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.”
