Tuesday, December 8, 2015

A Dish of Hope

Share About My Friend's Journey

https://sparkatncis.wordpress.com/2015/02/03/issue-4-a-dish-of-hope/#more-129

Issue 4 – A Dish of Hope

Yvonne, Stage 4 Nasopharyngeal Cancer Survivor
Yvonne, Stage 4 Nasopharyngeal Cancer Survivor aka The Foodie
Ask any Singaporean about the best part of Singapore and their answer would be the same – her food. Known far and wide for her culturally diverse mix of food bound to whet just about anyone’s appetite, it is hard to resist the tantalising spread of food across Singapore, which is no wonder why some would go the distance by travelling from the East to the West and vice versa, just to satisfy their food cravings.
Meet Yvonne, otherwise also known as a foodie, defined as someone who has an ardent interest in food and seeks out food experiences as a hobby. In the flesh, one would never think of Yvonne as a foodie; petite and unreflective of a person with a voracious appetite, Yvonne pleasantly surprised us with her love for food.
However, life for Yvonne has not always been peachy and her story is testament to not taking the littlest things such as eating, for granted.


Lost Childhood
 Yvonne as a young girl pictured with her grandmother, her primary caregiver growing up
Yvonne, as a young girl pictured with her grandmother

Her primary caregiver growing up 42 years old this year, Yvonne’s troubles began when she was just a young girl. Growing up sandwiched between her parents’ tumultuous marriage, Yvonne bore the brunt of a fruitless marriage when her parents finally decided to divorce. The youngest child in the family, Yvonne was cast to her grandmother, while her mother continued to care for both her elder sister and brother. Isolated and neglected from her parents’ love, Yvonne found love and refuge under her grandmother’s wings who took it upon herself to care and provide for her till adulthood.
A child estranged from her parents, Yvonne’s childhood was peppered with troughs. When both her parents remarried, she once again found herself caught between two separate families, with little emotional and physical attachment to either. It was as though she was the missing piece to the puzzle; even though she belonged somehow, but was ultimately still lost without any sense of belonging.

 Yvonne's children Sean, Dawn & Gwen
Yvonne’s children Sean, Dawn & Gwen

The Rainbow after the Storm
When she was 21, Yvonne saw a glimmer of hope when she met the love of her life, Eddie, through her cousin. In the blink of an eye, Eddie and her now share a beautiful marriage of 21 years and counting, as well as three lovely children, Gwen, Sean and Dawn, aged 20, 18 and 13 years old respectively.
Y
Eddie, Yvonne & youngest daughter, Dawn enjoying a fun day out

A victim of divorce, Yvonne fully understands the importance of family and treasures every single moment spent with her family. She brightens up as she tells us of her family’s love for bowling and of course, their all-time favourite activity, eating! She giggles as she referenced her husband to being the “jest of the family”, constantly jostling the family into high spirits with his comical antics. Her voice lowered into a note of seriousness as she expressed her heartfelt love for her husband, and how thankful she was to have met him.

Yvonne with her favourite sinful indulgence - ice-cream waffles from Kovan
Yvonne with her favourite sinful indulgence – ice-cream waffles from Kovan

For the Love of Food
Yvonne then let us in on her favourite food haunts; a fan of local food, Yvonne’s comfort food come in the form of ice-cream waffles, chicken chop and steak, located at Kovan. She also delights in Xiaolongbaos, a type of steamed bun that originates from the Jiangnan region of China, found in Causeway Point shopping mall. Her eyes sparkled as she enthusiastically added Serangoon and Marsiling to the list, her favourite dishes there comprising of Hor Fun (a type of Chinese noodles made of rice), crispy noodles, bitter gourd fish soup and Wonton (dumpling) noodles.

A Twist of Fate
A trip down memory lane caused Yvonne’s lips to curl downwards as she reminisced the time when food was not her friend. The year was 2011 when she discovered swollen lymph nodes on the left side of her neck; a trip to her nearest General Practitioner diagnosed her with a bacterial infection to be treated with antibiotics. However, the swelling never subsided and one year later, to her horror, she discovered that the lymph nodes on the right side of her neck were swollen too.

IMG-20140815-WA0072
Yvonne (top row, left) with her family & friends who helped her tide through the difficult times

A delve into her family history uncovered her family’s run-in with cancer; her mother was a victim of cervical cancer, and her sister, a victim of throat cancer which she eventually succumbed to at age 40. Yvonne was then scheduled for a blood test.
20 April 2012 – A date that remains permanently etched in Yvonne’s mind as it was the day Yvonne found herself diagnosed with Nasopharyngeal Cancer (NPC). Her world came crashing down as a biopsy revealed her to be suffering from Stage 4 NPC, a large tumour located behind the left side of her nose.

Yvonne with her youngest daughter Dawn
Yvonne posing for a wefie with her youngest daughter, Dawn

Tsunami of Bad News
Upon hearing the news, Yvonne found herself in the shoes of a young girl she once filled years ago, lost and scared. However, this time round, she was not alone. Her husband and friends were overwhelmed with shock and sadness at the diagnosis and to Yvonne, it was as though the happy life she built for herself was slowly crumbling away.
Another wave of bad news followed – Yvonne was told that she might lose her sense of taste and was advised to extract all her wisdom teeth before commencing on treatment. To someone whose life passion revolved around food, the news came as a huge blow. Yvonne vividly recalled how the news set her off on a food rampage to conquer all her favourite foods to prepare for the worst case scenario.

Yvonne celebrating her birthday with her husband, Eddie
Yvonne celebrating her birthday with her husband, Eddie

The Route to Recovery
On 23 May 2012, Yvonne embarked on her chemotherapy treatment that lasted over a period of four months. She shared with us her struggles as an inpatient; with the treatments often leaving her drained, fatigued and waned. Although dispirited, Yvonne kept her options open and never lost hope, even participating in a research drug study that used novel drugs aimed at shrinking tumourous growths in concurrence with chemotherapy and radiation therapy treatment.
Yvonne & her family who supported her through the stormy times
Yvonne & her family who supported her through the stormy times

The course of treatment was very trying, said Yvonne as she suffered from temporary hearing loss, blistered skin and an inability to swallow food and drinks. However, she found comfort in her loved ones who provided her with both emotional and physical support during this period. No longer having to fight her battles alone, Yvonne’s family and friends took turns to accompany her down for her treatment, a gesture she is truly appreciative of.
Yvonne shared of how she drew strength from her doctors, as well as the NPC Support Group, which she considers one of the biggest blessings in her life.


Yvonne (left) celebrating Chinese New Year with her friends

To Yvonne, the NPC Support Group members are more than just beacons of hope. Coming from all walks of life, battling and overcoming different stages of cancer, their forthcoming passion and enthusiasm to help others in the same boat has touched Yvonne’s heart and shaken its core. To her, they are now her friends, her family, united in strength and hope. It was with their support, that she got a better hold on what to expect during her cancer journey, and how to cope.

Yvonne celebrating Chinese New Year with her NPC oneHeart Support Group family
Yvonne (extreme right) celebrating Chinese New Year with her NPC Support Group family

After five cycles of chemotherapy and thirty-three sessions of radiation therapy, Yvonne’s perseverance has paid off. Fast forward to today and she has officially been declared cancer-free for two years now. Yvonne believes she walked out of battle stronger than she ever was, and has newfound joy, love and inner peace that have since shaped her perception of life.

