疗 法 ”(Hormone Replacement Therapy, 简 称 HRT) 可 根 据 不 同 的 组 合 和 时<br />
间 表 来 进 行 。 医 生 可 以 使 用 非 对 抗 性 雌 激 素 的 “ 雌 激 素 替 代 疗 法 ”(Estrogen Replacement<br />
Therapy, 简 称 ERT), 或 是 结 合 孕 激 素 的 “ 综 合 荷 尔 蒙 替 代 法 ”(Combined HRT) 来 治 疗 。<br />
口 服 荷 尔 蒙 替 代 疗 法 有 多 种 服 用 法 , 从 周 期 性 到 持 续 性 皆 有 。<br />
荷 尔 蒙 替 代 疗 法 在 1940 年 代 开 始 采 用 于 治 疗 更 年 期 症 状 。 它 被 视 为 “ 万 灵 药 ”, 可 用 来 治 疗 停<br />
经 后 女 性 因 雌 激 素 不 足 而 出 现 的 潮 热 、 失 眠 、 情 绪 波 动 和 盗 汗 等 症 状 。 荷 尔 蒙 替 代 疗 法 的 其 他<br />
宣 称 功 效 包 括 预 防 心 血 管 疾 病 和 改 善 骨 骼 健 康 。<br />
到 了 1970 年 代 , 有 报 道 指 出 , 如 果 子 宫 完 好 的 停 经 后 女 性 使 用 雌 激 素 替 代 疗 法 , 患 上 子 宫 内<br />
膜 癌 的 机 率 明 显 提 高 。 不 过 , 如 果 孕 激 素 和 雌 激 素 一 起 使 用 , 患 癌 风 险 则 会 大 幅 降 低 。<br />
到 目 前 为 止 , 荷 尔 蒙 替 代 疗 法 仍 是 治 疗 更 年 期 症 状 的 最 有 效 方 法 。 它 目 前 是 获 准 治 疗 中 度 到 重<br />
度 血 管 舒 缩 症 状 和 预 防 骨 质 疏 松 症 的 方 法 。<br />
荷 尔 蒙 替 代 疗 法 具 有 潜 在 副 作 用 , 包 括 乳 房 胀 痛 、 抽 筋 、 水 肿 , 以 及 静 脉 或 肺 部 出 现 血 块<br />
( 血 栓 症 )。 不 过 , 最 具 争 议 性 和 值 得 关 注 的 是 使 用 荷 尔 蒙 替 代 疗 法 与 癌 症 的 关 系 。<br />
研 究 报 告 的 论 据<br />
乳 癌<br />
一 些 已 发 表 的 研 究 报 告 , 如 协 作 研 究 (Collaborative Study) 1<br />
、 妇 女 健 康 倡 议 (Women’s Health Initiative, 简 称 WHI) 2-3<br />
和 百 万 妇 女 研 究 (Million Women Study, 简 称 MWS) 4<br />
的 论 据 显 示 , 荷 尔 蒙 替 代 疗 法 与 乳 癌 的 因 果 关 系 是 成 立 的 。<br />
(1) 协 作 研 究<br />
近 期 但 不 是 过 去 使 用 荷 尔 蒙 替 代 疗 法 , 以 及 使 用 的 时 间 , 是 罹 患 乳 癌 的 风 险 因 素 。 患 病 风 险 会 随 着 疗<br />
程 停 止 而 降 低 。 每 多 使 用 荷 尔 蒙 替 代 疗 法 一 年 , 患 上 乳 癌 的 风 险 就 会 增 加 2.3%。<br />
(2) 妇 女 健 康 倡 议<br />
这 是 为 了 确 定 荷 尔 蒙 替 代 疗 法 可 预 防 停 经 后 女 性 患 上 心 脏 病 和 乳 癌 , 而 展 开 的 一 项 标 志 性 随 机 安 慰<br />
剂 对 照 试 验 。 由 于 罹 患 心 脏 病<br />
5<br />
和 乳 癌 的 机 率 不 断 增 加 , 这 项 研 究 提 前 在 2002 年 终 止 。<br />
疾 病<br />
每 年 每 1 万 名 女 性 接 受 荷 尔 蒙 替 代 疗 法 的 病 例 增 幅<br />
乳 癌 8<br />
失 智 症 (65 岁 以 上 ) 23<br />
心 脏 病 8<br />
中 风 8<br />
静 脉 血 栓 事 件 18<br />
在 使 用 荷 尔 蒙 替 代 疗 法 后 的 第 二 年 , 患 上 乳 癌 的 风 险 明 显 增 加 , 但 疗 程 停 止 后 的 两 年 内 , 患 癌 风 险 将<br />
消 除 。 使 用 雌 激 素 替 代 疗 法 则 不 会 增 加 患 上 乳 癌 的 风 险 。 6<br />
近 期 发 表 的 《 妇 女 健 康 倡 议 》 第 11 年 跟 进 研 究<br />
7<br />
显 示 , 同 安 慰 剂 相 比 , 接 受 综 合 荷 尔 蒙 替 代 疗 法 的 女<br />
性 因 罹 患 乳 癌 而 死 亡 的 比 率 增 加 两 倍 。 由 此 可 见 , 综 合 荷 尔 蒙 替 代 疗 法 不 仅 跟 患 乳 癌 风 险 增 加 有 关 ,<br />
而 且 跟 死 亡 率 也 有 关 。<br />
(3) 百 万 妇 女 研 究<br />
这 是 一 项 大 规 模 预 期 性 观 测 研 究 。 使 用 综 合 荷 尔 蒙 替 代 疗 法 的 停 经 后 女 性 , 患 上 乳 癌 的 风 险 比 非 使<br />
用 者 高 出 一 倍 。 同 样 的 , 患 乳 癌 的 风 险 会 随 着 使 用 时 间 的 增 加 而 提 高 。<br />
总 的 来 说 , 使 用 荷 尔 蒙 替 代 疗 法 会 提 高 患 乳 癌 的 风 险 ( 综 合 荷 尔 蒙 替 代 疗 法 比 雌 激 素 替 代 疗 法 更 高 ),<br />
而 且 患 癌 风 险 会 随 着 荷 尔 蒙 替 代 疗 法 使 用 时 间 的 增 加 而 提 高 。 尽 管 如 此 , 疗 程 停 止 后 的 两 年 内 , 患 癌<br />
风 险 将 消 除 。<br />
子 宫 内 膜 癌<br />
根 据 妇 女 健 康 倡 议 和 心 脏 与 雌 激 素 / 孕 激<br />
素 替 代 研 究 跟 进 (Heart and Estrogen/<br />
Progestin Replacement Study follow<br />
up, 简 称 HERS II) 的 数 据 , 综 合 荷 尔 蒙 替 代<br />
疗 法 并 不 会 增 加 患 子 宫 内 膜 癌 的 风 险 。 2,8<br />
卵 巢 癌<br />
根 据 一 些 观 测 研 究<br />
9<br />
的 综 合 分 析 , 雌 激 素 替 代<br />
疗 法 使 用 者 患 上 卵 巢 癌 的 风 险 , 比 综 合 荷 尔<br />
蒙 替 代 疗 法 使 用 者 更 高 。 患 癌 风 险 也 会 随 着<br />
使 用 时 间 的 增 加 而 提 高 。 百 万 妇 女 研 究 显 示 ,<br />
长 期 使 用 荷 尔 蒙 替 代 疗 法 , 会 增 加 患 卵 巢 癌<br />
的 风 险 。 换 句 话 说 , 每 1 万 名 荷 尔 蒙 替 代 疗 法<br />
使 用 者 中 , 有 4 人 在 5 年 内 会 面 对 患 癌 风 险 。 10<br />
癌 症 幸 存 者 能 否 使 用 荷 尔 蒙 替<br />
