salubris november/december 2011

an nccs bi-monthly publication November / December 2011

...helping r eaders to achieve good healthSalubris is a Latin word which means healthy, in good condition (body) and wholesome.

Issue No. 19 • MICA (P) 061/10/2010

THE GIFT OF LIFE

SALUBRISNovember / December 2011

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Mr Yue said, “At that time, I really could not believe it. I have not expected this at all. My thoughts were racing through my mind and all I could think of was the fact that I exercise regularly, I do not smoke and am not an alcoholic. How could this happen to me?”

Sports and travelling are the interests of mr yue Keng siang. he teaches physical Education in a local

institution and the outdoors are a part of his daily routine. to him, the greatest takeaway from sports is how it hones his fighting spirit. and, indeed, little did he realise that someday this spirit would be called into play when he was unexpectedly diagnosed with liver cancer at the prime of his life.

back in 1999, he was bringing his young daughter for her screening at Queenstown polyclinic. While waiting, he decided on a whim to go for a blood test. Doctors had been nagging mr yue’s family to go for screenings since his mother was diagnosed with liver cirrhosis. he had been pushing it to the back of his mind, but this time he thought he might as well take the opportunity to go for a test. after all, he was already at the clinic. since then, there was no turning back.

he was overseas when he received the call from his doctor on his test results. When he returned from his trip, the doctor broke the news to him that he was suffering from stage one liver cancer.

In Other Words THE GIFT OF LIFE

at age 39, mr yue Keng siang was practically at the peak of his life. he was just into the third year of his marriage and has two children, aged three and one. however, all these came crashing when he was diagnosed with liver cancer. that was in 1999. CHARISSA ENG reports.


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in fact, mr yue feels so much better after the transplant that he is back to doing the things he loves. Just last month, he took part in the World transplant Day in sweden. this international event had a sporting element where transplant patients all over the world come together to compete in various sports. he was there competing in table tennis, track and field, and badminton and even won a silver medal in the badminton doubles event.

on how cancer has changed his perspective on life, he said, “When you have cancer, your mindset and attitude towards it are very important. i faced a lot of things when i had cancer but when i began to accept the illness, i start to take it as part of my learning process.”

“I am so grateful to be given the gift of life, I will really treasure this. I think in life, we should take it easy and not neglect the ones important to us. I nearly missed the chance to be able to spend time with my family. Now all I want is to spend more time with them.”

In Other Words

it was also a shock to his family and friends. For him and his family, it was their most trying period. Just into the third year of marriage, with two young kids in tow, what would the future have in store for them now? if anything happens, what will his wife do? not one to surrender easily, mr yue said, “i know i have got to face it so i started getting more positive about it.”

With a chuckle, he recalled telling his wife: “at least i know this is how i may die and i can plan before i go. i just have to take it easy.”

mr yue started his treatment shortly after. he went to various specialists to have more tests done and was advised to go for surgery to remove the cancer in his liver. he also started on six cycles of chemotherapy. the main cause of his cancer was due to hepatitis b from his mother.

prior to that, mr yue had not known much about hepatitis b and had no clue that it can lead to liver cancer. Fortunately, his cancer was detected early and it had not spread to other parts of his body. “From the day of my surgery, my lifestyle habits took a drastic change. i went on a strict diet of just vegetables and i do not take any red or white meat, with the exception of fish. i started adopting a healthy lifestyle like cutting down on my intake of fried food,” he said. “after the cancer cells were destroyed, i quickly went into remission.”

“six years later, i suffered a relapse. i was really disappointed. i had been very disciplined in my lifestyle choices,” said Mr Yue. He went for a second surgery in 2005 and restarted the entire process of keeping healthy. Barely less than 10 months later, he suffered from a second relapse. “Doctors told me the cancer is now growing on the other side of my liver. i also had signs of liver cirrhosis and they suggested that i get a transplant. otherwise, my cancer will just keep coming back, given that i am a hepatitis b carrier,” he said.