A Dish of Hope
A survivor who has emerged courageously from battle, Yvonne now has a different take on life. To her, time is now tagged with a value, and every moment has to be spent wisely, on things she holds dear to, particularly spending time with her family and loved ones.
Apart from bowling and eating, Yvonne has also acquired a myriad of new hobbies under her belt, ranging from singing, swimming, zumba to yoga, healthy exercises that are beneficial to her health and personal wellbeing.
Yvonne (right) and fellow cancer survivors at the NCIS Celebrates Life Party 2014
Yvonne (right) and fellow cancer survivors at the NCIS Celebrates Life Party 2014

Still an active member of the NPC Support Group, the once introverted Yvonne has now broken out of her shell and relishes every opportunity to inspire and motivate others around her, to fight arm in arm with fellow cancer patients. She no longer lives life in the fast lane and has learnt to slow down and not push herself too hard, be contented and appreciate life to the fullest, let go of any misgivings and above all, live life in moderation.
Battered but not broken, Yvonne wants others to know that life is an adventure, regardless of the circumstances one may be in. A strong heart and mind is the recipe to beating the disease and the journey to recovery will reward you with strength, inspiration and hope.
Yvonne (right) at the finish line of a marathon
Yvonne (right) at the finish line of a marathon

Complete Article About Nasopharyngeal Carcinoma

http://www.webmd.com/cancer/nasopharyngeal-cancer

Nasopharyngeal Cancer

Nasopharyngeal cancer is a rare type of head and neck cancer. It starts in the upper part of your throat, behind the nose. This area is called the nasopharynx.
The nasopharynx is precariously placed at the base of your skull, above the roof of your mouth. Your nostrils open into the nasopharynx. When you breathe, air flows through your nose into your throat and nasopharynx, and eventually into your lungs.
Nasopharynx
Nasopharyngeal cancer is also called nasopharyngeal carcinoma (NPC).

Causes of Nasopharyngeal Cancer

Scientists are not sure what exactly causes nasopharyngeal cancer. However, the cancer has been strongly linked to the Epstein-Barr virus (EBV).
Although EBV infection is common, not everyone who has EBV will get nasopharyngeal cancer. In the U.S., most people who have had an EBV infection never have long-term problems. That's because the body's immune system destroys the virus.
But sometimes, genetic material (DNA) from the virus mixes with the DNA in the cells of the nasopharynx. The change in DNA causes cells to grow and divide abnormally, causing cancer. This is rare.
The chance that EBV will fuel cancer growth goes up if you eat a diet rich in salt-cured fish and meat. That type of diet is common in Asia, particularly China. Scientists believe that chemicals in such foods further damage the DNA in cells.

Who Gets Nasopharyngeal Cancer?

Only about seven in 1 million people in North America get this type of cancer, according to the American Cancer Society.
The cancer is most common in southeast China. It is also much more common in:
  • Other parts of Asia
  • North Africa
  • Inuit populations of Alaska and Canada
  • Chinese and Hmong immigrant groups in the U.S.
In the U.S., nasopharyngeal cancer has also been seen in African-Americans, Hispanics, and white people.
You are more likely to get this type of cancer if you:
  • Are male
  • Younger than 55
  • Eat a diet rich in salt-cured fish and meats
  • Have a family history of nasopharyngeal cancer
  • Have certain genes linked to cancer development
  • Have come in contact with EBV
Some, but not all, studies have found a higher risk of nasopharyngeal cancer in people who:
  • Smoke
  • Drink a lot of alcohol
  • Work around wood dust or a chemical called formaldehyde

Nasopharyngeal Cancer Symptoms

Symptoms of nasopharyngeal cancer may include:
Keep in mind, such symptoms are more likely to occur with many other diseases and health conditions that are less serious than nasopharyngeal cancer.
If you have any of the above symptoms, see your doctor or nurse. Only an experienced medical person can diagnose or rule out nasopharyngeal cancer.

How Nasopharyngeal Cancer Is Diagnosed

Your doctor or nurse will examine you. This includes a detailed look at your ears, nose, and throat. You may be sent to a doctor that specializes in these areas, called an otolaryngologist.
The doctor or nurse will also feel your neck. Most patients with nasopharyngeal cancer have a lump in the neck. This is a sign that the cancer is spreading to the lymph nodes.
Small mirrors and lights or a flexible, lighted tube may be placed through your mouth or nose to help the doctor better view the nasopharynx. This is called a nasopharyngoscopy. It helps the doctor check the area for abnormal growths, bleeding, or other problems.
If the exam is abnormal, your doctor may recommend a biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope.
A biopsy may be taken during the nasopharyngoscopy. If there is a lump in your neck, the biopsy may be done by placing a very thin, hollow needle into the lump.
Imaging tests can help spot nasopharyngeal cancer or determine if it has spread. Imaging tests may include:
The following tests may also be done to confirm or rule out cancer:
If you are diagnosed with nasopharyngeal cancer, other tests will be done to determine if and where the cancer has spread. This is called staging.
There are four stages of nasopharyngeal cancer. The lower the number, the less the cancer has spread to other parts of the body.
  • Stage 1 is called early stage nasopharyngeal cancer.
  • Stage 2 is called intermediate-stage nasopharyngeal cancer.
  • Stages 3 and 4 are called advanced or late-stage nasopharyngeal cancer.
  • If nasopharyngeal cancer returns, it is called recurrent cancer.

Nasopharyngeal Cancer Treatment

If you are diagnosed with nasopharyngeal cancer, you will need regular follow-ups with your medical team before, during, and after treatment.
Your treatment will depend on many things, including:
  • Location of the tumor
  • Stage of the tumor
  • Your overall health
Treatment may include:
Radiation Therapy . Radiation therapy uses X-rays to kill cancer cells and stop them from growing. It is the standard treatment for early stage nasopharyngeal cancer.
One type called IMRT delivers high-dose radiation directly to the tumor, while minimizing damage to nearby healthy tissue. It may cause fewer side effects or complications than conventional radiation treatment to the nasopharynx, which can lead to:
Surgery. Surgery can cure nasopharyngeal cancer if all of the tumor and cancer cells are removed. But the surgery can be difficult because of the tumor's location near the skull. It may cause permanent damage to the eye and other nearby structures.
Not all people with nasopharyngeal cancer can have surgery. Your doctor will consider the location and stage of your tumor when discussing your treatment options.
Biologic drugs. Biologic drugs affect how your body's immune system fights disease. They are also called monoclonal antibodies.
A biologic drug called Bevacizumab blocks production of a substance called vascular endothelial growth factor (VEGF). Studies show that patients with nasopharyngeal cancer who have lower levels of VEGF are more likely to remain disease-free after treatment. Bevacizumab is currently being evaluated to see if it will help improve your overall survival when combined with other treatments, such as chemotherapy. Other biologic drugs are also under investigation and have shown promising results in clinical trials.
Chemotherapy . Chemotherapy uses drugs to kill cancer cells. By itself, it is not usually helpful for treating nasopharyngeal cancer. But it may help you live longer when combined with radiotherapy or biological drugs.
Palliative therapy. At this time, there is no cure for head and neck cancer that has spread, or metastasized. The goal of treatment is to control your symptoms and make you as comfortable as possible. This is called palliative therapy.
Clinical trials. If treatment does not work, consider joining a clinical trial. Researchers are always testing new ways to treat cancer, and they need your help. Ask your doctor or nurse if there are any clinical trials on nasopharyngeal cancer in your area.

 Can Nasopharyngeal Cancer Be Prevented?
Taking these steps may lower your risk of nasopharyngeal cancer:
  • Eat a diet rich in fruits and vegetables
  • Avoid salt-cured fish and meats
  • Do not smoke
  • Do not drink a lot of alcohol

Another Early Detection Article Of Nasopharyngeal Carcinoma

http://www.hindawi.com/journals/ijoto/2011/638058/

Abstract

Nasopharyngeal carcinoma (NPC) is a unique disease with a clinical presentation, epidemiology, and histopathology differing from other squamous cell carcinomas of the head and neck. NPC is an Epstein-Barr virus-associated malignancy with a marked racial and geographic distribution. Specifically, it is highly prevalent in southern China, Southeast Asia, and the Middle East. To date, most NPC patients have been diagnosed in the advanced stage, but the treatment results for advanced NPC are not satisfactory. This paper provides a brief overview regarding NPC, with the focus on the early detection of initial and recurrent NPC lesions.
1. Introduction

Nasopharyngeal carcinoma (NPC) is a nonlymphomatous squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx. This neoplasm shows varying degrees of differentiation and is frequently seen in the pharyngeal recess (Rosenmüller’s fossa), posteromedial to the medial crura of the Eustachian tube opening in the nasopharynx [1].