代 疗 法 ?<br />
目 前 , 医 学 界 没 有 足 够 的 数 据 显 示 癌 症 幸 存 者 可<br />
以 使 用 荷 尔 蒙 替 代 疗 法 。 虽 然 荷 尔 蒙 不 会 直 接<br />
导 致 脱 氧 核 糖 核 酸 (DNA) 受 损 , 但 它 会 刺 激 细<br />
胞 增 生 和 影 响 癌 细 胞 生 长 。 因 此 , 这 类 病 人 一 般<br />
上 是 不 被 允 许 使 用 荷 尔 蒙 替 代 疗 法 的 。<br />
总 结<br />
妇 女 健 康 倡 议 研 究 结 束 后 , 荷 尔 蒙 替 代 疗 法 没 有<br />
被 用 来 预 防 心 血 管 疾 病 等 慢 性 疾 病 , 也 不 再 被 建<br />
议 用 来 缓 解 停 经 后 女 性 的 更 年 期 症 状 。 不 过 , 当<br />
荷 尔 蒙 替 代 疗 法 被 用 于 为 60 岁 以 下 提 早 进 入 更<br />
年 期 的 女 性 治 疗 中 度 到 重 度 血 管 舒 缩 症 状 和 预<br />
防 骨 质 疏 松 症 的 短 期 疗 程 时 , 则 利 大 于 弊 。<br />
美 国 临 床 内 分 泌 学 家 协 会 (American<br />
Association of Clinical<br />
Endocrinologists, 简 称 AACE) 11 和 北 美 更<br />
年 期 协 会 (North American Menopause<br />
Society, 简 称 NAMS) 12 的 指 导 准 则 都 认<br />
同 , 除 了 特 定 组 别 的 女 性 外 , 荷 尔 蒙 替 代 疗 法<br />
还 是 适 合 使 用 的 。 另 外 , 美 国 国 会 妇 产 科 学 会<br />
(American Congress of Obstetricians<br />
and Gynecologists, 简 称 ACOG) 也 建 议<br />
使 用 最 低 有 效 剂 量 的 荷 尔 蒙 替 代 疗 法 和 最 短 时<br />
间 , 来 治 疗 更 年 期 症 状 。<br />
在 使 用 荷 尔 蒙 替 代 疗 法 前 , 医 生 必 须 先 评 估 个<br />
别 病 人 的 更 年 期 症 状 。 与 此 同 时 , 医 生 也 必 须 告<br />
诉 病 人 有 关 荷 尔 蒙 替 代 疗 法 的 利 弊 , 以 及 跟 病<br />
人 讨 论 治 疗 选 项 。 如 果 决 定 采 用 荷 尔 蒙 替 代 疗<br />
法 , 病 人 也 必 须 接 受 适 当 监 督 。<br />
参 考 文 献 , 请 参 阅 第 B4 页<br />
以 上 文 章 由 施 丽 娟 提 供<br />
肿 瘤 药 学 首 席 临 床 药 剂 师<br />
新 加 坡 国 立 癌 症 中 心
Page B8<br />
Outreach<br />
SALUBRIS<br />
November / December 2011<br />
Upcoming Public Education<br />
activities / Programmes<br />
Event Name<br />
Date and Time<br />
Support Group: NPC (Nasopharyngeal/Nose <strong>Cancer</strong>)<br />
Managing the Side Effects of Radiotherapy and Chemotherapy<br />
Lung Supportive Care Programme<br />
Exercising Right<br />
Malay Support Group – Sinar Harapan<br />
What is This Feeling?<br />
Patient Ambassador Training<br />
Issues in Grief & Managing Emotions<br />
Look Good Feel Better (for Ladies only)<br />
Mandarin Support Group<br />
Your <strong>Cancer</strong> Journey<br />
Support Group – Grief in Recovery (for surviving spouse)<br />
Agreement between Expectations and Yearnings – Key to Satisfactory Post Loss<br />
STEER Series<br />
Brushes in action<br />
The Revival Connection (for Advanced & Recurrent <strong>Cancer</strong>s)<br />
Lunar New Year Get-Together<br />
Support Group: NPC (Nasopharyngeal/ Nose <strong>Cancer</strong>)<br />
Nutrition – Your Kitchen, Your Pharmacy<br />
Malay Support Group – Sinar Harapan<br />
A Psychological Way of Managing Your Symptoms<br />
6 January 2012, Friday<br />
7pm to 9pm<br />
Session will be conducted in English<br />
13 January 2012, Friday<br />
2.30pm to 4.30pm<br />
Session will be conducted in Mandarin<br />
14 January 2012, Saturday<br />
2.30pm to 4pm<br />
Session will be conducted in Malay<br />
21 January 2012, Saturday<br />
9am to 12pm<br />
Session will be conducted in English<br />
27 January 2012, Friday<br />
2pm to 5pm<br />
Session will be conducted in English<br />
27 January 2012, Friday<br />
6pm to 8pm<br />
Session will be conducted in Mandarin<br />
27 January 2012, Friday<br />
7pm to 9pm<br />
Session will be conducted in English<br />
4 February 2012, Saturday<br />
9.30am to 1pm<br />
