The Parkway Oncology Programme also has a panel of surgical oncologists, who work closely with the Centre to co-manage the cases in a comprehensive and integrated manner. These specialists offer advanced surgical methods including radical surgery, conservative surgery, minimal surgery, and reconstructive surgery in the various sub-specialty areas such as:

• Breast surgery
• Colorectal surgery
• Thoracic surgery
• Head and Neck surgery
• Gynaecological surgery
• Neurosurgery
• Orthopaedic surgery
• Gastrointestinal and Hepatic surgery
• Reconstructive surgery
• General surgery

Dr Anselm Chi-Wai Lee

Consultant - Paediatric Haemato-oncology

Dr Anselm Lee helped establish the paediatric bone marrow transplantation (BMT) programme in the Queen Mary Hospital, Hong Kong. He performed the first BMT for thalassaemia. In 1994, Dr Lee performed the first case of umbilical cord blood transplantation in Hong Kong. In 1995, Dr Lee moved to Tuen Mun Hospital and successfully restructured its paediatric haematology and oncology service.

A graduate of the University of Hong Kong, Dr Anselm Lee received his postgraduate training in the Department of Paediatrics in Queen Mary Hospital. His sub-specialisation in paediatric haematology and oncology started in 1990. As a Croucher Foundation Fellow, Dr Lee trained in paediatric oncology and bone marrow transplantation (BMT) in the Institute of Child Health, Department of Haematology and Oncology at the Great Ormond Street Children’s Hospital, London.

Dr Lee was the Chairman of the Hong Kong Paediatric Haematology & Oncology Study Group. He is also a member of the International Society of Paediatric Oncology and the Children's Cancer and Leukaemia Group (UK), as well as a Fellow of the Royal College of Paediatrics & Child Health (UK), the Academy of Medicine (Singapore), the Hong Kong Academy of Medicine and the Hong Kong College of Paediatricians.

Address and Contact Details

6A Napier Road
Gleneagles Hospital Level 1
Radiation Oncology Centre
Singapore 258500

Tel: (65) 6470-5830

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Dr Kok Jaan Yang

Consultant - Palliative Medicine

Before joining Parkway Cancer Centre, Dr Kok was a Consultant in Dover Park Hospice, and a Visiting Consultant in the Department of Haematology-Oncology, National University Hospital. Dr Kok graduated with a Bachelor of Medicine and a Bachelor of Surgery in Singapore. He was subsequently awarded the Master of Medicine in Family Medicine (Singapore), and the Postgraduate Diploma of Palliative Medicine (Cardiff, UK). In 2004-05, under the Ministry of Health’s HMDP programme, Dr Kok spent a year in advanced training in Palliative Medicine in Melbourne, Australia.

Dr Kok has extensive experience in palliative care, being one of the pioneer members of the Palliative Medicine Subspecialty Training Committee, appointed by the Specialists Accreditation Board, Ministry of Health (Singapore), to oversee the training of Palliative Medicine Specialists in Singapore.

He is also a Clinical Tutor with the Yong Loo Lin School of Medicine, National University of Singapore, and is actively involved in undergraduate and postgraduate medical and nursing training in palliative care. He was the immediate past Chairman of the Training & Research Committee, Singapore Hospice Council, and the Chairman of the Organising Committee of the Singapore Palliative Care Conference 2008.

Address and Contact Details

6A Napier Road
Gleneagles Hospital #01-35
Singapore 258500

Tel: (65) 6472-2662

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Dr Ang Peng Tiam

Medical Director and Senior Consultant - Medical Oncology

Dr Ang Peng Tiam graduated from the National University of Singapore (NUS) with Bachelors in Medicine and Surgery in 1982. He did his residency in Internal Medicine, and was conferred the Master of Medicine (Internal Medicine) in 1986. He completed his Fellowship in Medical Oncology at MD Anderson Cancer Centre, Houston, Texas and Stanford University Medical Centre in 1989.

Dr Ang was awarded the Singapore President’s Scholarship in 1977. He was awarded the Prof Sir Gordon Arthur Ransome Gold medal for being the top candidate in the Master of Medicine Clinical Examinations in 1986, and Singapore’s National Science Award in 1996 for his outstanding contributions in medical research. In recognition of his public service, the Sultan of Kedah conferred upon him a datukship in 2003. Dr Ang was the founding Head of the Department of Medical Oncology at Singapore General Hospital from 1991 to 1997. He held the concurrent post of Director of the Oncology Centre and Clinical Associate Professor at the Faculty of Medicine, NUS. He remains a Visiting Consultant at National Cancer Centre. He is the Vice Chairman of Singapore Cancer Society, Chairman of the Medical Advisory Committee of Breast Cancer Foundation.

