Advances in Cancer Treatment

One in three people in developed countries will suffer from cancer. And one in four wll lose their lives to this dreaded disease.

What exactly is cancer?

The term “cancer” originated from the Greek term for “crab”. This description came from a physician-philosopher in ancient Greece- Hippocrates. When he first studied the nature of cancerous growths, the typical appearance of cancer as a mass with extension and invasion of the surrounding normal organ reminded him of the appearance of a crab with legs extending out of a body.

Cancer cells evolve from normal cells. The behavior of normal cells is regulated by the genetic code. They multiply, grow and die a natural death in a controlled fashion. However, the genetic code can be frequently damaged. Cells are usually able to self-repair the damage. Cells that fail to self-repair will usually undergo self-death. However, if a damaged cell fails to self-repair or undergo self-death, this abnormal cell may then multiply and grow in an uncontrolled fashion with abnormal characteristics enabling it to invade its surrounding and to spread through the blood circulation to other parts of the body leading to damage of vital organs and ultimately, death.

Many factors may contribute to the damage of the genetic code of cells and also to the lost of ability of self –repair. Some factors are inherited. Other factors involve the environment such as pollution and radiation. Life-style factors such as cigarette smoking and the use of alcohol also play a significant role.

The growth of cancer cells occurs in an exponential way. By the time a cancer can be detected, it is usually at lease 1 centimeter in size. A one-centimeter tumor carries within itself 1 billion cancer cells. It would have under gone the multiplication process 30 times. If the tumor were to undergo the cycle a further 10 times, there would be a trillion cancer cells in the body invariably causing death.

The symptoms of cancer depend on the site of the growth. Lung cancer, for instance, typically cause cough, chest pain and shortness of breath. Unfortunately, early cancer often produces no symptoms. By the time any discomfort is felt, the cancer is often advanced and the window of opportunity for a cure would have been lost.

The rapid rate of growth of cancer cells and the propensity to disseminate, makes early detection a corner stone of the successful fight against the disease. Screening mammogram, Pap smear and colonoscopy are tools that have been successfully employed for the early detection of breast, cervix and colon cancer respectively. With advances in technology, non-invasive means of cancer screening, such as virtual colonoscopy using advanced 64-slice tomography, is fast gaining popularity.

The treatment strategy for cancer has to be customized according to the tumor-type, the stage of the cancer as well as the characteristics of the patient.

Surgery remains an important corner stone of cancer treatment. The total surgical removal of a tumor is often necessary to achieve a cure. Advances in surgical care aim to reduce the morbidity of surgery without compromising the cure rate. A technique for breast cancer surgery known as axillary sentinel lymph node biopsy is now a widely accepted alternative to the traditional procedure of removal of large number of axillary lymph nodes which may lead to a higher incidence of chronic swelling of the affected arm.

In the field of radiation, image guided radiotherapy intensity modulated radiotherapy promises to deliver the required treatment to the tumor in a far more accurate way thereby improving treatment effectiveness while at the same time, reducing treatment related side effects.

Chemotherapy advancement has made impressive strides. While more effective treatments are available, conventional chemotherapy nevertheless suffers the drawback of significant associated toxicity. The problem arises from the relatively non-specific mechanism of action of most chemotherapy leading to damage of not only cancer cells, but also of normal cells of the body. More potent combinations of chemotherapy therefore often carry with them more severe side effects. In the quest for better treatment, specific therapy that targets the cancer cells and boosts efficacy while minimizing the “collateral damage” to normal cells of the body, remains the holy grail of anti-cancer treatment strategy.

Over the last few years, targeted therapy has become a reality. Anti-cancer drugs now have characteristics of “smart bombs” with the ability to home in to destroy caner cells while sparing the normal cells of the body. The era of “smart drug” has thus arrived.