Session will be conducted in English<br />
4 February 2012, Saturday<br />
1pm to 3pm<br />
Session will be conducted in English<br />
10 February 2012, Friday<br />
7pm to 9pm<br />
Session will be conducted in English<br />
11 February 2012, Saturday<br />
2.30pm to 4pm<br />
Session will be conducted in Malay<br />
Venue:<br />
Function Room, Level 4<br />
<strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> <strong>Singapore</strong><br />
To register, please call:<br />
Patient Support at 6436 8117 / 6436 8126 or <strong>Cancer</strong> helpline at 6225 5655<br />
Mon – Fri: 8.30am – 5.30pm
From asPIrING F1 racer<br />
TO LIFe-savING surgeON<br />
Page A5<br />
People<br />
SALUBRIS<br />
November / December 2011<br />
Many people would agree that the job of a Formula One racer is<br />
possibly one of the most exacting jobs in the world. After all, not<br />
many jobs would give you that kind of high-speed thrill and spill<br />
of racing at neck-breaking speeds in the full view of glamorous TV<br />
cameras broadcast worldwide. This is not to mention, the paycheck<br />
that goes with the job.<br />
Hence in his early days, a young Lee Ser Yee had thought of getting<br />
himself in the F-1 driver’s seat. But his hopes were dashed after learning<br />
that the training and equipment would cost a big money chest.<br />
Spurred on by his inclination for Science, love for helping people<br />
and doing things with his hands, he turned to his next passion to<br />
become a surgeon.<br />
Dr Lee Ser Yee (left) receiving the<br />
Young Surgeon’s Award.<br />
Today, Dr Lee Ser Yee, a consultant with the <strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong><br />
<strong>Singapore</strong>, is pleased with that choice. His passion for his work has been<br />
rewarded by his receiving of the Young Surgeon’s Award from the College of<br />
Surgeons of the Academy of Medicine, <strong>Singapore</strong>.<br />
After graduating from medical school, Dr Lee chose to become a cancer surgeon<br />
because it combines two of his interests – surgery and oncology. Most importantly,<br />
cancer is one of the leading causes of death in <strong>Singapore</strong>. To him, it is immensely<br />
satisfying to be part of a team of specialists to combat this killer disease. No<br />
amount of glamour and thrills from speeding on a race track can grant him as much<br />
satisfaction as saving lives.<br />
“Having cancer is not necessarily a death sentence. There have<br />
been improvements in the treatment of cancer and one can still<br />
lead a fulfilling life after appropriate treatment. More importantly,<br />
patients have a dedicated team of cancer specialists and<br />
paramedical staff who are here to walk with them every step of<br />
the way on their journey to recovery,” he said.<br />
The complexity of surgery thrills Dr Lee. Challenging as it is, it also demands a<br />
good knowledge of anatomy, innovation and hours of training and practice to be<br />
competent. “It is immensely satisfying because you can literally put your hands on<br />
the problem to deal with it and in some situations, it is the definitive treatment for<br />
