IN THIS ISSUE: Breast cancer | Miracles... can they happen? | 乳癌：它究竟是什么

March 2011

Stories ofHOPE

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SISTERPOWERTheodora (below, with her daughter

Yulie) has Stage II breast cancer. But a group of special women keep her spirits high and help

her battle her illness

A tight cluster of women walked as one into the Parkway Cancer Centre (PCC) lobby. It was hard to make out Mrs Theodora Sophia Panggabean, 69, as she was

hemmed in by her sister Mdm Ade Sylvana on her left and her son-in-law’s relative Mdm Jeane Bororing on her right. Close on her heels was her daughter Ms Yulie Panggabean, who never fails to accompany her mum on her trips to Singapore for breast cancer treatment.

In the entourage was also CanHOPE executive Ms Sakeena Mohamed and PCC senior dietician Ms Fahma Sunarja. The women chattered 19 to the dozen in Bahasa Indonesia. They made jokes about the lights and camera set-up for this interview. When the photographer asked them to enact walking from the entrance into the lobby, they treated it like a model’s catwalk. Then, when the camera turned elsewhere, the ladies collapsed laughing on the sofa. Everything was fodder for their humour.

“They are always joking,” laughed Sakeena as she observed the family, “There is just no time for Mrs Theodora to feel down or bitter about her situation.”

Yes, all the jokes were a careful ploy by the family members to keep things light. It was obvious that the ladies had set themselves the mission to make every trip to Singapore a pleasant and

memorable experience for Theodora.When Theodora first had an inkling that something was

wrong, it was February 2010. She was feeling generally unwell − her body ached and she could not lift up her right arm. Consultations with doctors in Jakarta revealed the shocking news that there was a lump on her left breast. “It’s 50 per cent confirmed that this is cancer,” she was told.

To most people, the term “cancer” sounds like a death sentence and Theodora reacted this way too when she first received the news. However, into the crisis quickly stepped her son Mr Okki Panggabean and daughter Yulie.

“Mama, you have to get well, you have to be cured,” said Yulie firmly.

“Yes Mama, don’t worry about anything, we will take care of you. Concentrate on getting well, we need you,” affirmed Okki.

They encouraged her to put her faith in God, and reminded her that God can strengthen her. When the possibility of travelling to Singapore to seek treatment was raised, her children immediately assured her, “We will bring you there.”

Theodora’s strong faith in God began to re-assert itself as her church members visited her and prayed over her. She made her first decision not to let the disease conquer her, but to conquer it. And she has not looked back since that decision.

The specialist in Jakarta referred her to CanHOPE, which recommended consultation and treatment in Singapore. Accompanied by her children, Mrs Theodora flew to Singapore and was greeted by a smiling Mdm Jeane. Jeane lives in Singapore and has been instrumental in accompanying Theodora on many of her subsequent trips

HealthNewsInspiring and informative stories for patients MICA (P) No. 153/01/2011

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Editorial teamFong Mue Chern, Pauline Loh, Philip Pang, Vincent Tan, PublisherPreston Communications PrinterImpress Printing

No portion of this magazine may be reproduced in any language, stored in or introduced into a retrieval system, or transmitted, re-sold, redistributed, in any form or by any means without the prior written permission of the publisher. Information provided in this magazine is not intended to replace the advice of your health professional.

Stories of Hope

乳癌是新加坡妇女最普遍患上的癌症，但百汇癌症中心医务副主任邱继祥医生(右)表示，随着更多人及早发现癌症，以及更有效治疗的出现，乳癌死亡率已经显著下跌。乳癌专科医生邱继祥与您分享乳癌的真相，破解跟这类癌症有关的一些不实说法。

这类癌症在新加坡有多普遍？乳癌是新加坡妇女最普遍患上的癌症，占所有妇女所患癌症的近30%。在2004至2008年间，本地平均每年有1800人被诊断出患有乳癌。

有什么关于这类疾病的资料是我们非知不可的？我们应该知道这类癌症的治愈率非常高。过去20年里，利用乳房X光检查及早检验出癌症，以及辅助疗法 - 如手术后化疗和电疗 - 的使用大大减低了乳癌死亡率。