He was a past President of Singapore Society of Oncology. He maintains a keen interest in research, and has published and presented more than a hundred papers and abstracts to date.

Address and Contact Details

3 Mount Elizabeth
Mount Elizabeth Hospital Level 2
Singapore 228510

Tel: (65) 6737-0733

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Dr Khoo Kei Siong

Deputy Medical Director and Senior Consultant - Medical Oncology

Dr Khoo Kei Siong presently serves as the Vice President in the Council of the College of Physicians, Singapore. He also sits on the Medicine Advisory Committee, and the Medical Clinical Research Committee in the Ministry of Health.

Before moving to his current practice, Dr Khoo was a Senior Consultant and the Head of Department of Medical Oncology at the National Cancer Centre (NCC). He was the founding Director of the Division of Clinical Trials and Epidemiological Sciences, and was instrumental in setting up the clinical trials capabilities in NCC.

Dr Khoo graduated from the National University of Singapore and received his training in Internal Medicine and Medical Oncology at the Singapore General Hospital. He was awarded the Singapore Government HMDP fellowship in 1993 to pursue advanced training and research in breast cancer at the Memorial Sloan Kettering Cancer Centre in New York.

Dr Khoo is a member of the American Society of Clinical Oncology, the European Society of Medical Oncology, and a fellow of the Royal College of Physicians in Edinburgh. He was President of the Singapore Society of Oncology from 1998 to 2000.

Address and Contact Details

6A Napier Road
Gleneagles Hospital Level 2
Singapore 258500

Tel: (65) 6472-2662

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Dr Teo Cheng Peng

Senior Consultant - Haematology

Dr. Teo Cheng Peng was awarded the Public Service Commission Scholarship by the Singapore Government to study Medicine at the National University Hospital. He graduated in 1984 and completed the post-graduate examination in 1987. Under another scholarship, he received further specialised training in stem cell transplantation at the Royal Marsden Hospital, one of the specialist cancer hospitals in the United Kingdom.

Upon returning, he started the Bone Marrow and Peripheral Blood Stem Cell Transplant programme at the National University Hospital. In 1995, he was then recruited to develop the Autologous Stem Cell Transplant programme for solid tumours in the Department of Medical Oncology, Singapore General Hospital. After a successful implementation of the clinical programme, he continued his career in Gleneagles Hospital, where he continued his work with stem cells in the fields of haematology and medical oncology. He continued to develop his interest in the field of stem cells and was one of the pioneers in starting an autologous stem cell bank in Singapore.

Address and Contact Details

6A Napier Road
Gleneagles Hospital #01-35
Singapore 258500

Tel: (65) 6472-2662

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Dr Lim Hong Liang

Senior Consultant - Medical Oncology

Dr Lim Hong Liang had headed the thoracic oncology service, head and neck service and bone marrow transplant programme at the National University Hospital. From 2000 to 2005, he was the Chief of the Department of Haematology and Oncology Department there. He was also the Associate Chairman of the Medical Board of NUH when he left for private practice at the Mount Elizabeth Hospital.

Dr Lim graduated from the National University of Singapore in 1986. He was trained in internal medicine and Medical Oncology at NUH. In 1992, he received a Japan JICA scholarship for further training in the Department of Thoracic Oncology at the Tokyo National Cancer Centre. Dr Lim also was trained in high dose chemotherapy and bone marrow transplant at the St Vincent’s Hospital in Sydney under a scholarship from the Ministry of Health, Singapore.

Address and Contact Details

3 Mount Elizabeth
Mount Elizabeth Medical Centre #13-16/17
Singapore 228510

Tel: (65) 6733-8118

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Dr Lee Kim Shang

Senior Consultant - Radiation Oncology

Dr Lee Kim Shang is a Senior Consultant Radiation Oncologist at Mount Elizabeth Hospital and a Visiting Consultant at the Singapore Gamma Knife Centre.

He graduated from the National University of Singapore in 1985. He received the Ministry of Health HMDP Fellowship to train in Saint Bartholomew’s Hospital in London from 1990 to 1992, and at the Neuro-Oncology Unit, Royal Marsden Hospital, United Kingdom, in 1996. He was appointed Senior Consultant, Therapeutic Radiology Department, at the National Cancer Centre, where he was also the Department Subspecialty Head for colorectal cancer. During this time, Dr Lee held numerous concurrent appointments, including Chairman of the Therapeutic Radiology Department Safety Committee, member of Ministry of Health Colorectal Cancer Clinical Practice Guidelines Committee, and member of the Specialist Training Committee (Radiation Oncology) in the Ministry of Health, Singapore.

