the big C

Cancer is the No. 1 killer in Singapore. Here, oncologists take a look at five common cancers – their symptoms, treatments and prevention.

lung cancer Symptoms: Shortness of breath, coughing up blood, chronic coughing, chest and abdominal pains. Smokers have the highest risk of developing lung cancer. Treatment methods: Surgery, chemotherapy and radiotherapy. Varying combinations of these methods are commonly used depending on the cell type, stage of disease and the aim of treatment. Oncologists (doctors specialising in cancer) will be able to advise on the best combinations for treatment. Help prevent it: Active and secondary tobacco smoke exposure should be avoided at all costs. Screening can help to detect lung cancer. To avoid lung cancer, active and secondary tobacco smoke exposure should be avoided at all costs. liver cancer Symptoms: There are few, if any, in the early stages. In the later stages, jaundice (yellowing skin and eyes) commonly occurs due to liver tissue damage. Bloating of the abdomen may also occur. Sudden abdominal pains may occur if the tumour ruptures. Treatment methods: Surgery and liver transplantation is the only cure for liver cancer. However, surgery is possible for only 20-25 per cent of patients and not possible if the liver has been damaged by cirrhosis (hardening of the liver) or hepatitis. Other methods, including chemotherapy, radiotherapy and hormonal therapy are largely palliative, which is concerned with improving the quality of life, but is not a cure. Help prevent it: Alcohol abuse can lead to liver cirrhosis and this dramatically increases cancer risk. Also, the risk of an individual with hepatitis B or C getting liver cancer is 100 times more than that of a normal person.      Hepatitis B and C are sexually transmissible, hence safe and responsible habits are, as always, highly advisable. stomach cancer Symptoms: Does not show symptoms, or only non-specific symptoms, in its early stages. In its later stages, patients often suffer from abdominal pains, nausea, vomiting, diarrhoea or constipation, and dramatic weight loss. Treatment methods: Typically, removal of the tumour through surgery, followed by chemotherapy and radiotherapy. Help prevent it: Have a diet with plenty of fruits and vegetables, and low salt intake. Avoid smoking and second-hand smoke. prostate cancer Symptoms: Most early stage prostate cancers do not produce symptoms. They are picked up incidentally during general health screening or during treatment of an associated benign condition known as benign prostatic hyperplasia (BPH). Symptoms of BPH are frequent urination, increased urination at night, blood in the urine, difficulty starting and maintaining a steady flow of urine, and painful urination. Painful ejaculation and impotence are not common symptoms of prostate cancer. Treatment methods: If the cancer has not metastasised (spread to other parts of the body), radiotherapy or surgery is preferred. If it has spread, then hormonal therapy or chemotherapy will be done. Help prevent it: In general, early detection is the best preventive measure. Consult a doctor if you have the symptoms cited above. Increasing your intake of lycopene (found in tomatoes), soya proteins and Omega-3 fatty acids (from oily fish) and stopping smoking may also decrease the risk of prostate cancer.

nasopharyngeal cancer Symptoms: A painless lump in the neck, excessive nose discharge or blockage, or bleeding, decreased hearing or ringing in the ears, or unusual pain or numbness over the face, double vision or headache. Treatment methods: In its early stages, radiotherapy is used; in advanced cancer, chemotherapy is added to improve the efficiency of radiotherapy. Surgery is reserved as an option if the cancer recurs in spite of radiotherapy. Help prevent it: Eating plenty of fresh fruit, green vegetables and other sources of vitamin C will lower your cancer risk. Avoid taking excessive amounts of salted fish and other preserved foodstuff. skin cancer Symptoms: Discolouring in parts of the skin, sores or changes in the skin that do not heal, skin ulcers, and changes in existing moles. Treatment methods: Minor skin cancers are very treatable by surgery or radiotherapy. However, if the cancer has metastasised, then other techniques such as chemotherapy may be used as well. Help prevent it: Avoid sunburn, especially in the childhood and teenage years. It is also important to minimise exposure to UV radiation. Steer clear of outdoor activities from 10am to 4pm, and use sunblock lotion and protective clothing when you’re outdoors. Avoid sunburn, especially in the childhood and teenage years. Steer clear of outdoor activities from 10am to 4pm, and use sunblock lotion. lymphoma (cancer involving lymphocytes, a particular type of white blood cell) Symptoms: Painless swellings in the neck, armpits and/or groin. In about a third of the patients, there is unexplained fever, weight loss or night sweats. Treatment methods: There are many different subtypes of lymphoma and treatment differs depending on the subtype. Treatments range from radiotherapy (early stages) to chemotherapy and bone marrow transplant. Help prevent it: There are no specific prevention measures for lymphoma. It has, however, been closely associated with abnormally decreased immune systems, which may be present from birth or caused by viruses such as the HIV virus. Hepatitis B and C are sexually transmissible, hence safe and responsible habits are, as always, highly advisable.

8 warning signs These signs do not always mean cancer but if they persist, see your doctor at once. • A sore which refuses to heal • Any unusual bleeding or discharge • Any change in normal bowel habits • Any change in a mole or wart • Persistent indigestion or difficulty in swallowing • Persistent hoarseness or cough • Impairment of hearing with noise in the same ear

what’s new The newest therapies target the cancer cells with greater accuracy and precision than ever before. Two such examples: • Advanced Radiotherapy Techniques, which allow doctors to target tumours more precisely, thereby dealing less collateral damage to neighbouring cells and in turn reducing side effects • Targeted Therapy, with new treatments like "designer" drugs which maximise the therapeutic effect on the cancer cells and limit the toxic effects on the normal cells.

cancer screening As each individual is unique, there is no standard battery of tests that is suitable for everyone. Screening for colorectal and liver is recommended and has been proven to be effective.

Cancer Type	Screening Test	When	Who
COLORECTAL	1. Faecal Occult Blood Test (FOBT) and Digital Rectal Examination (DRE) 2. Sigmoidoscopy 3. Colonoscopy 4. Barium Enema	Yearly Every 5 years Every 10 years Every 5 to 10 years	- Individuals 50 years and above - Individuals 45 years and above with family history of colorectal cancer or polyps
LIVER	1. Alpha Fetoprotein 2. Ultrasound examination	Every 6 months Yearly	Chronic Hepatitis B and Hepatitis C patients Patients with liver cirrhosis

The Neoplasm Interception Programme (NIP) at National Cancer Centre Singapore (NCCS) offers thorough and customised screening for major cancers tailored to the patient’s risk profile. Call 6436-8383.

NCCS operates several specialist oncology clinics in chemotherapy, radiation and surgery as well as hormonal therapy and biological therapy. Counselling services are also available. Call 6436-8000 or visit www.nccs.com.sg.