关于这类癌症，坊间有哪些不实说法或误解？有很多。有些人认为接受乳房X光扫描会引发癌症。有些人相信只要他们不接受检验，不主动寻找癌症的迹象，就不会得癌症。事实是：乳房X光检查让病人及早查出癌症，拯救生命。另外一个传言是我们不应该以切片检验或手术“骚

扰”癌细胞，令它扩散得更快。事实是：我们需要通过切片检验确定诊断，确认乳癌种类。尤其当肿瘤体积大且病人需要在手术前接受化疗时，切片检查更加重要。通过乳房肿瘤切除手术或乳房切除手术去除癌症不会提高肿瘤扩散的可能性。也有人认为化疗一定会导致脱发和呕吐，引起痛苦。

事实是：新治疗不会导致大量脱发和恶心，相对轻微的副作用让病人可以接受更长期的化疗，更好地控制癌症。

及早检验就一定可以确保成功治愈癌症吗？及早检查可大大提高治愈率但不能保证病人一定能够痊愈。第一期乳癌病人的5年存活率超过90%，而第四期乳癌病人大多无法治愈，但也有30%到40%的病人可以活多5年。乳癌四期是：

第一期: 肿瘤还小，直径只有2公分或以下，没有影响腋窝淋巴结； 第二期: 肿瘤超过2公分或已经影响淋巴结； 第三期: 肿瘤体积大，超过5公分，种类已经侵入乳

乳癌：它究竟是什么2004年到2008年间，乳癌平均占每年新增癌症病例当中的1800起。但邱继祥医生说，好消息是，这类癌症的治愈率非常高

to Singapore.Theodora consulted with two doctors, one in

a prestigious Singapore hospital and the second with Dr Khoo Kei Siong. She was immediately taken by Dr Khoo. Dr Khoo is the Deputy Medical Director and Senior Consultant, Medical Oncology, of PCC.

“I was feeling frightened and lost when I stepped into his clinic,” she recalled, “But he was very comforting, very inspiring. He made me feel calm and helped me focus on how to get better.”

“Mrs Theodora has Stage II breast cancer,” described Dr Khoo. “She also has other issues such as hypertension, high cholesterol, excess weight and poor diet. It is important that patients understand their condition. I have always made it a point to go through with her before each treatment, symptoms that she may experience and what she can do to address them. I set milestones and cheered her on when she attained each of them.”

The Panggabean clan had also squeezed into the consultation room along with Theodora. They, too, had a good first impression of Dr Khoo, who took pains to explain Theodora’s diagnosis and recommended treatment to them. Dr Khoo believes in working with the family as he feels that their support can make a vital difference in the patient’s determination to get well.

“Mrs Theodora has a very supportive family with her children and sisters rallying beside her from the very day she was diagnosed with cancer. They worked closely with us and played a big part in helping her in her journey during the months of treatment,” praised Dr Khoo.

Theodora felt further assurance about her decision to seek treatment at PCC when she met Sakeena and Fahma. Both these ladies speak Bahasa Indonesia fluently. Their job scope includes arranging medical consultations and interpretation services for Theodora. Fahma’s duty was to recommend suitable diets during treatment. However, Theodora says they often went beyond the call of duty. “They encouraged me and gave me emotional support,” she said as she described her 15 trips to the cancer clinic, her surgery and convalescence in Gleneagles Hospital which lasted three weeks and her six-month course of chemotherapy.

Theodora has completed her treatment smoothly without the side effects she feared. She wants to spread hope and cheer among other cancer patients and she freely shares her experience with them in the waiting rooms and in the hospital.

Dr Khoo describes her as an exemplary patient. “She is always very motivated and positive. She makes it a point to dress up and look good, and is ever ready for her next treatment. Her jovial, friendly and generous personality has endeared her to all the staff and nurses in our centre.”