Address and Contact Details

3 Mount Elizabeth
Mount Elizabeth Hospital Level 2
Radiation Oncology Centre
Singapore 228510

Tel: (65) 6731-2781

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Dr Yang Tuck Loong Edward

Senior Consultant - Radiation Oncology

Dr Yang Tuck Loong Edward is a Senior Consultant Radiation Oncologist at Gleneagles Hospital. Dr Yang was previously the Senior Consultant in Radiation Oncology at the National Cancer Centre. At the Singapore General Hospital, he was the Consultant Radiation Oncologist, where he oversaw Urologic Oncology in the Department of Therapeutic Radiology. Dr Yang began a 3D conformal radiotherapy programme for prostate cancer in 1997. He was also appointed as Chairman of Quality Assurance in the Department of Radiation Oncology at the National Cancer Centre.

Dr Yang graduated from the National University of Singapore in 1981. He started his training in Radiotherapy in 1984. He was the senior registrar and clinical lecturer in Radiotherapy and Oncology in Middlesex Hospital and the Middlesex-University College Hospital Medical School from 1987 to 1988.

Dr Yang has special interests in the management of urologic, paediatric, breast, and nasopharyngeal cancer. Dr Yang is currently a member of the Specialist Training Committee, which oversees training in Radiation Oncology in Singapore.

Address and Contact Details

6A Napier Road
Gleneagles Hospital Level 1
Radiation Oncology Centre
Singapore 258500

Tel: (65) 6470-5830

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Dr Foo Kian Fong

Senior Consultant - Medical Oncology

Dr Foo Kian Fong is a Senior Consultant Medical Oncologist and Physician at Parkway Cancer Centre. He was previously a Senior Consultant in the Department of Medical Oncology at the National Cancer Centre, as well as a Clinical Teacher in Medicine at the National University of Singapore.

Dr Foo obtained his Masters in Internal Medicine and was a member of the Royal College of Physicians (UK) in 1997. He started training in Medical Oncology in 1998. He completed his advanced training in 2001 and was certified a specialist in 2001. He had a one-year stint as a Fellow at the Peter McCallum Cancer Institute in Melbourne where he underwent training in gastrointestinal cancers from 2001 to 2002.

Dr Foo is a member of the American Society of Clinical Oncology, European Society for Medical Oncology, and the Hong Kong College of Physicians. He served as a committee member of the Singapore Society of Oncology in 2000 and 2003, and was a member of Pharmacy and Therapeutic Committee of the National Cancer Centre from 2004 to 2008.

Address and Contact Details

6A Napier Road
Gleneagles Hospital (Annexe Block) #04-37
Singapore 258500

Tel: (65) 6472-4477

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Dr See Hui Ti

Consultant - Medical Oncology

Dr See Hui Ti is a Consultant Medical Oncologist and Physician at Parkway Cancer Centre, Gleneagles Hospital. She was previously a Consultant in Medical Oncology at the National Cancer Centre, as well as a Visiting Consultant at the KK Women’s and Children’s Hospital, specializing in adult breast and gynaecologic cancers.

Having registered with the General Medical Council (UK) in 1996, Dr See worked at Queen Elizabeth Hospital in Birmingham, UK, before continuing her internal medicine training at the Singapore General Hospital. She has recently obtained her Fellowship from the Royal College of Physicians (FRCP) from Edinburgh.

Dr See was awarded the Singapore Government HMDP fellowship in 2002 after completing advanced oncology training at the National Cancer Centre. From 2003 to 2004, she furthered her training in Medical Oncology at the M.D. Anderson Cancer Center in Houston, Texas.

Dr See is a member of the International Gynaecologic Cancer Society, American Society of Clinic Oncology and the Singapore Medical Association. She served as an executive committee member of the Singapore Society of Oncology from 2001 to 2007.

Address and Contact Details

3 Mount Elizabeth
Mount Elizabeth Medical Centre #13-16/17
Singapore 228510

Tel: (65) 6733-8118

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Breast Cancer is a disease in which malignant (cancer) cells are detected in the tissues of the breast. These cancer cells can then spread within the tissue or organ, and to other parts of the body.

 

How Common Is Breast Cancer?

Breast Cancer is the second leading cause of death in women today. In Singapore, almost one in 20 women will be diagnosed with breast cancer in her lifetime. Chinese women are at a higher risk as compared to Malay or Indian women by about 10-20%. The highest incidence is in the 55-59 years age group. The risk of breast cancer increases with age.

