Webinar Early Management HNC in the New Normal

 https://www.youtube.com/watch?v=qRZESxn3APc&t=9503s

Pilih Alternatif atau Kemoterapi/ Radiasi?

Sharing yang barus dari teman saya mengenai pilihan pengobatan alternatif atau medis untuk pengobatan kanker Nasofaring :

https://www.youtube.com/watch?v=WhaJjw8Ey1Q

Complete Patients Guide Line For Nasopharyngeal Cancer

Ini petunjuk lengkap mengenai Kanker Nasofaring :

Here is pdf file for complete patients guide line for NPC :

https://drive.google.com/open?id=1fPV1IW6RV8fJ1gEbUMJDAC4m9gVaQUP8

Seminar Bagaimana Mengurangi Efek Samping Radiotheraphy

Pengobatan paling utama dari kanker nasofaring adalah dengan radiotherapy. Karena sel kanker nasofaring sangat sensitif terhadap radiasi. Sayang nya radiotheraphy ini menimbulkan sejumlah efek samping. Berikut ini seminar tentang bagaimana mengurangi efek samping dari pengobatan radiasi :

https://www.youtube.com/watch?v=Ck3VE-Rjw18

Bingung cari dokter di Singapore?

Sekiranya pembaca ada yang berminat untuk berobat di Singapore dan bingung untuk konsultasi ke dokter siapa di sana, saya mau share seorang dokter yang bagus dan baik di Singapore. Nama nya Dr Choo Bok Ai. 

Saya kenal Dr Choo waktu saya gabung dengan NPC OneHeart support group. Dr Choo adalah salah satu pendiri dari NPC OneHeart. Di group itu dia aktif memberikan guide line dari sisi medis jika ada yang memerlukan walau pun member bukan pasien dia. Dr Choo banyak membantu saya ketika saya mendampingi istri berobat di sana. Dr Choo juga mendirikan Sarcoma support group. 

Di luar jam praktek nya, di waktu luang Dr Choo kadang menyempatkan diri untuk mengunjungi pasien yang membutuhkan. Saya pernah membawa 2 orang pendeta yang terkena sakit kanker nasofaring ke NPC OneHeart. Dr Choo menyempatkan diri sebagai advisor dari NPC OneHeart untuk datang ke penginapan para pendeta tersebut. Dr Choo juga sering memberikan seminar di radio Singapore atau di forum untuk meng-edukasi masyarakat di sana seputar penyakit kanker.

Dr Choo sangat care terhadap pasien nya dan mendapatkan penghargaan "The highest accolade in the Healthcare Humanity award with an honorable mention and a medal" dari  presiden  Singapore.

Dr Choo Bok Ai is conferred the "Honourable Mention" at the Healthcare Humanity Awards (HHA) 2018. This is the highest accolade for the HHA and the award recognises and honours exemplary healthcare workers who have displayed altruism above and beyond their call of duty.

Dr Choo juga memprakarsai program "Dream Maker" yang bertujuan mengabulkan cita-cita pasien .

https://www.ncis.com.sg/Cancer-Support/NCIS-Dream-Makers/Pages/default.aspx

 Seperti episode The Wish di bawah ini :

https://www.youtube.com/watch?v=S6vIN4baiVA
(ada subtitle bahasa indo)

webinar tentang early breast cancer oleh Dr Choo dan team :

https://www.youtube.com/watch?v=Am4rr38Ld7A

Untuk profil dan contact untuk Dr Choo Bok Ai bisa dilihat di link ini :

https://www.farrerpark.com/hospital/Specialist/Pages/Choo-Bok-Ai.aspx

Dr Choo dapat berkomunikasi dalam bahasa Indonesia dengan cukup fasih.