When asked about her goals, Theodora said that she hopes to be in full remission and have no relapses. “I must be stronger than the illness,” she asserted, “I want to remember that I am in control of my health, I will exercise my fighting spirit to overcome this cancer.”

对抗癌症

乳癌：它究竟是什么房上的皮肤或胸腔肌肉，或大量的淋巴结已经受到影响；第四期: 肿瘤已经扩散到其他器官。

近年有哪些医疗进展？这十年来，新药的出现是乳癌治疗中的其中一个突破。其中一种药物是以影响癌细胞的某种蛋白或酶为目标的标靶治疗。只有在癌细胞内有这类标靶蛋白或酶时，这类药物才能发挥作用。 例如，以Her2受体为目标的Herceptin。乳癌中有

20%含有大量的Her2受体。当医生在治疗Her2阳性早期乳癌的化疗药物中添加Herceptin时，癌症的复发率得以进一步减低50%，死亡率减低30%。

要做什么才可以预防患上乳癌？导致乳癌的因素包括家庭乳癌或卵巢癌病史、早来月经、更年期完、使用荷尔蒙替代疗法（尤其使用期在五年以上）、肥胖、喝酒和无子女。因此，避免吃过于油腻的食物及保持标准体重、例常

运动、避免或减少口服避孕药或荷尔蒙替代疗法的使用、饮酒适量、在30岁前生育子女、多吃蔬菜水果都是一些减低乳癌风险的简单措施。及早检验癌症也被证实可以让乳癌死亡率降低20%到40%。因此，所有妇女都应该从40岁起每年接受一次乳房

X光检查。

为什么选择以乳癌作为执业专科？我在1991年开始接受癌症内科培训，两年后到外国接受副专科培训，在那时选择专攻乳癌的。促使我想要进一步专研这类癌症的原因包括癌症比例不断增加、医学界对这类癌症病理的理解突飞猛进，以及新疗法的出现。

经常自行进行乳房检查有助于及早检测出乳癌。下面是自行检验乳房的指南：

步骤一：面向镜子，双肩挺直，双手插腰。目视乳房看看乳房上是否出现红疹、发红、发肿或出现任何变化，如乳头凹陷等。

步骤二：双手举起，看看是否有步骤一所提的变化。

步骤三：轻轻压挤两个乳头察看是否有异物泄露。异物可能是水状、乳状、黄色液体或血。

步骤四：接着，平躺时触碰两边乳房。手指平放，合起，用右手触碰左胸、左手触碰右胸。从上至下、从一边到另一边—从锁骨到腹部，从腋下到乳沟。刚开始时用手轻碰，逐渐增加压力以便触及更深层的组织。覆盖整个胸部。

步骤五：最后，在站立或坐立时遵照步骤四的方式，检查乳房。检查乳房的最佳时机是在洗澡后，皮肤还湿时。

两分钟的不适可以救你一命

利用安全性高的小量X光检验乳房的乳房X光检查可以探测到很小的肿瘤，乳房X光检查至今仍是检验乳癌的最有效方法。乳房X光检查过程中，胸部会被

压挤几秒钟以便分散胸部组织，让胸部的影像更清晰。一些妇女可能会觉得过程不舒服或疼痛，但切记这只是暂时的，而且整个过程只要两分钟的时间。而那两分种可能救你一命。因此，建议所有40岁至49岁的妇

女每年接受一次乳房X光检查，而50岁或以上的妇女应当每两年接受一次乳房X光检查。所以今天就鼓励您的母亲、姑姑、姐妹们接受检验。

电疗在乳癌的治疗和痊愈上扮演重要角色。百汇癌症中心放射肿瘤科高级顾问医生杨德龙(右)说，在手术后进行电疗作为辅助治疗有助减低癌症复发的可能性。他进一步说明，所有接受乳房修

复手术、乳房切除手术或有类似腋窝淋巴结、大肿瘤（5公分或以上）、及血管淋巴瘤的病人都需要接受手术后电疗。在针对早期乳癌病人所进行的手术上，医生通常尽量

保留病人的乳房，不会切除病人的乳房。在这样的情况下，为了更好地避免受影响位置再次长出肿瘤，电疗往往是强制性的。我们发现，在所有在保留乳房情况下动手术切除肿瘤，并接受电疗的病人中，百分之94不会出现原发部位再出现肿瘤的情况。 杨医生说，好消息是，科技和技术的跃进大大减轻了