NPC is a distinct form of head and neck cancer that differs from other malignancies of the upper aerodigestive tract in terms of its etiology, epidemiology, pathology, clinical presentation, and response to treatment [2]. Outside of endemic areas in Southeast Asia, NPC is rare, occurring in less than 1/1,000,000 people [3]. In North America, NPC accounts for approximately 0.2% of all malignancies, with approximately 0.5–2 cases per 100,000 males and about one-third of that in females [4–6]. The incidence of NPC reportedly remains high among Chinese people who have emigrated to Southeast Asia or North America, but is lower among Chinese people born in North America than in those born in Southern China [7, 8]. This finding suggests that genetic as well as environmental factors play a role in the cause of the disease [9].

The mainstay of NPC treatment is radiotherapy, but treatment results for advanced NPC is not satisfactory. The focus of this review is to provide an overview of NPC, especially the recent insights regarding early detection of NPC.
2. Epidemiology and Etiology

NPC is a relatively rare malignancy in most parts of the world. It accounts for 2% of all head and neck squamous cell carcinomas, with an incidence of 0.5 to 2 per 100,000 in the United States [10]. However, it is endemic in many geographical regions, including Southern China, Southeast Asia, Japan, and the Middle East/North Africa [10, 11]. Ho [12] reported that NPC is the third most common malignancy among men, with an incidence of between 50 per 100,000 in the Guangdong Province of Southern China. Emigration from high- to low-incidence areas such as the United States and Canada reduces the incidence of NPC in first-generation Chinese, but it still remains at seven-times the rate in Caucasians [8].

NPC presents as a complex disease caused by an interaction between chronic infection with oncogenic gamma herpesvirus Epstein-Barr virus (EBV) and environmental and genetic factors, involving a multistep carcinogenic process [10]. EBV exists worldwide, infecting over 95% of the global adult population [13]. In Hong Kong, 80% of children are infected by 6 years of age, and almost 100% have seroconverted by 10 years of age [14]. Although primary EBV infection is typically subclinical, the virus is associated with the later development of several malignancies, including NPC [11]. It is transmitted by saliva, and its primary infection occurs during childhood with replication of the virus in the oropharyngeal lining cells, followed by a latent infection of B lymphocytes (primary target of EBV). Elevated titers of EBV-associated antigens (especially of IgA class), a latent EBV infection indentified in neoplastic cells of virtually all cases of NPC, and the clonal EBV genome consistently detected in invasive carcinomas and high-grade dysplastic lesions suggest a critical role of EBV in the pathogenesis of NPC in endemic areas [10].

Nonviral exposure associated with the risk of NPC involves the consumption of salt-preserved fish, a traditional staple food in several NPC-endemic areas [11]. In studies of Chinese populations, the relative risk of NPC associated with weekly consumption, compared with no or rare consumption, generally ranged from 1.4 to 3.2 per 100,000 whereas that for daily consumption ranged from 1.8 to 7.5 [15–22]. Salt-preserved foods are a dietary staple in all NPC-endemic populations [23]. Thus, this dietary staple pattern may explain part of the international distribution of NPC incidence. The carcinogenic potential of salt-preserved fish is supported by experiments in rats, which develop malignant nasal and nasopharyngeal tumors after salted fish consumption [18, 24, 25]. The process of salt preservation is inefficient, allowing fish and other foods to become partially putrefied. As a result, these foods accumulate significant levels of nitrosamines, which are known carcinogens in animals [23, 26, 27]. Salt-preserved fish also contain bacterial mutagens, direct genotoxins, and EBV-reacting substances [28–30], any or all of which could also contribute to the observed association. However, there have been no prospective studies of NPC risk associations with salt-preserved fish consumption, or virtually any other environmental exposure, in endemic areas.

Several associations have been described between the frequency of human leukocyte antigen (HLA) class I genes in certain populations and the risk of developing NPC. For example, increased risk of NPC was observed in individuals with the HLA-A2 allele, particularly HLA-A0207 [31]. Recent genome-wide association studies confirmed involvement of HLA molecules in NPC generation [32, 33]. Cellular gene alterations also contribute to development of NPC, especially inactivation of tumor suppressor genes, SPLUNC1, UBAP1, BRD7, Nor1, NGX6, and LTF [34].
3. Pathology

In 1978, the histological classification guideline proposed by the World Health Organization (WHO) categorized NPC into three groups: type 1 (keratinizing squamous cell carcinoma), type 2 (nonkeratinizing carcinoma), and type 3 (undifferentiated carcinoma). The 1991 WHO classification of nasopharyngeal carcinoma divided them into two groups: squamous cell carcinoma (keratinizing squamous cell carcinoma, type 1 of the former classification), and nonkeratinizing carcinoma (types 2 and 3 of the former classification combined into a single category). Nonkeratinizing carcinoma was further subdivided into differentiated and undifferentiated carcinomas [35]. This classification is more applicable for epidemiological research and has also been shown to have a prognostic significance. Undifferentiated carcinomas have a higher local tumor control rate with treatment and a higher incidence of distant metastasis than do differentiated carcinomas [36, 37].  

Published data indicate a higher proportion of keratinizing squamous cell carcinoma among all NPC in nonendemic compared with endemic areas. Some studies reported that squamous cell carcinoma accounts for approximately 25% of all NPC in North America, but only 1% in endemic areas; whereas undifferentiated carcinoma accounts for 95% of all cases in high-incidence areas, but 60% of cases in North America [9, 10, 38].
4. Initial Treatment

Radiotherapy is the mainstay of treatment for NPC. Typical radiation fields encompass the adjacent skull base and nasopharynx. Fields are bilaterally directed and include the retropharyngeal lymphatic drainage pathway. The control rate on conventional radiotherapy is 75 to 90% in T1 and T2 tumors, and 50 to 75% in T3 and T4 tumors. Because of the high incidence of occult cervical node metastasis, prophylactic neck radiation is recommended even in N0 cases [39]. The control of cervical nodal regions is achieved in 90% of N0 and N1 cases, and about 70% of N2 and N3 cases [40]. It is mandatory to keep the treatment schedule because interrupted or prolonged treatment reduces the benefits of radiotherapy [41].

Recent studies have suggested that addition of chemotherapy to radiotherapy improves the treatment results in patients with nasopharyngeal carcinoma. Phase III randomized intergroup study 0099 showed that patients treated with radiation alone had a significantly lower 3-year survival rate than those receiving radiation with cisplatin and 5-fluorouracil chemotherapy [42]. A meta-analysis of chemotherapy for NPC conducted by Baujat et al. [43] employed an individual patient data design. They reported a definite improvement of the 5-year survival rate due to the addition of chemotherapy (56% with radiotherapy alone versus 62% with chemoradiotherapy). In addition to these findings, other phase III or meta-analysis studies also reported the superiority of concurrent chemoradiotherapy versus radiotherapy alone [44–46]. The above-described reports suggest the benefits of the addition of chemotherapy, especially in advanced NPC cases. However, there is still debate on the effectiveness of the addition of chemotherapy, and issues regarding the addition of adjuvant chemotherapy are even more controversial [40].
5. Early Detection of Nasopharyngeal Carcinoma

Wei and Sham [9] divided symptoms presented by NPC patients into four categories: (1) symptoms caused by the presence of a tumor mass in the nasopharynx (epistaxis, nasal obstruction, and discharge), (2) symptoms associated with dysfunction of the Eustachian tube (hearing loss), (3) symptoms associated with the superior extension of the tumor (headache, diplopia, facial pain, and numbness), and (4) neck masses. Because symptoms related to NPC in the early stage are usually nonspecific, most NPC patients are diagnosed in the advanced stage. As treatment results for NPC are not satisfactory in the advanced stage, early diagnosis and appropriate management are important to achieve favorable treatment results. The development of a good primary NPC screening protocol may thus contribute to the early detection and improve the treatment outcome.