Untuk perwakilan di Indonesia bisa menghubungi :

FriendLink dengan alamat email : halo@friendlinksingapore.com

Good Article : My Experience With Nasopharyngeal Carcinoma (NPC) Treatment

https://www.healthxchange.sg/cancer/nose-cancer/my-experience-nasopharyngeal-carcinoma-npc-treatment

Name of Patient: Lim Cheng Koon
Age: 60+
Diagnosed: Stage 4 - NPC
Date Confirmed NPC: 18 July 2016
Treatment Period: 02 Aug 2016 to 16 Sept 2016
Treatment Pattern: 33 Sessions of RT c/w 7 Cycles of CT

History & Radiotherapy Treatment

I recall my first encounter with NPC or nose cancer. It was sometime in July 2015 when I discovered a small lump on my right neck just behind my right ear. Initially I did not pay much attention to it. It was not until September 2015 when I was admitted to Changi General Hospital (CGH) due to the sudden loss of strength in my entire right arm and I was unable to lift up my whole arm.
During the hospitalization, I alerted the doctor to the lump behind my neck. The doctor concluded, after he has conducted a non-systematic check, that it was just a small muscle and had no relation to the movement of my arm.

However, in June 2016, I noticed that the lump had grown bigger. Feeling uncomfortable, I went to see a General Practitioner and was given antibiotics for 2 weeks. Thereafter, he referred me to the ENT Specialist in CGH where I was confirmed to have contracted NPC on 13th July 2016. I was then referred to the National Cancer Centre, Singapore (NCCS) for treatment.

I still can recall the turmoil in my mind after I was told I had contracted NPC. I had even contemplated ending my own life. I was also suffering from a serious nose block that often left me feeling breathless. On my request for medication to clear the blockage, the radiation doctor told me it was caused by the tumor and there was nothing he could do about it. This added to my misery.
Fortunately, my good friends and colleagues came alongside to encourage and console me. My children advised me to look for volunteer groups to seek their advice and learn from their experience. From the internet search, I found the NCCS NPC Support Group and contacted their programme leader, Teo Thiam Chye (TC as he is known), who is also a 13th year NPC survivor.

From the experience sharing by TC, I came to understand that I was not alone in my cancer journey where 465 survivors from the Support Group have successfully undergone their treatment and returned to living as normal a life as possible. This had given me further encouragement to face my treatment.

My treatment at NCCS began on 2nd August 2016 with 7 cycles of chemotherapy (chemo) and 33 sessions of radiotherapy (RT). The sharing by TC on “Managing the 4 major side effects of Radiotherapy” played a big role in helping me through the treatment with minimal pain and discomfort, (https://www.healthxchange.sg/cancer/nose-cancer/nose-cancer-managing-four-major-side-effects-radiotherapy)

From my treatment journey, I would like to share some of my own personal experiences in the hope that it may also help the next person: -

1. A week before RT treatment, I drank concentrated Manuka Honey UMF 10+ as least 3 times a day. I also try to drink as much water as I can.
2. After the 5th RT, when my mouth and throat felt very dry and eating became uncomfortable, I continued to drink lots of fluids especially ice water. Chinese cooling drink such as “Ling Yang”, “Yi Mi Jui” and fresh coconut juice helped to cool my body from the RT exposure.
3. After every RT session, I take a cool shower immediately when I reach home. For 15 minutes I direct the shower to my forehead, side and back of the neck and head area which was exposed to radiation. The cool water helped to reduce the heat from the radiation of the day.
4. Even though my saliva had thickened and the taste changed, I continued to eat as best as I can in order not to lose more weight.
5. The use of the Nystatin Suspension prescribed by the doctor had helped me tremendously in managing the mouth fungus. I gargle my mouth after every meal, every morning and before sleep, especially targeted at the area with fungus. After gargling, I swallowed the solution slowly into the throat to further prevent throat infection. I have also requested from the doctor antibiotic tablets for fungus prevention.
6. Apart from the Chinese cooling drinks, every morning I will take 2 “Daneuron” tablets which contain Vitamin B7 & B12 together with one tablet of “Vitamin C”. It worked well until I reached 30 RT without any ulcers in mouth and throat.
7. Apart from my own discovery I followed TC’s instruction strictly in managing oral hygiene and keep my mouth clean after every meal. I have also consumed 2 bottles of Manuka Honey UMF +10 during the entire course of treatment. Indeed, it was effective in keeping the ulcers away.
8. The aloe vera gel applied at least 4 to 5 times a days and immediately after the RT worked well until I completed my 30 RT without any tears on the skin of my neck. The signs of tears appeared after the 31st session but it was still manageable.

Painful Throat

A day after I have completed my 30 RT, I felt my entire throat beginning to feel more and more painful. After a physical examination, the RT doctor re-affirmed that I did not have any ulcers and that the cause of the pain was due to the radiation burns to the throat, which he claimed all patients will face at the end of the treatment.