The good news is that more women are surviving the disease as a result of earlier detection and improved treatment.

 

What Causes It?

The triggering factors of this cancer are unknown. It could be attributed to a family history of breast cancer, early menarche, or other possible risk factors. As it is difficult to ascertain, any one of us can be at risk, especially when we are aged 40 and above. While the factors are unknown, a complete cure is possible with early detection through regular breast checks.

 

What are the Warning Signs of Breast Cancer?

• painless lump in the breast
• persistent itch and rash around the nipple
• bleeding or unusual discharge from the nipple
• skin over the breast is swollen and thickened
• skin over the breast is dimpled or puckered
• nipple is pulled in or retracted

 

What are the Guidelines on Breast Screening?

39 years and below	Monthly breast self examination Baseline mammography
40 to 49 years	Monthly breast self examination Annual screening mammography
50 years and above	Monthly breast self examination Two-yearly screening mammography

 

How is diagnosis made?

• Through a clinical examination by the doctor, especially if a lump or an unusual breast change is detected
• By a mammogram, which may detect changes or abnormalities
• Based on an ultrasound scan of the breast that may be suspicious for changes or abnormalities

To confirm the presence of breast cancer, a biopsy will have to be performed, in which a piece of breast tissue is removed for examination under a microscope.

 

What are the common biopsy techniques performed?

• Fine Needle Aspiration (FNA)
• Core Needle or Tru-cut Biopsy
• Excision Biopsy

 

How is Breast Cancer assessed?

Stage	Extend of Spread	Average Survival Rate (%)
0	Non invasive cancer	90
1	Small invasive cancer (less than 2cm without invasion of lymph nodes)	70
2	Invasive cancer (between 2cm without invasion of lymph nodes)	60
3	Large invasive cancer (more than 5cm with skin invasion)	40
4	Widespread or metastic cancer	20

 

GRADE/ DEGREE OF AGGRESSIVENESS

The grades are Grade 1, Grade 2 & Grade 3. Grade 3 is the most aggressive, and has the least favourable outcome.

 

EOSTROGEN RECEPTOR (ER) STATUS

If ER is positive, the cancer cells can respond to hormonal therapy such as tamoxifen.

Treatment options and prognosis (chance of recovery) depends on the stage of the cancer (whether it is in the breast only or has spread to other places in the body), the type of breast cancer, certain characteristics of the cancer cells, and whether the cancer is found in the other breast. A woman's age, menopausal status (whether a woman still has menstrual periods), and her general health can also affect treatment options and prognosis.

 

What treatment is offered?

Most have surgery to remove the cancer. Forms of surgery include:

• Breast-conserving Surgery
• Lumpectomy - removal of the cancer and a small amount of surrounding tissue
• Mastectomy - removal of the whole breast with or without lymph nodes under the axilla

 

Is any other treatment required?

Often this is followed by systemic therapy, which may include either chemotherapy or radiotherapy, and/or hormonal therapy to improve the chances of recovery.

 

What are the rehabilitation steps?

Physical rehabilitation includes:

• Shoulder exercises after surgery
• Arm care to avoid lymphoedema
• Balanced Nutrition and lifestyle adaptation to enhance recovery

Mental rehabilitation involves:

• Close support of spouse, family, friends & support groups
• A woman may feel reassured by knowing her chances of survival
• Attending doctor reviews regularly

 

What is the best approach to care?

The development of a treatment plan by a multi-disciplinary team - breast surgeons, pathologists, radiologists, medical and radiation oncologists, radiologists, social workers, and breast care nurses to diagnose, treat and manage the condition – has shown to be vastly helpful in improving the outcome for patients with cancer.

 

What is the support available?

CanHOPE, a ParkwayHealth initiative, together with the multi-disciplinary team of doctors, tries to bring about a holistic approach to cancer care at no extra cost. Counsellors man its cancer counselling service, through a hotline and email, to provide emotional and psychosocial support to all patients and caregivers, so as to assist them in coping effectively with cancer. A meet-and-greet service with face-to-face counselling can also be arranged. Patients, health care professionals, and the general public can also receive up-to-date cancer information, its related screening tests, treatment, and referral to appropriate cancer services, resources for further rehabilitation and support services, advice on side-effects of cancer treatment, coping strategies and diet and nutrition.

For further enquiries please contact CanHOPE at:

Tel: (65) 6738-9333 or
Email at: canhope@parkway.sg
Website: www.CanHope.com.sg

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Lung cancer originates from tissues of the lung, usually from the cells lining of the air passages. The two major types of lung cancer are small cell lung cancer and non-small cell lung cancer. These are diagnosed based on how the cells look under a microscope. More than 80% of all lung cancers belong to the non-small cell type. The three main sub-types of non-small cell lung cancer are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

 

What Causes It?