The endemic form of NPC is associated with EBV, although the exact role of EBV in the pathogenesis of NPC remains unclear. IgA antibody titers to EBV viral capsid antigen (EBV-IgA-VCA) and EBV early antigen (EBV-EA) in immunofluorescent assays may be used for the serologic screening of NPC [47, 48]. In recent years, enzyme-linked immunosorbent assays (ELISA) employing purified recombinant EBV antigens are increasingly advocated in place of traditional immunofluorescent assays [49]. These tests frequently precede the appearance of NPC and serve as tumor markers of remission and relapse [50, 51]. Ji et al. [52] monitored EBV IgA antibody levels of NPC cases in a prospective manner. They confirmed that elevation of the EBV antibody levels preceded the clinical onset of NPC. They also reported that there is a window of about 3 years preceding the clinical onset, when the antibody level is elevated and maintained at high levels [53]. However, none of these serologic screening tests appear satisfactory to date because of low-level sensitivity or specificity. Detection of the EBV gene in nasopharyngeal swabs from symptomatic patients has been shown to be highly predictive of symptomatic NPC [54, 55].

Proteomic approaches have been applied for the analysis of malignant neoplasms. For practical usage in tumor screening, biomarkers should be measurable in body fluid samples [55]. Recently, Wei et al. [56] analyzed serum samples from patients with NPC employing proteomic analysis. In their report, four protein peaks at 4,097, 4,180, 5,912, and 8,295 daltons (Da) discriminated NPC patients with a sensitivity of 94.5% and specificity of 92.9%. Furthermore, Chang et al. [55] reported that the use of a three-marker panel (cystatin A, MnSOD, and MMP2) could contribute to improved NPC detection. Other potential markers for the diagnosis of NPC include Galectin-1, fibronectin, Mac-2 binding protein, and plasminogen activator inhibitor 1 [57, 58]. There is a possibility that the incorporation of these tests in the routine screening of NPC may enhance its early detection.

The importance of clinical syndromes, history, and clinical examination for helping the early diagnosis of NPC could not be ignored. Individuals with acquired immunodeficiency syndrome (AIDS) manifest an increased risk of NPC [59]. The most common presenting complaint is a painless upper neck mass or masses. Any adult presenting with unexplained unilateral serous otitis media should be carefully examined to rule out NPC. Endoscopy plays a key role in detecting the early NPC lesions, and endoscopic biopsy enables their definitive diagnosis. Early lesions usually occur on the lateral wall or roof of the nasopharynx. Vlantis et al. [60] reported an objective endoscopic score of abnormality of nasopharynx to predict the likelihood of NPC. However, clinicians should keep in mind the fact that detection of NPC is sometimes difficult with endoscopy. Endoscopic findings may be subtle in early NPC lesions: only slight fullness in the Rosenmüller’s fossa, or a small bulge or asymmetry in the roof. When NPC is strongly suspected, considering early diagnosis of NPC, appropriate imaging examinations and/or biopsy of the nasopharyngeal mucosa are recommended even if the mucosal surface exhibits normal appearance.

Careful attention should be paid when MRI is conducted for a patient with unilateral serous otitis media (stasis of secretions in unilateral middle ear) or cervical lymph node adenopathy. Most NPC cases originate in Rosenmüller’s fossa. Obstruction of the pharyngeal orifice of the Eustachian tube results in serous otitis media. Approximately 70% of NPC patients initially present with neck masses, and 60 to 96% of NPC patients exhibited cervical lymph node adenopathy at the time of presentation [61–63]. Neck masses are usually observed in the upper neck [40]. T1 tumors, confined to the nasopharynx, may be clinically occult, and also may be difficult to differentiate from the normal mucosa on a CT scan and MRI. However, such small tumors are usually readily evident by their less intense enhancement by gadolinium than the normal nasopharyngeal mucosa [64]. Furthermore, MRI may help to depict subclinical cancers missed at endoscopy [65]. It has been suggested that MRI is superior to 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) for the assessment of locoregional invasion and retropharyngeal nodal metastasis. PET is not suitable for detecting small retropharngeal nodes or for distinguishing retropharyngeal nodes from adjacent primary tumors [66].
6. Early Diagnosis of Recurrent Nasopharyngeal Carcinoma

To date, the modalities commonly used in the followup of patients with NPC include clinical examinations and imaging studies. Inspection with a flexible fiberscope plays a primary role in followup examinations. However, mucosal reactions to radiotherapy make it difficult to find early recurrent lesions. Secretions and crust covering the nasopharyngeal mucosa also hamper the early detection of local recurrence. In addition, the detection of submucosal or deep-seated recurrent lesions is difficult with fiberscopic examinations. If recurrent NPC lesions can be diagnosed properly and in a timely manner, these lesions may be treated by chemotherapy, reirradiation, such as further conventional external beam radiotherapy, brachytherapy, and stereotactic radiotherapy, or surgery [9]. Regarding surgery, conventional nasopharyngectomy for recurrent NPC lesions can still result in serious complications. However, early recurrent lesions (such as rT1 lesions) may be effectively treated with laser nasopharyngectomy [67]. Diagnostic uncertainty may result in delayed treatment, which reduces the life expectancy of patients with recurrent NPC lesions.

Narrow-band imaging (NBI) is a novel technique that enhances the diagnostic sensitivity of endoscopes for characterizing tissues using narrow-bandwidth filters in a sequential red-green-blue illumination system. Superficial mucosal carcinoma lesions, which are rarely detected using conventional endoscopy, can be observed with NBI by viewing the nonangiogenetic, microvascular proliferation pattern [68, 69]. Recently, Lin and Wang [69] applied this technique to the detection of early recurrent mucosal lesions of NPC. They reported that early recurrent lesions of NPC after radiotherapy were successfully detected by NBI coupled with conventional endoscopy.

Regarding imaging studies after initial treatment, CT and MRI are widely used for the detection of recurrent lesions. Generally, MRI is superior to CT in the detection of soft tissue abnormalities. The baseline MRI study is often conducted 2 to 3 months after termination of the initial treatment. After the baseline evaluation, close evaluation is recommended with further imaging followup every 3 to 6 months for the first 2 years posttreatment [63]. Edema induced by radiotherapy may be noted in the initial imaging studies. However, any signal abnormalities in the nasopharynx on MRI should be stable or reduced in this followup period. After 2-year followup without evidence of recurrence, the imaging interval is extended to be every 6 to 12 months [63]. Recently, the effectiveness of FDG-PET in the detection of residual or recurrent NPC lesions has been reported from several institutes. FDG-PET is increasingly being used for detection of recurrent lesions in many types of tumor. PET is reportedly useful to distinguish recurrent NPC tumors from postirradiation changes, such as tissue necrosis, fibrosis, and edema [70–73]. Liu et al. [74] reported that sensitivities of CT, MRI, and PET for the detection of residual or recurrent NPC lesions were 76, 78, and 95%, respectively. These findings suggest that PET can be a useful tool for the detection of recurrent NPC lesions. However, there are also some limitations regarding the use of PET for the detection of early recurrent NPC lesions. FDG uptake was increased by inflammatory reactions in the early period after radiotherapy [74]. Furthermore, a recent cost-based analysis suggested that it is most cost-effective to perform PET if MRI results are unclear [75].
7. Conclusions

NPC detection in the early stage is often difficult because the symptoms are not specific. EBV-related serologic tests are used as screening tools in high-risk populations, although the screening tests available in daily clinics are not satisfactory. Molecular biomarkers are under examination as a new tool for the detection of early NPC lesions. Regarding imaging modalities, MRI seems suitable for the detection of early lesions, and the routine use of PET for the initial diagnosis of NPC does not seem to be justified. The early diagnosis of recurrent or residual NPC lesions is also challenging. Postradiation mucosal reactions make a precise diagnosis difficult. PET is useful in distinguishing recurrent NPC regions if MRI findings are not definitive. NBI may also be useful in detecting early recurrent mucosal lesions. In addition to the new diagnostic modalities, improvement in the awareness of physicians and the general population regarding this carcinoma undoubtedly contributes to the earlier detection of the disease.