皮肤反应、疲惫和恶心等副作用，让病人在接受电疗的同时继续工作。此外，在病人的肿瘤已到无法动手术或当癌细胞已经

扩散到骨头或脑部的情况下，电疗也在病人的慈怀护理中扮演重要角色。电疗可以帮助这些较不幸的病人延长他们仅有的生命时限。

电疗的需要

如何自行接受乳房检验？

Fighting Cancer

Breast cancer is the most common cancer among women in Singapore but

with early detection and better treatment, the mortality rate has dropped significantly, says Dr Khoo Kei Siong, Deputy Medical Director of Parkway Cancer Centre (right). The specialist in breast cancer shares facts and dispels the myths associated with it.

How common is it in Singapore?Breast cancer is the most common cancer among women in Singapore, accounting for close to 30 per cent of all female cancers. From 2004 to 2008, an average of 1,800 new cases were diagnosed here each year.

What is the most important thing we should know? That it is highly curable. Early detection with mammography screening and the use of adjuvant therapy – i.e. additional post-surgery treatment, such as chemotherapy and radiotherapy (see box) – has significantly reduced the mortality rate of breast cancer patients in the last 20 years.

What are some of the myths or misconceptions about breast cancer? There are many. Some believe mammograms may lead to cancer, others choose not to go for screening because they think that if they don’t look for it, they will not have it. The truth: Mammograms allow early detection and save lives.

Another myth is that one should not “disturb” the cancer with a biopsy or surgery as that may cause it to spread faster. The truth: A biopsy is needed to establish the diagnosis and determine the type of breast cancer. This is particularly important when the tumour is big and needs chemotherapy before the operation. Removal of the cancer by a lumpectomy or mastectomy does not increase the chances of it spreading.

There are yet others who think that chemotherapy invariably leads to hair loss, vomiting and misery. The truth: There are newer treatments that do not cause significant hair loss and nausea, and the relatively mild side effects allow such chemotherapy to be administered for prolonged periods to keep the cancer in check.

Does early detection guarantee a cure?Early detection greatly increases but it does not guarantee a cure. Patients with Stage I breast cancer have over 90 per cent chance of surviving five years while Stage IV cancers are generally not curable but with modern treatment, 30-40 per cent can expect to live five years.

The four stages of breast cancer are: Stage I: Cancer is small, 2 cm or less, and lymph nodes

Breast cancer: What’s it all aboutIt accounts for an average of 1,800 new cancer cases diagnosed every year from 2004 to 2008. But the good news is that the cancer is highly curable, says Dr Khoo Kei Siong

in the axilla (underarm area) are not involved.Stage II: Cancer more than 2 cm or the lymph nodes are involved.Stage III: Cancer is large, more than 5 cm, overlying skin or chest wall muscles are invaded, or large number of lymph nodes are affected.Stage IV: The cancer has spread to other organs.

What medical advances have taken place in recent years?One of the key advances in breast cancer treatment in the last decade is the introduction of new drugs. One particularly important group of drugs is targeted therapy, which are designed to target a specific protein or enzyme crucial to the function of cancer cells. These drugs only work when that targeted protein or enzyme is present in the cancer cells.

An example is Herceptin which targets the Her2 receptor. This receptor is present in large quantities in about 20 per cent of breast cancers. When Herceptin is added to chemotherapy in Her2-positive early breast cancer, the relapse rate is further reduced by 50 per cent and the death rate is reduced by 30 per cent.

What can we do to prevent it?Factors that put a person at a higher risk include a strong family history of breast or ovarian cancer, early start of menstruation and late menopause, use of hormonal replacement therapy (especially if used longer than five years), obesity, alcohol consumption

A safe low-dose X-ray examination of the breast that can pick up very small lumps, mammography screening is currently still the most effective way to detect breast cancer.