the patient,” he added.<br />
During his apprenticeship, Dr Lee had the privilege to train under many<br />
accomplished surgeons. One of them is Director of NCCS, Prof Soo Khee Chee.<br />
Dr Lee is full of praise for his mentor. “Prof Soo is tireless in his efforts to help<br />
patients, raise standards of healthcare and medical research in <strong>Singapore</strong>, as well<br />
as to impart skills and knowledge to younger surgeons like myself. He has been<br />
tremendously inspiring to work with.”<br />
Besides spending hours in the operating<br />
theatres, he also initiated the first-ever Liver<br />
<strong>Cancer</strong> Support Group in <strong>Singapore</strong> with<br />
the help of his co-chair, Dr Chan Chung Yip,<br />
Consultant of the <strong>Singapore</strong> General Hospital.<br />
The support group was launched during the<br />
Liver <strong>Cancer</strong> Awareness Month event held at<br />
IMM Garden Plaza in September.<br />
He initiated this support group after being<br />
approached by many patients enquiring about<br />
the availability of a support group for liver cancer<br />
patients. Realising the importance and need<br />
of having a support group to help patients and<br />
caregivers during and after their cancer journey,<br />
Dr Lee escalated his idea to his seniors and<br />
fellow colleagues, who were very supportive of it.<br />
“I hope that this group provides a platform<br />
for liver cancer patients to come together<br />
and share their stories. Through this, they<br />
will be able to better prepare themselves for<br />
the treatment that lies ahead, and the kind of<br />
changes they may expect.<br />
I also hope that through this support group, we<br />
can help dispel myths about liver cancer and its<br />
treatments. Most importantly, our liver cancer<br />
survivors are able to impart hope to newly<br />
diagnosed liver cancer patients,” said Dr Lee.<br />
By Mark Ko
Page A6<br />
Community<br />
SALUBRIS<br />
November / December 2011<br />
PRUDENTIAL GOLF CHARITY<br />
RAISES $250,000 FOR NCC<br />
RESEARCH FUND<br />
A day of sporting<br />
fun in aid of<br />
cancer research<br />
More than a hundred<br />
warm-hearted partners<br />
and business associates of<br />
Prudential <strong>Singapore</strong> were<br />
greeted with beautiful<br />
weather on 27 September<br />
as they teed-off and golfed<br />
for the cancer cause,<br />
raising $250,000 in aid of<br />
the NCC Research Fund.<br />
Guest-of-Honour Prof Tan Ser Kiat, Group CEO of SingHealth and Board member of NCC<br />
Research Fund, receiving the cheque from CEO of Prudential <strong>Singapore</strong>, Kevin Holmgren.<br />
This was part of Prudential<br />
<strong>Singapore</strong>’s 80th anniversary<br />
celebrations this year, which<br />
revolves around giving back to the<br />
community. “With this gesture, we hope<br />
to help NCCS’ efforts in the development<br />
of cancer treatment methods,” said Kevin<br />
Holmgren, Chief Executive Officer of<br />
Prudential <strong>Singapore</strong>.<br />
The day of golfing excitement showcased<br />