Wednesday, November 18, 2015

Nasopharyngeal cancer: Early detection is key

http://www.todayonline.com/daily-focus/health/nasopharyngeal-cancer-early-detection-key

SINGAPORE — It started with a nosebleed and blocked nose, which Mr Lim Kok Kiong’s family doctor had dismissed as trivial. “The doctor suggested that the nosebleed could be a case of ‘heatiness’ and even told me to boil some barley water,” said Mr Lim, 54, an outsourced business technology writer and editor. 

A second massive nosebleed several months later led him to see an ear, nose and throat specialist in 1994.

It turned out to be third-stage nasopharyngeal cancer (NPC). By then, the tumour had grown to the “size of a peach”, said Mr Lim, who was in his 30s then. 
As in Mr Lim’s case, delays in detection of the cancer are fairly common. 

Adjunct Assistant Professor Tay Hin Ngan, consultant and otolaryngologist, head and neck robotic surgeon at Mount Elizabeth Medical Centre, said that more than 70 per cent of patients were diagnosed with late-stage cancer (stage three or four disease), based on data from the Singapore Cancer Registry 2010 to 2012. 

“Most NPC patients actually present with symptoms that are easily mistaken for innocuous problems like blocked ears, similar to a feeling of water trapped in the ears after showering or swimming, blocked nose and lumps in the neck,” said Asst Prof Tay.

Neck swelling is the most common symptom. Other symptoms include persistent blood in phlegm or nasal discharge, or a one-sided headache, added Dr Soong Yoke Lim, consultant at Division of Radiation Oncology at the National Cancer Centre Singapore (NCCS) and medical adviser of the NCCS NPC Support Group, which marked its 10th anniversary last month by launching a book. 

“In our society, many patients attribute these symptoms to being ‘heaty’ and often self-medicate with traditional medicine. In addition, early-stage NPC may have little or no symptoms,” said Dr Soong.
NPC is more common among men, particularly those of Cantonese descent in the Chinese population. Mr Lim is a quarter Cantonese. NPC is the eighth most common cancer among men in Singapore. 

Known causes of NPC include genetics, regular intake of salted fish and Epstein Barr Virus (EBV) infection. It is unclear why this very common virus triggers the cancer in some people. 
 
The cancer typically strikes between the ages of 35 and 55, when patients are in the prime of their lives. 

“Many of these patients are the main breadwinners of the family. The diagnosis can have a devastating impact, not only on the patient but also the family,” said Dr Soong.
Side effects of treatment are usually more obvious than with other cancer types. Its effects may also last for months to years, even after treatment ends, which can affect the patient’s ability to return to work immediately. 

HIGHLY TREATABLE
However, developments in treatments in the past decade has significantly improved survival rates for NPC, which is particularly sensitive to radiation and chemotherapy. 

Dr Soong said: “In the past, all patients, regardless of stage, are treated with radiation alone. In the 1990s, studies done on patients with stage three and four NPC show that an addition of three cycles of chemotherapy during radiation, followed by another three cycles of chemotherapy after radiation, improves the survival of patients by 30 per cent.” 

When detected early, the survival rate for stage 1 and 2 disease is more than 90 and 80 per cent respectively.

Dr Soong added that a patient with stage three NPC now has a five-year survival rate (the chance of surviving five years after diagnosis) of 70 per cent. At the same stage, a lung cancer patient only has a 20 to 30 per cent chance of survival. 

Another development is improvement in radiation therapy technologies. “Newer technologies allow radiation oncologists to target the cancer more accurately and, at the same time, spare the surrounding normal organs, hence improving the quality of life of patients during and after radiation treatment,” said Dr Soong.

For NPC that persists or recurs after radiation therapy. Asst Prof Tay said that minimally invasive techniques are now available to surgically remove the tumour, with the aid of either a surgical robot or endoscope, a medical device consisting of a thin, flexible tube with an attached light and video camera.

Asst Prof Tay said: “Robotic and endoscopic surgical techniques allow the cancer to be surgically removed without sawing through the facial bones, making the recovery process much easier. The availability of these techniques have allowed us to achieve similar results as with more invasive surgery, but with better functional and cosmetic outcomes.”

Currently in his 22nd year of cancer survivorship, Mr Lim still experiences after-effects of radiotherapy, including persistent throat dryness, which he manages by sipping water every 15 minutes. But he is not complaining, as he treats every year after treatment as “a new lease of life”.

Currently a member of the NCCS NPC Support Group, Mr Lim is one of the cancer survivors who has shared his experience battling the disease in the group’s book, The NPC Journey. The book features a collection of personal stories and tips in coping with the side-effects of treatment. 

By sharing his experience, Mr Lim hopes to encourage newly diagnosed patients to trudge through their cancer journey: “I think it is very reassuring for new patients to see someone go through the disease and is still standing here 20 years after treatment.”


Tuesday, November 3, 2015

Try Google Translate For My Blog

First sorry for my bad english.

I checked many visitors came to my blog are from other countries. So I tried to translate my blog to other language. Finally I found a way. Today I apply google translate to my blog. Just choose other language from the side bar at the top right.

Hope with this tool, my blog can reach more friends from other countries.


Last month I joint this group on FB (Nasopharyngeal Cancer Awareness Group):

https://www.facebook.com/groups/41426522671/?fref=nf



This is a very good group with many helpful and caring people. So joint the group and we will meet there.

Friday, September 18, 2015

Pola Makan Bagi Penderita Kanker Nasofaring

Sumber : https://m.facebook.com/photo.php?fbid=1124781144218635


Apa saja pola makan yang baik untuk pasien kanker nasofaring?

Banyak pertanyaan yang muncul dari masyarakat, bagaimana pola makan yang baik untuk penderita kanker nasofaring? Apa ada pantangannya?

Modern Cancer Hospital Guangzhou akan membahasnya untuk anda!

1. Bagi anda yang tidak suka sayur dan buah, harus mencoba membiasakan diri mengkonsumsinya karena selain memberikan vitamin pada tubuh, sayur dan buah dapat membantu melawan berbagai penyakit, salah satunya untuk kanker nasofaring. Dengan kita mengkonsumsi sayur dan buah yang cukup secara rutin, akan dapat membantu pemulihan pasien dan menjaga kualitas anti body pasien.

•Konsumsi sayur dan buah ( 4-5 macam setiap hari ) seperti anggur,  apel, papaya, alpukat/kiwi/mangga, jambu merah/ strawberry/buah naga, jeruk dll. Bayam merah, bayam hijau, ginseng, daun papaya/bunga papaya, broccoli, bit, wortel, jagung dll.

•Pilih sayur dan buah yang berwarna menarik dan jangan mengkonsumsi jenis-jenis sayur dan buah yang sama dalam jangka waktu lama. Lebih baik secara kombinasi agar tubuh tidak kelebihan zat tertentu tapi kekurangan zat yang lain. Variasikan warna-warna buah dan sayurnya agar lebih menarik.

2. Makan kabohidrat bikin gemuk? Tapi bagaimana jika kabohidrat baik untuk kesehatan? Memang benar dalam studi ilmiah jika konsumsi berlebihan akan mengakibatkan obesitas, tapi kita tidak dapat menghentikan konsumsi kabohidrat.

•Untuk konsumsi sumber kabohidrat, pilih karbohidrat kompleks, contoh nasi merah, roti gandum dsb

3. Anda pecinta seafood? Apa saja jenis protein yang baik untuk tubuh? Coba simak informasi berikut. Khususnya untuk para pasien kanker!
Perbanyak makan ikan laut ( usahakan tidak makan cumi, kepiting, bandeng ), untuk ayam konsumsi ayam kampung atau ayam organic.