Doctors cannot always explain why one person develops lung cancer and another does not. However, we do know that a person with certain risk factors may be more likely than others to develop lung cancer. Tobacco smoke is by far the most important and the main risk factor for lung cancer. It is responsible for more than 80% of all lung cancer worldwide. Harmful substances in smoke damage lung cells. Over time, the damaged cells may become cancerous. This is why smoking cigarettes, pipes, or cigars can cause lung cancer. Inhaling such second-hand smoke can also cause lung cancer in non-smokers. The more a person is exposed to smoke, the greater the risk of lung cancer.

Other risk factors for lung cancer include exposure to radon (a radioactive gas), asbestos, arsenic, chromium, nickel and air pollution. People with family members who have had lung cancer may be at a slightly increased risk of the disease. People who have had lung cancer are at increased risk of developing a second lung tumour. Most people are older than 65 years of age when diagnosed with lung cancer.

 

Symptoms

Early lung cancer often does not cause symptoms. But as the cancer grows, common symptoms may include:

• A cough that gets worse or does not go away
• Breathing trouble, such as shortness of breath
• Constant chest pain
• Coughing up blood
• A hoarse voice
• Frequent lung infections, such as pneumonia
• Feeling very tired all the time
• Weight loss with no known cause

Most often, these symptoms are not due to cancer. Other health problems can cause some of these symptoms. Anyone with such symptoms should see a doctor to be diagnosed and treated as early as possible.

 

Screening

Screening tests may help doctors find and treat cancer early. Several methods of detecting lung cancer have been studied as possible screening tests. These methods include tests of sputum (mucus brought up from the lungs by coughing), chest x-rays, or spiral (helical) CT scans.

You may want to talk with your doctor about your own risk factors, and the possible benefits and harms of being screened for lung cancer. Like many other medical decisions, the decision to be screened is a personal one. Your decision may be easier after learning the pros and cons of screening.

 

Diagnosis

If you have a symptom that suggests lung cancer, your doctor must find out whether it originates from cancer or other health conditions. You may be required to do some blood tests and diagnostic procedures:

• Physical Examination
• Chest X-ray
• Computed Tomography (CT) Scan

Your doctor may order one or more of the following tests to collect samples:

• Sputum cytology: Thick fluid (sputum) is coughed up from the lungs. The lab checks samples of sputum for cancer cells
• Thoracentesis: The doctor uses a long needle to remove fluid (pleural from the chest; the lab checks the fluid for cancer cells
• Bronchoscopy: The doctor inserts a thin, lighted tube (a bronchoscope) through the nose or mouth into the lung; the doctor may take a sample of cells with a needle, brush, or other tool; the doctor also may wash the area with water to collect cells in the water
• Fine-needle aspiration: The doctor uses a thin needle to remove tissue or fluid from the lung or lymph node
• Open biopsy: In cases where the tumour tissue is difficult to obtain, a direct biopsy of the lung tumour or lymph nodes through an incision in the chest wall may be needed

 

How is Lung Cancer Assessed?

To plan the best treatment, your doctor needs to know the type of lung cancer and the extent (stage) of the disease.

Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body. Lung cancer spreads most often to the lymph nodes, brain, bones, liver, and adrenal glands.

 

Stages of Small Cell Lung Cancer

Doctors describe small cell lung cancer using two stages:

Limited stage: Cancer is found only in one lung and its nearby tissues.

Extensive stage: Cancer is found in tissues of the chest outside of the lung in which it began, or cancer is found in distant organs.

 

Stages of Non - Small Cell Lung Cancer

• Occult stage: Lung cancer cells are found in sputum or in a sample of water collected during bronchoscopy, but a tumour cannot be seen in the lung.
• Stage 0: Cancer cells are found only in the innermost lining of the lung and the tumour has not grown through this lining. A Stage 0 tumour is also called carcinoma in situ (CIS). The tumour is not an invasive cancer.
• Stage I: The lung tumour is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissues. Cancer cells are not found in nearby lymph nodes.
• Stage II: The lung tumour may be of any size but has not invaded surrounding organs. Cancer cells are found in nearby lymph nodes. Stage III: The lung tumour has either spread to the nearby organs, chest wall, diaphragm, big vessels, or lymph nodes on the same/opposite sides of the tumour.
• Stage IV: Malignant growths may be found in more than one lobe of the same lung or in the other lung. Cancer cells may be found in other parts of the body, such as the brain, adrenal gland, liver, or bone.

