|
Doc Talk - Dr Ang Peng Tiam
When it was recently reported that Singapore is going to invest $256 million in cancer research at the Cancer Research Centre of Excellence, I immediately thought of Mr Iswandi.
The Chinese Indonesian travel agent from Jakarta was first diagnosed with nasopharyngeal cancer (NPC) in October 2002.
The focus of the centre's research will be cancers that hit Asians hardest. Nasopharyngeal cancer is one of them.
Back to Mr Iswandi: he had delayed treatment and by the time he saw me in February 2004, there was a huge mass about the size of an orange on the left side of his neck.
He still carries in his wallet an old photo of him with this growth, and he sometimes shows it to other patients at my clinic - as a cautionary tale about always taking the sensible approach the first chance you get.
Radiotherapy was advised when he was first diagnosed with NPC. But he had heard so many horrendous stories about its side-effects that he refused treatment for more than a year.
Then, when swollen glands appeared on the left side of his neck, he sought help from a Chinese sinseh. He popped hundreds of herbal pills every day, but still his tumour grew larger and larger.
The sinseh then suggested that he soak himself in an electromagnetic bathtub filled with herbs. It purportedly augmented the herbs' effectiveness. When told that the tumour had continued to grow, the sinseh replied: "It must grow bigger first, then it will get small."
Finally, a year later, he decided enough was enough and came to see me. Despite the advance stage of the disease, he is now in complete remission after a chemotherapy and radiotherapy treatment programme.
Nasopharyngeal cancer, sited at the roof of the nasal passage, can spread. As in Mr Iswandi's case, the cancer spread to the lymph nodes causing a large growth on his neck.
For some unknown reason, NPC is common among Asians and more specifically natives of China's southern provinces.
The actual cause of NPC is not known but there are several suspects. It is more common in certain ethnic groups and genetics is believed to play a role. I still remember how, in my pathology class in 1970s, a distinguished professor challenged us to come up with possible reasons the Cantonese are more prone to NPC.
"It's the way they talk," one classmate ventured. "Has it got anything to do with kissing?" "Maybe it is their diet," said another.
Indeed, salted fish has been studied as a possible cause of NPC. Epidemiologic studies suggest that the use of diets with salted fish to wean babies off milk may increase the risk of developing NPC.
However, I have never heard of anyone adopting this practice here, so I doubt that it can explain why NPC is the sixth most common cancer among males in Singapore.
The biggest revolution in the treatment of NPC is adding chemotherapy to radiotherapy. An American team was the first to report improved outcomes in a random controlled study which showed the superiority of chemotherapy-plus- radiotherapy.
These results were initially met with scepticism. But when similar results were reported in Hong Kong and Singapore, there was general acceptance that this approach offered NPC patients at an advanced stage the best chance of a cure. This was my approach in Mr Iswandi's case and I am glad it worked.
Dryness of the mouth is a common and long-term side-effect of radiotherapy for NPC.
In clinical medicine, doctors are credited with making observations which aid in making a diagnosis. I joked that I should be credited for the "bottle sign".
Whenever a patient walks into my clinic with a bottle of water in his hand, I would look at his neck to see if there is any evidence of radiotherapy. When these findings are present, I would make a spot diagnosis for NPC.
NPC patients, after completing radiotherapy, almost always carry a bottle of water. This is because their mouths are perpetually dry, often embarrassingly so. They sometimes cannot complete a sentence because the tongue is parched. As such, they often take sips in between sentences.
However, there is a new radiotherapy machine called tomotherapy. This machine calibrates daily the target area, allowing radiotherapy to be administered to only the tumour sites. Side-effects like a dry mouth are kept to a minimum.
Just when I thought that I should write in to a medical journal to describe my "bottle sign", technology beat me to it. It is a good reminder that research in cancer is not a dry and dusty companion to treatment, but an active and vigorous partner.
For doctors, technology provides new tools each year to fight cancers. For patients, it gives new hope - and a better kind of life.
Dr Ang, the medical director of Parkway Cancer Centre, has been treating cancer patients for nearly 20 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.
Nasopharyngeal cancer is the 6th most common cancer among males in Singapore.
|