Although the Doctor had prescribed to me stronger Morphine Patch sticker it did not suppressed the pain fully. It is difficult to describe the pain in words. All I felt was that it was the most painful episode that I have ever encountered in my life. But I told myself that I have to bear with it. A price I had to pay for getting rid of the cancer from the body.

Chemotherapy - 2 Major But Bearable Side Effects:

In my first three cycles of chemo, I did not feel much side effects to my body. I began to feel the side effects from the 4 cycle and it became more serious through to the 5th & 6th cycle.
Here are the 2 major side effects which I encountered:

1. Nausea & Bloated Stomach
   From the 3rd to 5th day after the chemo, my stomach started to feel very uneasy. Nausea effects took place and I began to feel like vomiting. The stomach kept bloating especially at night. The anti-nausea/vomit tablets issued by the doctor helped somewhat to contain the problem.
2. Constipation
   I went 2 to 3 days without any morning bowel movement. Another side effect from chemo. Constipation tablets as well as liquid medication to soften the stool will help. If constipation persists for more than 2 days, request for the insert medication. It will work well.

Conclusion

I understand that every person is different and each may face and experience different side effects from exposure to chemo and RT. What I have shared is my own treatment experience in the hope that it will help the next person better manage his/her own journey.

Contributed By: Lim Cheng Koon
Date: 12 Sept 2016

Talk by Speech Therapist - Topic related to Cancer treatment side effects

NPC oneHeart Support Group Monthly Talk

 https://www.dropbox.com/s/vpzh62adlo5zfvw/Cancer%20Treatment%20Side%20Effects%20by%20Ms%20Susan%20Goh.pdf?dl=0

Talk by Speech Therapist - Topic related to Cancer treatment side effects - Ms Susan Goh

Synopsis of Talk:

• Patients who are diagnosed with cancer of the Head & Neck and the nose receive treatment in one or more the modalities i.e. chemotherapy, radiotherapy and/or surgery. Most of these patients experience a certain degree of difficulty in speech, voice and swallowing functions. Such difficulties can happen before, during and after treatment. In this talk Susan aims to share some of her experiences in helping these patients, as well as some practical pointers that may be helpful for the participants. 

About Susan Goh:

• Susan graduated from Flinders University (South Australia) more than 20 years ago. She has worked in hospital settings since 1996. She has been working with ENT doctors in managing patients diagnosed with Head and Neck cancers, with a side interest in voice rehabilitation. Susan visits the New Voice Club at times, a support group for laryngectomees at the Singapore Cancer Society, of which she has been appointed to the committee of the club as a clinical support member since 3 years ago

. The Talk details:
- Date: Thu, 23 June 2016
 Time: 7pm
 Venue: TTSH, CareConnect

Good Video About Radiotheraphy Procedure

Found this good video about radiotheraphy procedure :

https://m.youtube.com/watch?v=-dWm40P6elM

Voice Of Hope

Voice Of Hope

I mention we meet Sylvia during my wife treatment. She gave us new hope. Here is Sylvia story :

https://sparkatncis.wordpress.com/2016/06/16/issue-15-voice-of-hope/#more-563

63 year old Sylvia Khoh, who was diagnosed with Stage 1 Nasopharyngeal Cancer (NPC) in 2010

In the flesh, Sylvia is immaculately dressed, her hair unfurling in soft coils, her face radiating a rosy glow. Looking a little over 50 years of age, we were pleasantly surprised to learn that Sylvia turns 63 this year, as she chuckled and said that she gets this response from strangers all the time. Her secret to looking young? A positive mindset, and always remembering to smile.

Sylvia’s positive energy is infectious indeed. While most people her age look forward to enjoying their retirement, Sylvia proudly tells us that she loves her job; the empowerment it gives and the satisfaction it brings. A financial manager, Sylvia is presently into her sixteenth year at her job and has no plans of retirement in the near future.

As Sylvia goes about her five-day work week, she also juggles her time between her hobby – singing, a passion she has had since she was young, and which she continued to grow after her friend encouraged her to pick-up pop music back in 2010. After enrolling into the class, her vocal coach discovered the unique tonality in her voice and propelled her towards opera instead. A Teochew, Sylvia had to learn the Cantonese dialect from scratch in order to master the trade. It was a challenge, but Sylvia dedicated herself to perfecting the enunciation of the dialect.