“i decided to opt for transplant, despite the high risk involved with the transplant surgery. it was a chance for me to lead a ‘normal’ life,” said mr yue.

he was glad to be in touch with a few patients to share with one another their experiences, to offer support and to learn more on liver cancer and the process of transplant itself. he explained, “the sharing sessions helped me a lot back then. my wife was reluctant for me to undergo the surgery as she was worried for me. at the sharing sessions, i became better-informed about liver transplant and its risks and it made me more confident to want to go for it.”

“if there was a support group back then, it would have been very helpful. Fellow patients can meet and share experiences and offer one another some moral support. in times like this, knowing somebody who understands what you are going through can make a big difference to accepting the disease,” he explained. after an eight-month wait, a match from a donor was found and he underwent a liver transplant.

today, 11 years on after the first surgery, mr yue is a refreshed man. he said, “if you look at me today, you would not know that i have had cancer. life is certainly different now as it is no longer so uncertain like in the past. i am a lucky man. i discovered my cancer early and i got a match for my liver. i also had an understanding superior who understands my need to go for treatment and checkups in the early stage.”


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In Focus IT’S THE SEASON TO BE MERRY: PLAYING SANTA CLAUS TO PATIENTS’ CHILDREN

I t is as early as september when preparation for the year-end festive season will begin for the staff of

Dmo as part of their annual community project. the work begins with raising funds to buy presents for children of cancer patients in the spirit of christmas. a few of these children are themselves suffering from cancer.

A/Prof Koo Wen Hsin, Deputy Director of nccs, first thought of this initiative in 2004. He felt that the patients need more than just medication to help them in their recovery. Equally important is the patients’ psychological health. they need moral support from their family, friends and the community. and, what better time to provide this support than by showing the patients that they are not forgotten amid all the hustle and bustle at the year’s end?

From then on, Dmo has been continuing the project and never looked back. Department secretary ms ang hui lan, who was involved since its onset in 2004 explained that the project was divided into a few stages, namely, the fund raising, recruiting of volunteers, shopping for presents and later, the gift wrapping and distribution to the children.

good team work helped as everyone chipped in to volunteer their services including driving to various locations in the heartlands to distribute the gifts. A/Prof Koo even roped in his friend, an insurance agent, to mobilise his fellow agents to help out.

this year hopefully, the workload may be lighter as a church group from the church of the holy Family has offered to collaborate with the Dmo. the group spokesperson said, “We believe in the importance of the work of nccs and it seems to us that some of its patients face some of the sternest challenges life can throw at one – especially those who are also labouring under the financial burden that the costs of cancer treatment can present.”

“We feel that their children should not be forgotten at this time, and we want to share with them some of the joy and hope of the Christmas season, and to remind them that there is light even in the dark periods of our lives. We got in touch with a medical social worker from NCCS and are now working on this project for Christmas 2011.”

the church group is raising funds to buy the gifts for the children. they hope to raise about $1500 so that 30 children can smile during the festive season. the Dmo will support them by playing santa claus wherever needed, to bring the christmas mood to the children.

From past year’s experience, the children have mostly very simple wishes, such as new school shoes and socks, book vouchers, bicycles, toys etc. to expedite shopping and delivery, the volunteers will be divided into three teams – one team to do the shopping, another team to wrap and label the presents and the third to deliver the presents.

For ms ang and her colleagues, seeing the smiles on the young children is the best thing they have gained from being involved. she said, “it made the whole process very worth it. We probably caught lots of children by surprise that when we talked to them, some of them even muttered ‘santa claus, santa claus’.”

ms ang hopes that everyone who has participated will enjoy the process and see for themselves how their role has helped and benefited the children. her christmas wish this year is for the project to keep moving ahead… ho, ho, ho!

For the past seven years, come year end and the Department of Medical Oncology (DMO) in nccs will be buzzing with activities that are not quite related to their clinical responsibilities. it is the time when staffs are reined in to do their bit to bring joy to the children of cancer patients. CHARISSA ENG finds out what is in store for this year’s festive season.