During the procedure, the breast is compressed for a few seconds to spread the tissue apart and get a good image of the breast.

Some women may find this uncomfortable or painful, but remember that this is temporary and takes just two minutes. And that two minutes could save your life.

Women aged 40 to 49 are, therefore, advised to go for a mammogram once every year, while those 50 and above once every two years. So encourage your mothers, aunts and sisters to get screened today.

minutes of discomfort could... save your life2

Fighting Cancer

How to do a breast self-examinationRegularly examining your own breasts may help in early detection. Here’s how you can do it:

Step 1Face a mirror with your shoulders straight and your arms on your hips. Look at breasts and nipples for any rash, redness, swelling or changes, such as nipple that has become inverted (pushed inward instead of sticking out).

Step 2Raise your arms and look for the same changes as in Step 1.

Step 3Gently squeeze each nipple to check for discharge. This could be a watery, milky, or yellow fluid or blood.

Step 4Next, feel each breast while lying down. Keeping the fingers flat and together, use your right hand to feel the left breast and vice versa. Do it from top to bottom, side to side – from collarbone to abdomen, from armpit to cleavage. Begin with a soft touch, and increase pressure to feel the deeper tissue. Cover your entire breasts.

Step 5Finally, feel your breasts while standing or sitting, using the same movements as in Step 4. The best time to examine your breasts is after a shower when the skin is still damp.

Radiotherapy plays a key part in the treatment and cure of breast cancer. It can be used as post-operative adjuvant therapy to reduce risk of recurrence, says Dr Edward Yang, Senior Consultant, Radiation Oncology, at PCC (right).

He adds that all patients who’ve had breast conservation surgery, those who have undergone a mastectomy or have certain features like positive axillary nodes, large tumours (5cm or more), as well as lymphovascular involvement will need post-operative radiotherapy.

In early breast cancer when surgery is conservative,

Breast cancer: What’s it all about

The need for radiotherapythat is no mastectomy or breast removal done, post operative radiotherapy is often mandatory to improve local control. We find that 94 per cent of patients have permanent local control after radiotherapy in intact breast.

The good news is that most patients on radiotherapy are now able to continue working whilst undergoing treatment, says Dr Yang, as the side effects – ranging from skin reactions to fatigue and nausea – are mild with improved technology and techniques.

Radiotherapy also plays an important role in palliation when tumours are inoperable or when they have spread to other sites like the bones or brain. It can help improve as well as prolong the survival in many of these more unfortunate patients.

and being childless. Therefore simple measures to reduce the risk of breast cancer include avoiding excessive fat consumption and maintaining an ideal body weight, regular exercise, avoiding or using less oral contraceptives or hormone replacement therapy, moderate consumption of alcohol, having children by the age of 30, and eating more fruits and vegetables.

Early detection has also been shown to reduce the breast cancer death rate by 20 to 40 per cent. All women should therefore go for an annual

mammogram from 40 years of age.

Why did you make breast cancer your particular area of expertise?I started my training in medical oncology in 1991 and decided to focus on breast cancer when I was due to go overseas for subspecialty training two years later. The relentlessly-rising incidence of breast cancers, explosion in the understanding of its biology, as well new treatment options were why I was attracted to study this cancer in greater detail.

Serving You

Being a good companion to a critically ill patient is how nurse Toh Su Woon feels she can make a difference. The latest addition to Parkway

Cancer Centre’s (PCC) palliative care team, Su Woon has been a nurse for about six years.

Egged on by her sense of adventure, the 28-year-old Malaysian came to Singapore in 2001 to study nursing at a local polytechnic. “I had no idea what nursing was about before I came,” she recalls.

Su Woon had previously served in a multiple-disciplinary ward in a restructured hospital in Singapore and was working with patients suffering from neurological diseases.

“I had witnessed the recovery of patients who were critically ill from their diseases and was convinced that I have an important role when they are most in need,” says Su Woon, who is proud of her chosen vocation. Confident that she can contribute more as a palliative nurse, she joined PCC in May 2010.