 

Treatment for Lung Cancer

Depending on the stage of the lung cancer, the aims of treatment may be for the cure, control of disease for prolongation of survival, or management of symptoms and prevention of complications to improve quality of life. The following treatment modalities may be used singly or in combination.

Surgery

Surgery for lung cancer involves the removal of tissues that contain the tumour and nearby lymph nodes.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high energy rays to kill cancer cells. It affects cells only in the treated area.

Chemotherapy

Chemotherapy uses anticancer drugs to shrink/kill cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body.

Targeted Therapy

Targeted therapy uses drugs to block the growth and spread of cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body. Some people, with non-small cell lung cancer that has spread, receive targeted therapy.

 

What kind of support is available?

CanHOPE, a ParkwayHealth initiative, together with the multi-disciplinary team of doctors, tries to bring about a holistic approach to cancer care at no extra cost. Counsellors man its cancer counselling service, through a hotline and email, to provide emotional and psychosocial support to all patients and caregivers, so as to assist them in coping effectively with cancer. A meet-and-greet service with face-to-face counselling can also be arranged. Patients, health care professionals, and the general public can also receive up-to-date cancer information, its related screening tests, treatment, and referral to appropriate cancer services, resources for further rehabilitation and support services, advice on side-effects of cancer treatment, coping strategies, and diet and nutrition.

For further enquiries please contact CanHOPE at:

Tel: (65) 6738 9333 or
Email at: canhope@parkway.sg
Website: www.CanHope.com.sg

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What is Colorectal Cancer?

Colorectal cancer originates from the tissues of the colon (the longest part of the large intestine) or rectum (the last several inches of the large intestine before the anus). Most colorectal cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

 

What Causes It?

No one knows the exact causes of colorectal cancer. However, we do know that people with certain risk factors are more likely than others to develop colorectal cancer. Studies have found the following risk factors for colorectal cancer:

Colorectal Polyps

Polyps are growths on the inner wall of the colon or rectum and are common in people over the age of 50. Most polyps are benign (not cancer), but some polyps (adenomas) can become cancer.

Ulcerative Colitis or Crohn's Disease

A person who has had a condition that causes inflammation of the colon (such as ulcerative colitis or Crohn's disease) for many years is at an increased risk.

Personal History of Cancer

A person who has already had colorectal cancer may develop colorectal cancer a second time. Also, women with a history of cancer of the ovary, uterus (endometrium), or breast, are at a somewhat higher risk of developing colorectal cancer.

Family History of Colorectal Cancer

If you have a positive family history of colorectal cancer, you are more likely than others to develop this disease, especially if your relative had the cancer at a young age.

Lifestyle Factors

Individuals who smoke, or consume a diet that is high in fat, and low in fruits and vegetables, are at an increased risk of colorectal cancer.

Age over 50:

Colorectal cancer is more likely to occur as people get older. More than 90% of people with this disease are diagnosed after age 50 years and above.

 

Symptoms

SYMPTOMS
A common symptom of colorectal cancer is a change in bowel habits (diarrhoea or constipation). Other possible symptoms include:

• Feeling that your bowel does not empty completely
• Finding blood (either bright red or very dark) in your stools
• Finding that your stools are narrower than usual
• Frequently having gas pains or cramps, or feeling full or bloated
• Losing weight with no known reason
• Feeling very tired all the time
• Having nausea or vomiting

These symptoms are most often not due to cancer. Other health problems can cause some of these symptoms. Additionally, it is important to note that early cancer does not usually cause pain. Therefore, anyone with these symptoms should see a doctor to be diagnosed and treated as early as possible.

 

Screening

Screening tests help your doctor find polyps or cancer before you have symptoms. Early detection of colorectal cancer will also improve the effectiveness of cancer treatment.

The following screening tests can be used to detect polyps, cancer, or other abnormalities:

Fecal Occult Blood Test (FOBT)

Sometimes cancers or polyps bleed, and the FOBT can detect tiny amounts of blood in the stool. If this test detects blood, other tests are needed to find the source of the blood. Benign conditions (such as haemorrhoids) can also cause blood in the stool.

Sigmoidoscopy

Your doctor examines your rectum and the lower part of the colon with a lighted tube (sigmoidoscope). If polyps (benign growths that may lead to cancer) are found, they may be removed.

Colonoscopy

Your doctor examines your rectum and entire colon using a long, lighted tube (colonoscope). If polyps (benign growths that may lead to cancer) are found, they may be removed.

Double-Contrast Barium Enema

This procedure involves filling the colon and rectum with a white liquid material (barium) to enhance x-ray pictures. Abnormalities (such as polyps) can be seen clearly.