Apabila terpaksa makan daging merah ( daging sapi ) pilih yang rendah lemak . Dalam suatu penelitian disebutkan bahwa mengkonsumsi daging merah sebanyak lima hingga enam kali seminggu meningkatkan resiko kanker. Untuk menurunkan resiko, Institut Kanker Nasional AS menyarankan kita untuk membatasi konsumsi lemak hingga 30%. Untuk pasien kanker sebaiknya tidak mengkonsumsi DAGING lagi karena ditakutkan akan berkembang sel kankernya

4. Apa diperbolehkan pasien kanker nasofaring mengkonsumsi susu ? Jawabannya tentu! Mari simak infonya
Untuk pasien kanker nasofaring boleh mengkonsumsi susu dan olahannya tetapi pilih yang rendah lemak atau susu kedelai. Untuk Yoghurt pilih rasa plain.
Sebaiknya mulai kurangi gula ( bisa diganti madu kalau terpaksa), makanan yang mengandung nitrit, pengawet, pewarna, diasinkan, diasap.

5. Kacang-kacangan juga baik untuk pola makan pasien kanker nasofaring, seperti kacang kedelai olahan : tahu, tempe, kacang merah.

6. Untuk pasien kanker sebaiknya kurangi gorengan. Makanan yang mengandung karbohidrat seperti kentang goreng / keripik kentang akan merangsang terbentuknya senyawa pemicu kanker yang bernama akrilamida.

7. Untuk para istri/ keluarga pasien kanker nasofaring dalam memasak, hindari memasak makanan dengan suhu tinggi

8. Dalam menghidangkan makanan yang bersifat goreng untuk pasien kanker nasofaring sebaiknya menggunakan minyak goring khusus seperti Canola Oil/Olive Oil, hanya sekali pakai. Tidak boleh dipakai berkali-kali.

9. Biasakan minum dengan air putih setiap hari minimal 8 gelas.  Hindari alcohol dan minuman soft drink. Lebih baik minum air putih 8 gelas sehari

10. Hindari cemilan enak tapi tak sehat, seperti cake, permen dan aneka dessert.
Ganti camilan dengan misalnya : jagung rebus, kacang rebus, edamame rebus, chestnut, dan polong-polongan / kacang merah.

11. Apabila membuat salad sayur dressingnya pakai campuran olive oil. Jangan pakai yang mengandung lemak tinggi.

Sunday, September 13, 2015

Pengobatan Kanker di Penang

Mencermati kondisi kurs mata uang saat ini, di mana kurs SGD terus menaik. Sedangkan kurs Ringit yang hampir senasib dengan rupiah. Saat ini banyak orang dari Indonesia yang saat ini lebih memilih Penang sebagai tujuan mencari pengobatan.

Salah satu teman saya ada yang terdiagnosa kanker pita suara. Karena sama-sama pengobatannya dengan chemo dan radiasi di bagian kepala. Saya coba bandingkan biaya pengobatan antara Singapore dan Penang untuk kasus yang hampir sama. Ternyata untuk biaya chemo kira-kira biaya nya sama dengan di NUH Singapore. Mungkin karena obat tersebut sama diimport dari USA ? Yang berbeda adalah biaya pengobatan dengan radiasi. Penang lebih murah. Jika dikonversi ke rupiah beda sekitar 50 juta rupiah. Juga biaya konsultasi ke dokter pastinya lebih murah di Penang dan yang harus menjadi pertimbangan paling besar adalah biaya akomodasi.

Jika di antara pembaca bertanya mana kualitas pengobatan yang lebih baik ? Maaf saya tidak bisa menjawab karena saya belum pernah berobat ke Penang. Tulisan ini hanya membandingkan dari sisi biaya saja melihat kondisi kurs rupiah saat ini.

Berikut pengalaman sahabat saya yang keluarga nya berobat ke Penang :

Mount Miriam Cancer Hospital Penang

Mungkin sebagian orang berpikir bahwa pergi berobat ke luar negeri adalah proses yang rumit, tetapi sebenarnya mudah.

Kami tinggal di Bandung. Pada tahun 2012 ada anggota keluarga kami mengidap Breast Cancer. Setelah menjalankan proses pengobatan di Bandung dan Jakarta dalam kurun waktu yang cukup lama, kami menerima saran dari banyak orang dan dokter kami, bahwa proses dan biaya pengobatan di Malaysia boleh dipertimbangkan, kami pun mencari informasi lanjutan dan menghubungi beberapa Rumah Sakit dengan mengirimkan email. Akhirnya kami pun memilih Mount Miriam Cancer Hospital (MMCH) di Penang.

Pengalaman saya, dari pengiriman email pertama kali, tanggapan mereka sangat cepat dan ramah. Ada staff dari Indonesia yang berkomunikasi dengan kami dengan Bahasa Indonesia.

Untuk membuat janji pertemuan pertama, bisa siap dalam waktu 2-3 hari ke depan. Pada email lanjutan kami juga meminta gambaran biaya pengobatan atas rekomendasi dokter lokal, Pihak MMCH memberikan gambaran singkat atas biaya atas rekomendasi tersebut, namun pihak MMCH akan menganalisa kembali apakah cara ini sesuai dengan metode mereka.

Pihak MMCH juga memberikan gambaran biaya akomodasi di Penang, sehingga kami bisa berhitung sebelum memutuskan untuk pergi berobat ke Penang.

Dengan keterbatasan dana yang kami sekeluarga miliki, Dari estimasi ini, kami memperkirakan biaya proses rumah sakit pada saat itu hanya 30% dari biaya rumah sakit di Jakarta. Secara keseluruhan dengan akomodasi kami bisa berhemat lagi 20% bilamana kami pulang pergi ke Jakarta. Namun angka ini tidak bisa menjadi patokan karena setiap kasus pasti berbeda.                                                                                    

Website: www.mountmiriam.com
Tel: +604 - 892 3999 Fax:+604 - 890 1583
Email: enquiry@mountmiriam.com    
Office Hours:
8:30am - 5:15pm (Mon-Fri)
9:00am - 12:30pm (Sat)

Kami intensif berkomunikasi dalam waktu kurang dari satu minggu. Mereka membantu banyak hal yang sifatnya non teknis seperti penyediaan akomodasi dan penjemputan. Penjemputan dari airport untuk pertama kali disediakan cuma-cuma. Untuk akomodasi dan transportasi, kami diperkenalkan dengan agen perjalanan perorangan yang menawarkan apartemen sewaan. Agen perjalanan ini pun berbahasa Indonesia.

MMCH di mata saya sebagai orang Indonesia bukanlah rumah sakit dengan bangunan besar dan berliku-liku, dan rumit seperti rumah sakit yang saya pernah lihat di Jakarta, Bandung, mau pun Singapore. Sekilas rumah sakit ini seperti rumah sakit kecil, tetapi pengalaman yang saya alami sangat berbeda.

Sumber: www.mountmiriam.com

Saya kagum MMCH rumah sakit yang ringkas dan kompak baik organisasi maupun fasilitasnya. Jumlah dokter tidak banyak, namun selalu terlihat ditempat sepanjang hari sangat aktif. Fasilitas Ruang Konsultasi, Observasi, Lab, dan tindakan berdekatan. Dokter-dokter senior yang mungkin merangkap sebagai  petinggi rumah sakit pun terlihat sangat aktif melebihi jadwal dokter jaga di rumah sakit Indonesia, untuk menangani pasien dari konsultasi hingga proses pengobatan.

Berbeda dengan rumah sakit di Jakarta dan Bandung, dengan puluhan bahkan ratusan papan nama dokter terpampang di lobby tetapi jam nya terbatas. Pasien harus berpindah-pindah tempat baik di dalam  rumah sakit mau pun keluar rumah sakit sangatlah membingungkan dan melelahkan.

Peralatan yang ada di MMCH ini sangat komplit, malah menjadi rujukan dari RS pemerintah setempat. Terlihat banyak kendaraan rumah sakit pemerintah yang pulang pergi membawa pasien ke MMCH, tidak heran bila MMCH memiliki visi dan misi menjadi Rumah Sakit Cancer Terbaik Di Regional.