the skills of participants and culminated<br />
in an elegant dinner that featured an array<br />
of attractive prizes. Guest-of-Honour<br />
Professor Tan Ser Kiat, Group CEO<br />
of SingHealth, who is also a Board<br />
member of the NCC Research Fund,<br />
received the cheque and presented<br />
tournament prizes and tokens of<br />
appreciation to the participants.<br />
From left: Patrick Teow, Chief Distribution Officer of Prudential <strong>Singapore</strong>, Prof Tan Ser Kiat,<br />
Group CEO of SingHealth and Board member of NCC Research Fund, Benny Tay, Organising<br />
Chairman of Prudential Golf Charity, A/Prof Koo Wen Hsin, NCCS Deputy Director.
Page A7<br />
Community<br />
SALUBRIS<br />
November / December 2011<br />
Golfing action and bonding.<br />
Dr Tan Hiang Khoon, Director for Division<br />
of Community Outreach and Philanthropy<br />
at NCCS.<br />
Thanking Prudential <strong>Singapore</strong>,<br />
the organising committee<br />
initiated by Agency Force<br />
Alliance (a group of Prudential<br />
<strong>Singapore</strong>’s Agency Leaders),<br />
sponsors, donors and<br />
participants at the dinner for<br />
their big-hearted support,<br />
Director for Division of<br />
Community Outreach and<br />
Philanthropy at NCCS,<br />
Dr Tan Hiang Khoon said,<br />
“Donating to research can be<br />
likened to buying insurance;<br />
investing for the future. At times,<br />
the returns (in research) are<br />
received sooner than expected,<br />
benefiting or protecting you<br />
and your loved ones.”<br />
Organisations who would like to<br />
support the cancer cause through such<br />
corporate events are welcome to contact<br />
the NCCS Community Partnership at<br />
CommunityPartnership@nccs.com.sg.<br />
We will be pleased to work with you.<br />
By Adeline Teo<br />
Division of Community Outreach<br />
& Philanthropy<br />
NCCS
Page A8<br />
Community<br />
SALUBRIS<br />
November / December 2011<br />
Fun way to raising<br />
awareness on liver canceR<br />
Raising awareness on<br />
liver cancer is no easy<br />
task. This is especially<br />
when there are so many<br />
competing activities in<br />
September, from the<br />
lantern festival to the F-1.<br />
But the decision to create awareness<br />
the fun way for this year’s 4th Liver<br />
<strong>Cancer</strong> Awareness Month (LiCAM)<br />
proved to be a success. Held on 17 Sept<br />
at the IMM Garden Plaza, the day-long fun<br />
and games, and on-stage entertainment drew<br />
a steady crowd. At the close of the day, an<br />
estimated 500 people turned up at the event.<br />
Jointly organised by the <strong>National</strong> <strong>Cancer</strong><br />
<strong>Centre</strong> <strong>Singapore</strong> (NCCS) and the <strong>Singapore</strong><br />
General Hospital (SGH), the event attracted<br />
families with young children in tow as well<br />
as weekend shoppers who joined in the<br />
activities with a number of them walking<br />
home with prizes from the lucky draws.<br />
“We did a public exhibition this year,<br />
wanting to approach public education and<br />
raise awareness in a different way, rather<br />