Digital Rectal Exam

A rectal examination is often part of a routine physical check-up. Your doctor inserts a lubricated, gloved finger into your rectum to feel for any abnormalities.

 

Diagnosis

If you have a symptom or screening result that suggests colorectal cancer, your doctor must find out whether it originates from cancer or other health conditions.

Your doctor will ask about your personal and family medical history and perform a physical examination.

If abnormalities (such as polyps) are found, a biopsy may be required. Often, the abnormal tissue can be removed during colonoscopy or sigmoidoscopy. A pathologist checks the tissue for cancer cells using a microscope.

 

How is Colorectal Cancer Assessed?

If the biopsy shows that cancer is present, your doctor needs to know the extent (stage) of the disease to plan the best treatment. The stage is based on whether the tumour has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

Doctors describe colorectal cancer by the following stages:

• Stage 0: The cancer is found only in the innermost lining of the colon or rectum. Carcinoma in situ is another name for Stage 0 colorectal cancer.
• Stage I: The tumour has grown into the inner wall of the colon or rectum. The tumour has not grown through the wall.
• Stage II: The tumour extends more deeply into or through the wall of the colon or rectum. It may have invaded nearby tissue, but cancer cells have not spread to the lymph nodes.
• Stage III: The cancer has spread to nearby lymph nodes, but not to other parts of the body.
• Stage IV: The cancer has spread to other parts of the body, such as the liver or lungs.
• Recurrence: This is cancer that has been treated and has returned after a period of time when the cancer could not be detected. The disease may return in the colon or rectum, or in another part of the body.

 

What Treatment is offered?

Surgery

Surgery involves the removal of tissues that contain the tumour and nearby tissues/lymph nodes. This may be done via laparoscopy or open surgery.

Chemotherapy

Chemotherapy uses anticancer drugs to shrink/kill cancer cells. The drugs enter the bloodstream and can affect cancer cells all over the body.

Biological Therapy

Some people with colorectal cancer that has spread receive a monoclonal antibody, a type of biological therapy. The monoclonal antibodies bind to colorectal cancer cells. They interfere with cancer cell growth.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area.

 

What kind of support is available?

CanHOPE, a ParkwayHealth initiative, together with the multi-disciplinary team of doctors, tries to bring about a holistic approach to cancer care at no extra cost. Counsellors man its cancer counselling service, through a hotline and email, to provide emotional and psychosocial support to all patients and caregivers, so as to assist them in coping effectively with cancer. A meet-and-greet service with face-to-face counselling can also be arranged. Patients, health care professionals, and the general public can also receive up-to-date cancer information, its related screening tests, treatment, and referral to appropriate cancer services, resources for further rehabilitation and support services, advice on side-effects of cancer treatment, coping strategies, and diet and nutrition.

For further enquiries please contact CanHOPE at:

Tel: (65) 6738 9333 or
Email at: canhope@parkway.sg
Website: www.CanHope.com.sg

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Cancer and cancer treatments may cause nutrition-related side effects. Diet is an important part of cancer treatment. Eating the right kinds of foods before, during, and after treatment can help the patient feel better and stay stronger. To ensure proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients (vitamins, minerals, protein, carbohydrates, fat, and water). Symptoms that interfere with eating include anorexia (loss of appetite), nausea, vomiting, diarrhoea, constipation, mouth sores, trouble with swallowing, and pain. Appetite, taste, smell, and the ability to eat enough food or absorbing the nutrients from food may be affected. Malnutrition (lack of key nutrients) can result, causing the patient to be weak, tired, and unable to resist infections or withstand cancer therapies. Eating too little protein and calories is the most common nutritional problem faced by many cancer patients. Protein and calories are important for healing, fighting infection, and providing energy.

 

Common causes of malnutrition in cancer patients.

Anorexia

Some patients may have anorexia when they are diagnosed with cancer. Almost all patients who have widespread cancer will develop anorexia.

Cachexia

Cachexia is a wasting syndrome that causes weakness and a loss of weight, fat, and muscle. It commonly occurs in patients with tumours of the lung, pancreas, and upper gastrointestinal tract.

 

Effect of Cancer on Nutrition

Cancer can change the way the body uses food.

Tumours may produce chemicals that change the way the body uses certain nutrients. The body's use of protein, carbohydrates, and fat may be affected, especially by tumours of the stomach or intestines.

Drugs may help relieve cancer symptoms and side effects that cause weight loss.

Early treatment of cancer symptoms and side effects that affect eating and cause weight loss is important. Both nutrition therapy and drugs can help the patient maintain a healthy weight.