Pada saat kami konsultasi dan observasi ulang, penjelasan dokter memberikan informasi tentang cancer dengan baik, detail, dan cara menjelaskannya sangat menarik dan menyenangkan. Kami pun diajak membaca referensi obat. dasar pengambilan keputusan, dan resiko terhadap semua terapi yang akan dijalankan. Dari semua dokter yang menangani kasus ini, kami menilai dokter di MMCH ini yang terbaik buat kami.

Untuk pasien yang kurang mampu, janganlah sungkan untuk meminta diskon biaya. Pihak rumah sakit akan memberikan diskon biaya bilamana pasien meminta. Nilai yang diberikan akan dipertimbangkan oleh Rumah sakit setelah beberapa waktu dan proses wawancara.

Kami bergiliran mengantarkan dan menunggu pasien pada masa  Kemoterapi dan Radiasi selama kurang lebih 4 bulan. Namun kami selalu intensif kontak dengan dokter melalui email pribadi mendapatkan update sehingga kami merasakan perhatian penuh dalam proses ini.

Sekilas mengenai Penang
Penang merupakan destinasi pengobatan yang sedang menanjak popularitas nya. Berbagai macam fasilitas pengobatan dan kesehatan tersedia. Pasien bukan hanya warga Malaysia, tetapi banyak dari Indonesia juga.

Populer nya kota Penang sebagai destinasi wisata, membuka peluang-peluang bagi penduduk lokal untuk ikut terjun dalam bisnis ini antara lain akomodasi, transportasi, jasa pendaftaran ke Rumah Sakit, dan agen ke semua fasilitas ini.

Dari pengalaman saya, tidak perlu perantara atau Agen untuk  registrasi ke rumah sakit. Lebih baik langsung koresponden dengan pihak rumah sakit. Supaya informasi yang disampaikan tepat dan cepat. Karena mereka menyediakan staf khusus untuk pasien Indonesia. Yang saya membuat saya khawatir kalau ada agen perjalanan yang tidak dapat menjaga keutuhan data pasien akan sangat merugikan jika ada data yang hilang.

Untuk kebutuhan akomodasi dan transportasi, staf rumah sakit bisa bisa memperkenalkan agen akomodasi dan transportasi.

Pengalaman saya di tahun 2012-2013, kendaraan sewaan lebih unggul, mudah dan murah daripada taxi resmi. Bisa lebih hemat lebih dari separuh tarif taxi resmi. Beruntung kami mendapatkan agen yang baik, bisa berbahasa Indonesia, dan selalu standby kapan pun kami memerlukan bantuan transportasi. Dalam proses kami pun berkenalan dengan seorang pengendara yang baik sehingga beliau menjadi “sopir pribadi” kami di Penang.

Lokasi Airport ke kota cukup jauh, menggunakan Bis atau taxi resmi mau pun kendaraan sewaan. Waktu tempuh dari Airport ke kota kurang lebih 1 jam.Pusat kota lama adalah “George Town”, sedangkan pusat keramaian modern adalah “Gurney Street”


Sumber: Google Maps

Akomodasi terbaik di Penang untuk jangka pendek mau pun jangka panjang adalah sekitar Gurney Drive; Pesiaran Gurney, Jalan Kelawai,  Pusat aktifitas adalah Gurney Plaza, dam Gurney Paragon dimana kita mudah mendapatkan kebutuhan sehari-hari supermarket untuk rawat jalan jangka panjang.




Sumber:
https://farm6.staticflickr.com/5338/17001393640_e1369067f6_h.jpg

Lokasinya juga nyaman dekat dengan pantai dan sepanjang jalan Pesiaran Gurney adalah pusat kuliner. Area ini sangat nyaman untuk mengisi kekosongan waktu dengan berjalan pagi atau sore di sekitar pantai dan diakhiri dengan makan di pasar kuliner.



Untuk jangka pendek, daftar hotel dapat dicek dengan mencari kata kunci: "Hotel around Gurney Drive, Penang, Malaysia"
"Hotel around Mount Miriam Cancer Hospital, Penang, Malaysia"

MMCH letaknya agak jauh dari pusat kota, perjalanan kurang lebih 10 menit dari Gurney dan ada di dalam perumahan cukup lumayan jauh bila berjalan kaki, atau perlu berganti bis. Namun saran saya menggunakan taksi dan mobil sewaan adalah yang terbaik.


Sumber: Google Maps

Di sekitar MMCH juga banyak rumah penduduk yang dapat disewa dan lebih murah dari Gurney, akan tetapi untuk berbelanja kebutuhan sehari-hari jarak berjalan kaki agak jauh.

Selain di Gurney, masih banyak sewaan rumah dan kamar di lokasi lain harga beragam. Masih berdekatan dengan Gurney drive, saya melihat banyak apartemen sewa di sekitar jalan Tanjong Tokong,

Perkiraan Biaya Akomodasi pada tahun 2012-2013
Sewa Kamar harian di sekitar Apartmen Gurney,
Sharing Apartment, Kamar Mandi Luar RM60-80
Sharing Apartment, Kamar Utama, Kamar mandi dalam RM 80-100
1 Unit Apartment, 1 KM Utama 2 KM Anak, RM180-250

Sewa Kamar di sekitar Tanjong Tokong dan lokasi lain
1 Unit Apartment, 3 Kamar RM150-180
Apartment Hotel RM120

Sewa Kamar (sharing) di rumah-rumah sekitar MMCH
1 Unit Kamar RM50, 1 Unit Rumah RM150-180

Perjalanan Taxi Gurney Drive - MMCH
RM7-10 / Trip

Harga Makanan di Hawker Center
RM5-10

Harga Makanan di Mall
RM7-15

Mengisi waktu luang
Untuk mengisi waktu di Penang, banyak tempat menarik, untuk disinggahi dengan berjalan kaki di sekitar kota tua.

Untuk mencapai tempat wisata utama tersedia bus wisata gratis yang singgah di berbagai tempat wisata di Penang. Untuk informasi kota Penang dapat dilihat di sini:

http://www.visitpenang.gov.my/
http://www.tourismpenang.net.my/
http://www.penang.ws/

Hal-Hal yang perlu dipertimbangkan
Selain biaya akomodasi Penang yang lebih ringan dari biaya di Singapore, perlu mempertimbangkan bahwa saat tulisan ini dibuat tahun 2015, penerbangan ke Penang terbatas.

Beruntung pada pertengahan tahun 2012 kami masih mendapatkan penerbangan langsung antara Bandung - Penang - Bandung dengan Airasia. Pada akhir tahun 2012 penerbangan langsung sudah tidak ada, digantikan dengan transit di Kuala Lumpur dan berganti pesawat.

Selain transit Kuala Lumpur, alternatif transit lainnya adalah kota Medan, dan dapat melanjutkan penerbangan Medan - Penang.

Semoga bermanfaat, Tuhan Menyembuhkan dan Tuhan memberkati.

Update tulisan teman saya karena banyak pembaca yang tanya soal pengobatan di Penang :

Terima kasih sudah membaca blog kami.
Pengalaman penulis berobat ke Rumah Sakit Mount Mirriam Cancer Hospital (MMCH) pada tahun 2012, staf MMCH sangat membantu, dan ada staf yang dapat berbahasa Indonesia, yang siap membantu segala hal termasuk hal-hal non teknis seperti masalah akomodasi, transportasi, dll. Mereka pun bisa membantu mencarikan akomodasi di Penang.

Silakan menghubungi staff MMCH yang khusus menangani pasien dari Indonesia. Whatsapp +60165217044 atau BBM : 55E1075F.

Bisa juga kirim email dengan Bahasa Indonesia ke equiry@mountmiriam.com .  Untuk informasi terkini dapat melihat situs webnya : http://www.mountmiriam.com

Mengenai biaya secara umum pada tahun 2012, membandingkan dengan teman-teman lain, dari biaya periksa, biaya radiotherapy, chemotheraphy, lebih murah dari Rumah Sakit Pemerintah di Jakarta (non BPJS). Bahkan dengan biaya akomodasi dan tiket pesawat beberapa kali pun tetap lebih murah di Penang daripada di Jakarta. Tapi silahkan komunikasikan terlebih dahulu. Karena mungkin saja penanganan pasien dan kasusnya berbeda-beda.

