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.
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.”