 

Effect of Cancer Treatment on Nutrition

Effect of Surgery on Nutrition

Surgery increases the body's need for nutrients and energy. The body needs extra energy and nutrients to heal wounds, fight infection, and recover from surgery. If the patient is malnourished before surgery, there may be complications during recovery, such as poor healing, or infection.

Effect of Chemotherapy on Nutrition

Chemotherapy may affect the whole body. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells, or by stopping the cells from dividing. Because chemotherapy targets rapidly dividing cells, healthy cells that normally grow and divide rapidly may also be affected by the cancer treatments. These include cells in the mouth and digestive tract.

Effect of Bone Marrow and Stem Cell Transplantation on Nutrition

Bone marrow and stem cell transplant patients have special nutritional needs.

Bone marrow and stem cell transplantation are methods of replacing blood-forming cells destroyed by cancer treatment with high doses of chemotherapy or radiation therapy. Stem cells (immature blood cells) are removed from the bone marrow of the patient or a donor and are frozen for storage. After the chemotherapy and radiation therapy are completed, the stored stem cells are thawed and given back to the patient through an infusion. Over a short time, these re-infused stem cells grow into (and restore) the body's blood cells. Chemotherapy, radiation therapy, and medications used in the transplant process may cause side effects that prevent a patient from eating and digesting food like usual.

 

The benefits and risks of nutrition support vary for each patient.

Decisions about using nutrition support should be made with the following considerations:

• Will quality of life be improved?
• Do the possible benefits outweigh the risks and costs?
• Is there an advanced directive? (An advanced directive is a written instruction about the provision of health care or power of attorney in the event an individual can no longer make his or her wishes known)
• What are the wishes and needs of the family?

Cancer patients and their caregivers have the right to make informed decisions. The healthcare team, with guidance from a registered dietician, should inform patients and their caregivers about the benefits and risks of using nutrition support in advanced disease. In most cases, the risks outweigh the benefits. However, for someone who still has good quality of life, but also with physical barriers to achieving adequate food and water by mouth, enteral feedings may be appropriate. Parenteral support is not usually appropriate.

 

Advantages and disadvantages of enteral nutrition include the following:

Benefits

• May improve alertness
• May provide comfort to the family
• May decrease nausea
• May decrease hopelessness and fears of abandonment

Risks

• May cause diarrhoea or constipation
• May increase nausea
• Requires surgery for the placement of a tube through the abdomen
• Increases risk of choking or pneumonia
• Increases risk of infection
• Creates a greater burden on the caregiver

Current guidelines for promoting general health and well-being include the following:

• Eat nutrient-rich foods within calorie limits
• Maintain a healthy body weight
• Exercise regularly
• Eat a variety of fruits, vegetables, whole grains, and low-fat dairy products each day
• Eat less fat and avoid trans-fatty acid (trans fats)
• Choose fibre-rich fruits, vegetables, and whole grains often
• Eat fewer foods high in salt. Choose more foods high in potassium (like bananas, spinach and potatoes)
• Those who choose to drink alcoholic beverages should do so in moderation; certain individuals should avoid alcohol entirely
• Keep food safety in mind when preparing, storing, and serving food

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Healthy food choices and physical activity may help reduce the risk of cancer. The American Cancer Society and the American Institute for Cancer Research have both developed cancer prevention guidelines that are similar to those found below.

The following diet and fitness guidelines may help reduce the risk of cancer:

• Eat a plant-based diet; eat at least 5 servings of fruit and vegetables daily, and include beans in the diet, and eat grain products (such as cereals, breads, and pasta) several times daily
• Choose foods low in fat
• Choose foods low in salt
• Get to, and stay at, a healthy weight
• Be at least moderately active for 30 minutes on most days of the week
• Limit alcoholic drinks
• Prepare and store food safely
• Do not use tobacco in any form

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CanHOPE, a ParkwayHealth initiative, together with the multi-disciplinary team of doctors, tries to bring about a holistic approach to cancer care at no extra cost. Counsellors man its cancer counselling service, through a hotline and email, to provide emotional and psychosocial support to all patients and caregivers, so as to assist them in coping effectively with cancer. A meet-and-greet service with face-to-face counselling can also be arranged. Patients, health care professionals, and the general public can also receive up-to-date cancer information, its related screening tests, treatment, and referral to appropriate cancer services, resources for further rehabilitation and support services, advice on side-effects of cancer treatment, coping strategies, and diet and nutrition.

For further enquiries please contact CanHOPE at:

Tel: (65) 6738 9333 or
Email at: canhope@parkway.sg
Website: www.CanHope.com.sg

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