than just by didactic lectures alone,” said<br />
Dr Tan Hui Hui, co-chairperson for the<br />
LiCAM committee and Consultant with SGH.<br />
The other co-chairman is Dr Chan Chung<br />
Yip, who is also a Consultant with SGH.<br />
The draw for the children was the<br />
colouring contest, balloon sculpting<br />
and magic show. The adults signed<br />
up for the quiz and those who could<br />
answer a list of written questions<br />
correctly went home with a goodie<br />
bag each. To answer the questions,<br />
they had to view the exhibition of<br />
informational posters and learn<br />
about liver cancer. To entertain the<br />
crowd, there was a traditional Indian<br />
dance by the Jurong Jewels, and<br />
singing performances by a number<br />
of cancer survivors.<br />
To add a dash of colour, young children<br />
could pose in a surgeon’s scrub against<br />
a backdrop of an operating theatre.<br />
And it was all for free.<br />
The key highlight of the event was the<br />
launch of the first Liver <strong>Cancer</strong> Support<br />
Group by Dr Lee Ser Yee, Associate<br />
Consultant from NCCS and Chairman<br />
of the Liver <strong>Cancer</strong> Support Group.<br />
The group will help patients and their loved<br />
ones cope with their condition before, during<br />
and after treatment. Members can also use<br />
this platform to share their experiences and<br />
journey together with their family.<br />
“With this support group, we hope to<br />
provide our patients and their families<br />
with additional resource for the best care.<br />
Patients and their loved ones can use this<br />
opportunity to speak to other patients to<br />
understand the treatment process as well as<br />
their journey to recovery,” said Dr Lee.<br />
Among the upcoming events and activities<br />
include creating a Facebook page where<br />
patients can access more information<br />
and a Christmas party at the end of this<br />
year. The pioneers in the group include<br />
survivors Messrs Judson Guo Ji Quan,<br />
Jumaat bin Zahari, Yue Keng Siang and<br />
Zulkifli bin Samsuri.<br />
By Mark Ko<br />
Editorial Advisors<br />
Prof Kon Oi Lian<br />
Prof Soo Khee Chee<br />
Executive Editors<br />
Ms Charissa Eng<br />
Ms Veronica Lee<br />
Mr Sunny Wee<br />
Contributing Editor<br />
Dr Wong Nan Soon<br />
Members, Editorial Board<br />
Mr Mark Ko<br />
Ms Sharon Leow<br />
Dr Shiva Sarraf-Yazdi<br />
Ms Jenna Teo<br />
Medical Editor<br />
Dr Richard Yeo<br />
Members, Medical Editorial Board<br />
Ms Lita Chew<br />
Dr Mohd Farid<br />
Dr Melissa Teo<br />
Dr Teo Tze Hern<br />
Dr Deborah Watkinson<br />
is produced with you<br />
Salubris in mind. If there are other<br />
topics related to cancer that you would like to read about<br />
or if you would like to provide some feedback on the<br />
articles covered, please email to salubris@nccs.com.sg.<br />
<strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> <strong>Singapore</strong><br />
Reg No 199801562Z<br />
11 Hospital Drive <strong>Singapore</strong> 169610<br />
Tel: (65) 6436 8000 Fax: (65) 6225 6283<br />
www.nccs.com.sg