A typical workday involves making rounds with a palliative care consultant in the hospital ward and making calls to check on a patient’s condition. “My main role is to assist doctors to ensure patients and their families are coping well with care issues and that their symptoms are controlled,” she says.

Ultimately, Su Woon explains, the goal of the palliative care team is to see patients spend their days with a high quality of life: “We aim to empower family members by providing nursing advice, caregiver training, coordinating home equipment rental and also emotional support.”

Focused on her role as a nurse, Su Woon tries her best not to get too emotionally involved. “Being a palliative care nurse is emotionally and physically draining. Very often, my patients are dying and I need to be there to support them and their family.”

To de-stress, the staunch Christian finds solace in prayer and appreciates the little things in life while family and close friends provide emotional support. Grateful to God for making her a nurse, Su Woon feels that she has gained far more than she has given.

“I’ve learnt to become more patient, humble and

Parkway Cancer Centre’s (PCC) Palliative Care Service was started in July 2008 to provide care for those facing life-threatening illnesses such as advanced cancers.

The first of its kind in the private sector, the palliative care service aims to improve quality of life of such patients by providing emotional support besides treating pain and other symptoms.

The care service extends beyond terminal care and may be provided anytime from diagnosis of an advanced cancer to alongside potentially curative treatment.

Comprising of Consultant Dr Kok Jaan Yang and two palliative care nurses, the trio work closely

Not just a nurse... but also a friend

Toh Su Woon (right), the newest member of PCC’s Palliative Care Service team, answers her calling to be a good companion to critically ill patients

compassionate. It is only after listening to life stories shared by my patients and their family members that I truly appreciate how precious life is,” she says.

Su Woon feels a deep sense of satisfaction when patients or their family members sometimes express their appreciation.

Whether it is through spoken words, a squeeze of her hand or a little hug, Su Woon knows that she has touched their lives. “That alone is enough for me to carry on,” she says.

with patients’ oncologists and a team of trained counsellors.

An integral part of PCC’s comprehensive cancer programme, the care service ensures that the primary medical oncologist continues to oversee the patient’s care with the palliative care physician even at the terminal stages.

After a patient’s discharge, the care service reviews the patient’s medical and nursing needs carefully. Where necessary, arrangements are made for medical equipment to be delivered to the patient’s home. Follow-up reviews by the palliative care physician may also be carried out at the patient’s home if he or she is too weak to travel.

A Care Service you can count on

Fighting Cancer

Priced at $52.40, “Awakening the appetite” is available at major bookstores and Parkway Cancer Centre clinics. Nett sales proceeds will be donated to the Singapore Cancer Society.

Priced at $52.40,

Parkway Cancer Centre (PCC) guests and media representatives got a taste of healthy cooking recently, when they were treated to a

lunch featuring dishes from PCC’s new cookbook, “Awakening the appetite”.

Over fi ve courses, they got a sample of recipes that renowed local chefs had specially whipped up for the book, which is targeted at Asian cancer patients.

At the luncheon, PCC’s Deputy Medical Director Dr Khoo Kei Siong introduced the book to the media, and explained the motivation behind the project. Guests also got to meet some of the chefs as well as the authors of the book.

The book, which was launched late last year, is part of PCC’s community outreach project conducted through its non-profi t arm, CanHOPE. Part of the proceeds of the sales will be donated to the Singapore Cancer Society.

Co-authored by Vivian Pei and PCC senior dietitian Fahma Sunarja, it contains numerous recipes for tasty yet healthy dishes that were designed by eight renowed chefs in Singapore.

PCC has also organised Cooking Masterclasses, duirng which some of these chefs personally took cancer patients and caregivers through their recipes and showed them how to prepare the dishes.

Tasty yet healthy

Above and right: Guests sample some of the dishes featured in the cookbook. Below: PCC’s Dr Khoo (back row, far left) with some of the chefs and the book’s co-authors Fahma Sunarja (seated, far left) and Vivian Pei (standing, far right).