In the field of early breast cancer treatment, the use of the antibody HerceptinÒ in patients with tumors displaying the target has lead to a dramatic decrease in relapse rate not seen in several decades. In the treatment of non-Hodgkin lymphoma, the use of the antibody rituximab in patients with tumors displaying the target has lead to a dramatic decrease in relapse rate not seen in several decades. Further development in the field has yielded a newer generation of radioactive monoclonal antibodies such as ZevalinÒ with promising results in early clinical trials.

The treatment of lung cancer has also seen important breakthroughs in the recent years. The use of the antibody AvastinÒ has improved the survival in advanced lung cancer over the use of conventional chemotherapy alone. Apart from antibodies, a class of special molecules has been developed to block specific targets on cancer cell responsible for cancer growth. Members of this class of drugs, IressaÒ and TarcevaÒ have entered clinical use and have found applications in the treatment of advanced cancer of the lung. Their favorable side effect profile and ease of oral administration are especially attractive. These drugs have made available a treatment option for patients who are either unable to receive chemotherapy or who suffer from tumors that are not responsive to chemotherapy.

These improvements give us cause for optimism in our relentless pursuit of better cancer treatment.


Dr Wong Seng Weng
MBBS (Singapore), MRCP (UK), FAMS (Medical Oncology)
Consultant Medical Oncologist & Physician
The Cancer Centre, Paragon Medical

Medical Care for the Elderly

The medical standard in Singapore has long been highly regarded in Asia, and is evident from the many overseas patients seeking medical care in Singapore.

While Singapore is medically advanced among her neighbours, medical care can only reach patients who are willing to reach out to receive help.

Elderly in particular, often refuse to go to a clinic or hospital to seek treatment when they are struck with illness or suffer a relapse from an existing condition. They often brush off with an excuse that “they are alright” or “there is no big deal”. The common reasons why many elderly are disinclined to visiting a medical facility are because,

1. They feel that medical fees are exorbitant.
2. They detest taking medicines.
3. They fear of being admitted to the hospital after reaching there, and eventually die at the hospital. This is especially believed by those who are very old, or had an existing condition (e.g. heart attack) that is very serious.
4. They are unwilling to travel as they are physically weak due to deteriorated muscles, and believe that they will be a burden their family members when they have to accompany them to the clinic or hospital.

However advanced we are in the medical arena, there is no way to help these group of people if they are unwilling to seek for help. Family members often find themselves in a dilemma as they are unwilling or find it difficult to “compel” their elders to seek medical assistance. Some of these cases were delayed until the damage was irreversible.

In 2002, 2 doctors decided to look into these problems and thought of how to bring the hospital to these people if they refused to go to one. As healthcare professionals, they felt that they should not just be good at treating and healing, but they should also be able to help all those who needed medical help. MW Medical was born with these objectives in mind.

MW Medical created a new process to bring hospital care to the home, and the 2 doctors become “operationally ready medical doctors”. They would perform house calls at the ring of the phone, reaching the patient’s doorstep fully equipped with portable machines purchased from different parts of the world.

At reasonable rates, most families do not have to hesitate to call for medical assistance. Neither do they need to worry of having to persuade their elderly member to visit a clinic or hospital for medical treatment.

A year later, premier home services were started with Mobiledoctor, Mobilenurse, and shortly after that, Mobiletherapist. Mobiledoctor was the first licensed clinic specialising in providing house call medical care.

Mobiledoctor operates 24/7, making house call services available day and night throughout the year and bringing healthcare standards equivalent to that of a hospital.

Mobilenurse is dedicated to and stays with the patient at his premises for the duration of the treatment and procedure, and can provide up to 12 hours private nursing duties. A nurse in the hospital is assigned to several patients in a ward and is not dedicated to any particular patient.

To MW Medical, patients have the right to choose to stay at home to receive medical care. MW Medical’s services had solved the dilemma faced by many families and achieved her objective of bringing hospital healthcare to the patient’s home. Elderly receives their well-deserved medical assistance the way they want it to be. The service had also transformed into a concept known as Hospital@Home.