Sylvia’s hard work and effort paid off and seven months into classes, she gave her first stage performance. Today, she is a seasoned opera singer who regularly performs at the China Cultural Centre, NAFA, Lee Foundation, Kreta Ayer People’s Theatre and community centres.

It would seem that Sylvia has it all – good looks, an established career, a raw talent and a close-knitted family. But there was a time when Sylvia thought she would lose her soprano and no longer be able to perform opera, and this is her story.

 

It was during the Chinese New Year of 2010, and festivities were running high. Sylvia had scheduled a line-up of performances but to her dismay, found herself unwell in between performances to the point that she was no longer able to reach the high notes. This affected Sylvia greatly, as singing was her life’s passion. Suspecting nodules in her throat, she headed down to the ENT Department for a check.

The check proved her suspicions right, as soft nodules were discovered in her throat. But to her relief, her vocal chords were not affected. Thinking that her worst fears were allayed, Sylvia was in for a rude shock as her Doctor discovered two grained sized cancerous lumps at the back of her nose and diagnosed her with Stage 1 Nasopharyngeal Cancer (NPC). Sylvia’s first thoughts were “why me?” and “how did this happen?”, but she later accepted her diagnosis with calm and peace with the belief that her cancer was a sign from a higher calling for her to ruminate on her life.

 

 Sylvia and her close-knitted family. She has one son, and two daughters.

 Sylvia took comfort in the fact that the disease was discovered early and the cancer was contained in her nose. Upon her Doctor’s advice, she started on radiation therapy. Sylvia underwent a total of 35 radiation sessions over a period of seven weeks. During this seven-week period, Sylvia went about her daily life, undergoing treatment in the morning, and heading back to work right after treatment. Her boss was exceptionally understanding during this period, constantly checking in on her well-being and granting her permission to take the day off if she felt unwell. And of course, Sylvia did not give up on singing. She continued with her biweekly singing classes and continued training her vocal chords. To Sylvia, all these served as a good distraction and busied her mind from worrying about the cancer.

Voice of Hope

Not long later, the side effects of treatment started kicking in – sore throats, loss of appetite, drastic weight loss. Sylvia, who is naturally petite, lost a total of 13kg, from her initial weight of 62kg to 49kg at her lowest. Her friends jokingly teased her by saying that she looked like a little girl from behind. Despite these, Sylvia took everything in her stride and kept her spirits up.

She joined the NPC oneHeart Support Group and actively participated in talks and support group activities. Sylvia found the talks, conducted by professionals, especially useful in coping and managing with her condition and side effects. Through the support group, Sylvia also forged close bonds and friendships with the support group members whom she still meets up with regularly for social outings.

An active person, Sylvia also kick started a monthly walk at the Botanic Gardens for the group to bond while keeping a healthy lifestyle. To keep the group in positive spirits, Sylvia makes it a point to prepare homecooked fare the day before to spur them on on the day of the walk.

 

Sylvia and the members of the NPC oneHeart Support Group, at a Chinese New Year gathering at her house

 After one year of treatment, Sylvia’s scans turned up clear and the cancer was gone. Today, Sylvia has achieved remission and is a proud survivor of NPC.

The cancer may be gone, but it has changed Sylvia’s life in more ways than one. Before she was diagnosed, Sylvia focused her time and energy on herself and her family. But her cancer journey has taught her that there is more to life, and it includes caring for other people as well. Now, Sylvia gives back to the community by doing voluntary work such as coordinating haircut sessions for the old folk as well as cooking for them.
She feels her cancer journey has changed her for the better, and her vocal coach has encouraged fellow students to “learn from her spirit”. And what lies ahead? Sylvia hopes to continue doing more volunteer work, pursue her passion in opera, stay beautiful, and most importantly, stay happy.
To fellow cancer patients and survivors, this is what Sylvia has to say:

“Be positive, never submit yourself to the disease. Know there is always hope somewhere. Make sure you mix with the right people who can help you, but never wallow in self-pity. I find that sharing my experience with others in the support group has helped me learn from their experiences as well.