The Doctor Is In

“Happy Chinese New Year!” greeted my patient Hong Boon, as he walked into the consultation room. “I have extended

this greeting to you ten times before,” he grinned. “Am I a miracle?”

Whenever New Year, birthdays or anniversaries come around, patients often reflect on how many of such special days we have known one another. It helps them to keep track of how long we have managed to hold cancer at bay.

I paused to look at his medical records and true enough, I first saw him in February of 2001. I can remember the day we met as vividly as if it were yesterday.

Several other doctors, including a medical oncologist, had already seen him. The diagnosis and prognosis given to him was rather bleak. He had just been diagnosed to have stage IV renal cell cancer, which had spread to the bones and lungs.

Maybe he had difficulty accepting the news, perhaps he just needed another opinion, or maybe he didn’t find the right chemistry with the other doctors. I’m not sure I ever asked him why he came to see me.

There was a large cancer that had occupied his left kidney. The computed tomogram films showed lesions in both lungs, indicating that the cancer had already metastasised. One of the ribs was already badly “eaten up” by the cancer.

The cancer had spread to the spinal column and could be seen pressing on the spinal cord.

“Although the cancer has spread to many areas, the tumour involving the spine poses the greatest immediate danger,” I told him. “If we do not succeed in controlling the cancer at this site, you will end up paralysed in both legs.”

I went on to propose an immediate admission, an urgent consultation with a neurosurgeon to stand by in case there was evidence of neurological injury and a consultation with the radiotherapist for urgent radiotherapy. A combination of chemotherapy and interferon (a form of biological therapy) was also given.

That was more than nine years ago. For a patient with such an extensive disease, it may be thought to be a miracle to be alive and well.

“Do you believe in miracles?” I often get asked (especially by fellow-Christians). I assume that they are referring to miracles in regard to divine healing of cancer patients.

The Bible speaks of miracles – the blind can see and the lame can walk. Much as I am amazed how some of the cancer patients have beaten the odds and done extraordinarily well, would I classify these as miracles?

I recall watching a documentary on miracle cures

at Lourdes. There is apparently a medical science department, appointed by the Church, to study reports made by believers of miracle healings.

I truly cannot remember the entire documentary but one of the points made was the definition of a miracle cure. Such a cure had to be instantaneous, complete and without any medical intervention. By that definition, the researchers could not confirm that a miracle has ever occurred in modern times.

In 2001, there was little hope for patients with metastatic kidney cancer as there were limited treatment options. Back then, the treatment of choice was biological therapy with a combination of interleukin-2 with interferon. Treatment meant being warded in intensive care as, between drugs and cancer, the patient’s body becomes ravaged.

Unlike some of my more courageous colleagues, I have never used this programme since returning from my oncology training in the States. I found the treatment programme to be just too toxic. To me, the benefits of therapy did not warrant the risks and poor quality-of-life.

I have always opted for a programme, which very few oncologists use – a combination of chemotherapy and interferon.

Today, our understanding of the molecular pathways of cancer-genesis in kidney cancer has made available a host of new targeted agents for treating kidney cancer. These include sorafenib (Nexavar®) and sunitinib (Sutent®). These oral agents have established themselves as the new standard bearers for treatment of metastatic kidney cancer.

The latest contender in this area is everolimus (Afinitor®).

These targeted agents are not without side effects. It is misconception by many that targeted therapies are better than conventional chemotherapy drugs as they are more specific. What often fails to be mentioned is that the toxicities can be as bad, if not worse than chemotherapy.

Most patients cannot tolerate the recommended full dose of sorafenib or sunitinib. Even with dose modification, many patients struggle with the toxicities.

As for my old friend Hong Boon, he has been and is still on chemotherapy with interferon for the past nine years. New treatment is not necessarily better treatment for everyone. He continues to work all these years and all his scans have been normal since 2003.

He may not pass the definition of a miracle, but I am sure that he is evidence of the divine grace of God.

Dr Ang Peng Tiam

...can they happen?

Miracles...

The debate is still on about whether miracles have taken place, but some stories tell of divine grace