Dan yang penting, tidak perlu menggunakan agent booking rumah sakit di Indonesia. Silakan saja langsung menghubungi MMCH. Perlu diingat data medis juga jangan diberikan ke pihak lain. Penulis lihat banyak agen pemesanan rumah sakit di Indonesia maupun di Penang yang mencari-cari kesempatan padahal prosesnya tidak serumit yang dibayangkan.

Untuk pertanyaan khusus, balasan cepat, bisa hubungi saya ke wnlukman@yahoo.com.


Terima kasih



Sunday, August 30, 2015

Kunyit Putih (Curcumin) Sebagai Pendamping Obat Chemo

Pada posting awal saya sudah ceritakan bahwa  istri saya berobat ke dokter Eko Wahyuni sebelum menjalani pengobatan di Singapore. Kemudian istri saya mengkonsumsi obat kunyit putih (curcuma mangga rhizoma) yang diberikan oleh dr Eko Wahyuni.

Kebetulan saya menemukan artikel menarik tentang kegunaan kunyit putih (curcumin) sebagai suplemen yang dapat meningkatkan efektifitas obat chemo pada treatment NPC, yang diteliti oleh Professor Marilene B. Wang, M.D. di UCLA Jonsson Comprehensive Cancer Center :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004013/

http://www.upi.com/Health_News/2015/06/05/Cooking-spice-makes-head-neck-cancer-drug-more-effective/3631433528764/

 http://www.impactjournals.com/oncotarget/index.php?journal=oncotarget&page=article&op=view&path[]=4181

Saya teringat setelah 3x siklus chemo pertama, istri saya di-MRI scan ulang. Hasilnya menurut Prof Goh sangat menggembirakan. Sel kanker nya berkurang sangat banyak. Apakah hal ini dibantu oleh kunyit putih ? Hanya Tuhan yang tahu untuk saat ini. Suatu kebetulan? Sebagai orang percaya saya percaya ini termasuk dalam pertolongan dari Tuhan. Puji Tuhan.

Untuk meningkatkan penyerapan oleh tubuh sebaiknya curcumin digabung dengan juice anggur, juice nenas, atau black pepper :

http://www.rethinkingcancer.org/blog/spice-of-the-month-tumeric/

Buku tentang curcumin :

https://www.dropbox.com/s/br0t5dtcjn6907q/curcumin_the_miracle_of_turmeric_a_therapeutic_ove.epub?dl=0

Update : Saya tulis mengenai kunyit putih bukan berarti hanya minum kunyit putih saja bisa menyembuhkan kanker. Kami tetap memutuskan istri saya untuk menempuh jalur medis.
Saya belum lama kenal dengan pasien kanker nasofaring yang berobat ke dr Eko dan hanya bergantung pada obat-obatan dari dr Eko saja dan ternyata tidak cocok.

Monday, July 27, 2015

Seminar Hearing Loss oleh NPC One Heart

Sudah 6 bulan dari terakhir istri saya menjalani pengobatan. Puji Tuhan sekarang istri saya sudah sehat. Efek-efek radiasi setelah pengobatan seperti hilang rasa dan mulut kering (xerostomia), sekarang sudah mulai membaik walau tidak 100% kembali.

Yang istri saya alami sekarang adalah berkurangnya pendengaran. Mungkin akibat radiasi dan juga gendang telinga yang dipasang eartube waktu awal pengobatan. Kondisi ini cukup mengkhawatirkan saya. Seperti ketika istri saya mengganti gas elpiji dan gas elpiji itu berbunyi tapi dia tidak mendengarnya. Rata-rata penderita NPC memang mengalami masalah pendengaran setelah pengobatan dengan skala kerusakan yang berbeda-beda.

Jadwal check up masih lama di bulan Oktober 2015 jadi saya cari-cari informasi sendiri soal masalah pendengaran yang berkurang ini.

Untung nya minggu lalu NPC One Heart mengadakan seminar tentang Hearing Loss dan mengirimkan rekamannya kepada saya. Saya bagikan di sini slide dan rekaman suara seminar tersebut. Semoga bermanfaat. God Bless

link rekaman seminar :
https://www.dropbox.com/s/ezrf19l6rijrwia/Hearing%20and%20hearing%20aids%20talk%20at%20NUH%20by%20Dr%20Ho%20on25_07_15.mp3?dl=0

Slide2 selama seminar :








Friday, May 15, 2015

Nasopharyngeal Carcinoma Support Group - NCCS NPC

Seperti yang pernah saya ceritakan sebelumnya. Saya bergabung dengan NPC Support Group di rumah sakit Singapore General Hospital. Nama support group ini adalah NCCS NPC support Group.

Support Group ini dipimpin oleh Mr Teo Thiam Chye (TC). TC sudah membantu sekitar 400 orang pasien baru NPC. Dia menyebut dirinya NPC Ambassador.

Untuk bergabung dengan NCCS ini silakan kunjungi :

https://www.healthxchange.sg/forums/support-groups/nose-cancer/Pages/nose-cancer-support.aspx

Tiap bulan support group ini rutin mengadakan seminar tentang NPC. Dapat bertemu dengan para NPC survivor sangat memberikan semangat untuk sembuh. Selain juga mendapatkan tips-tips yang sangat berguna untuk menanggulangi side effect dari radiasi.

Buku tentang perjalanan para survivor NPC yang diterbitkan NCCS ini :

http://www.nccs.com.sg/Publications/CancerInformationBooklets/CancerType/Documents/Ebook%20NPC%20Journey.PDF

https://www.dropbox.com/s/66afud8enj4a81j/Ebook%20NPC%20Journey.PDF?dl=0

Nasopharyngeal Carcinoma Survivor Group - NPC OneHeart

Kali ini saya mau sharing mengenai NPC support group (NPC OneHeart)

Seperti yang pernah saya ceritakan, waktu istri saya sakit saya bergabung dengan NPC support group dengan nama NPC OneHeart

NPC OneHeart pertama kali didirikan oleh Mr Peter dan Dr Choo. Sekarang diketuai oleh Mr Dave. Mereka semua adalah para survivor NPC dan caregiver yang terbeban untuk membantu para penderita NPC yang baru. Dalam support group ini juga ada dokter Singapore yaitu Dr Choo yang menjadi advisor dalam support group. Jadi kita bisa langsung bertanya kepada dokter spesialis oncology dari Singapore.

Program kerja mereka adalah :
1. Mengadakan talk show mengenai kanker nasofaring, penanggulangan side effect radiasi dan
    chemo, sharing para survivor NPC.
2. BeFriend Program - Mengadakan kunjungan  ke hospital untuk mengunjungi para penderita
    NPC yang baru. Tujuan nya supaya mereka dapat sharing mengenai NPC dan menceritakan
    bahwa NPC dapat disembuhkan!
3. Jogging bersama di Botanical Garden. Kegiatan ini diadakan 1 bulan sekali. Mereka mengundang   para survivor dan caregiver untuk jogging pagi hari di Botanical Garden. Selama kegiatan ini mereka sharing mengenai NPC.

Kemudian mereka juga membuat Whatsapp Group. Para penderita NPC baru dapat menanyakan berbagai hal seputar pengobatan NPC dalam Whatsapp Group ini. Keberadaan Whatsapp group ini sangat berguna untuk para penderita NPC baru yang ingin langsung bertanya selama mereka menjalani perawatan chemo dan radiasi. Support group ini menerima semua orang. Mereka tidak membedakan agama, ras, kewarganegaraan. Mereka semua orang-orang yang baik.

Contoh photo kegiatan NPC OneHeart :




Sharing Mr Dave saat dia terkena NPC :



Contoh salah satu slide talk show :


website NUH khusus nasopharyngeal carcinoma :


Jika ada pembaca yang tertarik untuk berkenalan dengan NPC OneHeart silakan email ke saya :