Keep a healthy diet and lifestyle. For me, I make it a point to drink nourishing double-boiled soups every day. Root-based soups are particularly helpful for my recovery process as it helps build up my immune system to promote self-healing.  I try to abstain from red meat and heaty food, but consume more fish, vegetables and manuka honey to soothe my throat. Today, I have gained back half the weight I lost during treatment.

I also meditate and practice qigong regularly, as this helps calm me down and increase my mindfulness.

The journey after cancer is more important than the treatment itself. Always remember to fight the disease and defend against it or it will be easier for it to beat you.”

Penyebab dan Tanda-tanda Kanker Nasofaring (Jawa Pos)

PENYEBAB MUNCULNYA KANKER NASOFARING

http://www.jawapos.com/read/2016/06/13/33899/serang-tenggorokan-dan-hidung-ini-penyebab-munculnya-kanker-nasofaring-

JawaPos.com - Karsinoma Nasofaring (KNF) merupakan salah satu jenis  kanker  terganas yang berada di urutan ke-4 setelah kanker leher rahim, kanker payudara, dan kanker paru. KNF biasa  muncul pada area di atas tenggor‎okan dan belakang hidung penderitanya.

 

Sejumlah faktor menjadi penyebab munculnya kanker nasofaring ini. 

Dokter ahli Telinga Hidung Tenggorokan‎ (THT) - Kepala Leher (KL) dr. Cita Herawati, SpTHT-KL mengatakan, diantaranya Epstein-Barr Virus (peningkatan antibodi, genom virus pada sel tumor). Terpaparnya bahan zat kimia juga menjadi salah satu penyebabnya, termasuk‎ asap. 

"Asap rokok, dupa atau kemenyan,  serta  asap kayu bakar. Pekerjaan yang menghasilkan serbuk-serbuk kimia, seperti peleburan besi dan serbuk kayu," ujar dr. Cita saat ditemui di Jakarta. 

Tak hanya itu, konsumsi jenis makanan juga memicu kanker nasofaring ini. Misalnya, ikan asin dan sayuran yang diawetkan, dan makanan yang difermentasi. 

"Konsumsi jenis makanan ini akan menghasilkan kandungan nitrosamine ataupun precursor nitro yang akan menjadi pemicu terjadinya proses KNF," terang dr. Cita. 

 Kendati demikian, dokter yang berprakter di Sahid Sahirman Memorial Hospital itu memaparkan, untuk bahaya ikan asin memicu kanker nasofaring belum ditemukan adanya laporan yang jelas. "Selama ini, lebih banyak dipengaruhi oleh asap dan bukan makanan," ucapnya. 

Asap lebih berpengaruh, dia menjabarkan, lantaran asap bisa menahan di ruangan hingga akhirnya hidung harus menyaring asap dan debu yang masuk sekaligus. "Terpapar dengan racun karsigenik yang harus dibersihkan ini akhirnya picu kanker nasofaring," tandas dr. Cita.  

Dr. Hilman Tadjoebin, SpPD, KHOM menambahkan, ‎orang yang bekerja di pertambangan juga memiliki kecenderungan terkena kanker nasofaring. 

Selain itu, makanan pun ikut berperan keganasan kanker tersebut. "Itu terjadi karena  kanker nasofaring dipicu oleh zat kimia tertentu yang masuk ke dalam hidung," tutupnya.

GEJALA TERJADINYA KANKER NASOFARING

 http://www.jawapos.com/read/2016/06/13/33904/gejala-terjadinya-kanker-nasofaring

 JawaPos.com - Waspada terhadap kanker nasofaring. Masih banyak orang  belum menyadari bila sering terpaparnya asap, zat kimia, hingga mengonsumsi makanan tertentu bisa mengakibatkan kanker nasofaring.

Kanker tersebut muncul pada area di atas tenggorokan dan di belakang hidung. Untuk mengetahuinya, paling tidak harus memahami emoat gejala terkena kanker nasofaring. 

"Yaitu, gejala hidung berupa mimisan ringan sampai berat dan berulang, terasa sumbatan di hidung, kadang sering dirasakan pilek lama seperti gejala sinusitis, hingga kesulitan bernapas," ujar ‎Dokter ahli Telinga Hidung Tenggorokan‎ (THT) - Kepala Leher (KL) dr. Cita Herawati, SpTHT-KL saat ditemui di Jakarta. 

Dia menyatakan, gejala telinga karena tumor terletak di dekat muara tuba Eustachius atau fossa Rosenmuller yang akan menimbulkan rasa tidak nyaman. "Misalnya, telinga tersumbat, berdengung (tinitus), bahkan sering ada rasa nyeri (otalgia) sampai pendengaran berkurang," sebutnya. 

Lalu, dr. Cita melanjutkan, gejala mata dan saraf‎. Tumor yang mulai masuk ke dalam lubang-lubang tengkorak dimana banyak melalui saraf. "Akibatnya, membuat saraf terjepit yang memengaruhi penglihatan dobel atau ganda dan dirasakan nyeri di daerah pipi dan sekitarnya (trigeminal pain), hingga sakit kepala," sambungnya. 

Dokter yang berprakter di Sahid Sahirman Memorial Hospital itu menuturkan, ciri lainnya merasakan berbagai gangguan menelan, berbicara, kelemahan otot bahu, dan leher. Terakhir, adalah gejala metastasis lokal atau leher. ‎"Terdapat benjolan di leher di satu sisi maupun dua sisi leher," ungkapnya. (rka/JPG)

Setelah baca artikel di atas saya makin yakin dokter-dokter THT di Bandung yang dikunjungi istri saya sangat tidak kompeten. Gejala-gejala nya jelas dialami istri saya. Betul-betul bikin sesak dada. 
Gelarnya saja pakai embel-embel professor dan spesialis. Sales perusahaan farmasi mereka itu semua.

FAQ about Nasopharyngeal Carcinoma from NPC OneHeart

FAQ about Nasopharyngeal Carcinoma from NPC OneHeart's FB pages


https://www.dropbox.com/l/s/vlgYswmxj138W3qtGPllHu

Example :

A : Dr. Choo, why chemo doctor advises patient not to take beet root and other antioxidant food/fruits during chemotherapy.
D : To answer whether antioxidant can be used during chemo is that it can as most natural antioxidant is weak and does not affect the effectiveness of the chemo or radiotherapy.
Chemo and radio aim to disrupt and kill cells by an oxidant effect and so, antioxidant reduces their effect - this is possible interaction only.

A : Dr. Choo, how to treat burnt skin caused by radiation? It takes long time to heal and get back to normal skin colour.

D : Choose a moisturiser without perfume ie if it smells nice, then don't apply to radiotherapy skin. Silver sulphadiaxine cream is by doctor prescription only and only needed during the 4 weeks of completion of RT when skin layer is peeled off. It is a cream used in all fire and water burns and used only in hospital. After 4 weeks, can use any moisturiser like QV, Aquoes, Cetaphil, aloe vera, bio oil , physiogel. All the functions are really into sealing in moisture in the skin. Use 2-3 times a day frequently is more important than what type of cream to put on. More specialise cream includes 10% urea for itch and Restoderm by Cetaphil for eczema as it contains ceramide. But more expensive. I advise patient to expect permanent dry skin as hence moisturiser is for life, but expect the darken skin to get back to normal 3-6 months on completion of radiotherapy.
The itch is due to dry skin, darken skin is due to poor healing as skin is too dry. Skin scarring is more due to dry skin. So, moisturiser for dry skin will help. The reason for dry skin is radiotherapy damages the sweat gland of the skin and so the skin does not sweat like normal and will always be dry.

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 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 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

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.

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

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.

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 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

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

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 (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

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

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.

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:

• Blurry or double vision
• Difficulty speaking, including hoarseness
• Ear infections that keep coming back
• Face pain or numbness
• Headache
• Hearing loss, ringing in the ears, or a feeling of fullness in the ear
• Lump in neck or nose
• Nosebleeds
• Stuffy nose
• Sore throat

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:

• Chest X-ray
• CT scan
• MRI
• Ultrasound of the neck

The following tests may also be done to confirm or rule out cancer:

• Complete blood count (CBC) and other blood tests
• EBV testing

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:

• dry mouth
• inflammation of the lining of your mouth and throat
• blindness
• brain stem injury
• death of healthy tissue

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.

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.”

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.

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.