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SaLUBRISNovember / December 2011

The exact cause of this cancer is unknown. However, certain women are at higher risk than others:

• Obeseoroverweightwomen

• Womenwhoneverhavechildrenorhavefewchildren

• Womenwhoaresub-fertile

• Womenwhostartedmensesearlyandstartedmenopauselate

• Womenwhohavediabetes,highcholesterolorhighbloodpressure

• Womenwithahistoryofirregularmensesorhavepolycysticovariansyndrome

• WomenwithastrongfamilyhistoryofcanceroftheuterusorcancerofthecolonorknownfamilyhistoryofLYNCHIIsyndrome

• BreastcancerpatientsonTamoxifentherapy

The majority (80%) of cases present early with some form of abnormal bleeding:

• Bleedingaftermenopause

• Bleedinginbetweenmenses

• Prolongedspottingaftermenses

Anyone with the above symptoms should seek medical attention. The initial evaluation includes an ultrasound scan and endometrial biopsy (usually a D&C). Once the cancer is confirmed, the definitive treatment is a staging surgery (to assess the extent/spread of the cancer) and removal of the uterus. More advanced cancers may require additional treatment like radiotherapy, hormonal therapy and chemotherapy after the initial surgery.

GYNaeCOLOGICaLCaNCers:TreaTmeNTaNdsCreeNINGII

LookingForward

Continued on page B2.

For the past seven years, come year end and the Department of Medical Oncology (DMO) in NCCS will be buzzing with activities that are not quite related to their clinical responsibilities. It is the time when staffs are reined in to do their bit to bring joy to the children of cancer patients. CHarIssaeNG finds out what is in store for this year’s festive season.

CaNCerOFTHeUTerUs

Commonly referred to as cancer of the uterine lining also known as endometrial cancer, it is now the most common gynaecological cancer affecting Singapore women, especially postmenopausal women in their 50s and 60s. In KK Gynaecological Cancer Centre, we see an average of 180 new cases per year and the incidence is increasing.

as the majority of cases present early in stages, the overall outlook for endometrial cancer is good with five year survival of approximately 80 percent.

One can prevent endometrial cancer by having more children, by ensuring regular menses and by keeping an ideal body weight through a healthy diet and regular exercise. Prolonged usage of Combined Contraceptive Pill (COCs) and medicated IUD called Mirena can also reduce one’s risk of endometrial cancer.

There is no effective screening tool for endometrial cancer. Screening is often deemed not cost effective as majority of the cases present early and can be relatively easily treated with good outcome.

By Dr Chia Yin Nin Head & Consultant,

Gynaecological Cancer Unit, KK Women’s and Children’s Hospital

Adjunct Assistant Professor, Duke’s Medical School, Singapore

Visiting Consultant, National Cancer Centre Singapore


PAge B2

LookingForward

Continued from page B1.

GYNAECOLOGICAL CANCERS: TREATMENT AND SCREENING II

CANCER OF THE OvARY

ovarian cancer, though less common compared to endometrial cancer, is the most deadly. the majority of cases present late in advanced stages. in singapore, the incidence rate is about 15.2 per 100,000 per year. It mostly affects women aged between 40 and 60. in KK gynaecological cancer centre, we see an average of 120 new cases per year.

again, like endometrial cancer, the exact cause of it is unknown. certain women are, however, at higher risk than others:

• Womenwhoneverhaveanychildren

• Womenwhoaresub-fertile

• Womenwhostartedmensesearlyandstartedmenopauselate

• Womenwithastrongfamilyhistoryofbreastand/orovariancancerorknownfamilyhistoryofBRCAsyndromeor LYNCHIIsyndrome

ovarian cancer is often referred to as a silent killer. in the early stages, there are often no symptoms. by the time symptoms arise, the cancer is often in the advanced stages. Furthermore, symptoms of ovarian cancers are often vague and are often confused with gastritis, gallbladder disease or colorectal conditions.

common symptoms include:

• Abdominalbloatednessanddistension

• Indigestionor‘wind’

• Sensationoffullnessafterameal

• Palpableabdominalmass

• Urinarysymptomse.g.frequencyofurination

• Bowelsymptomse.g.constipation

• Unilaterallegswelling

it is hence important that women around the perimenopausal age group do not ignore such symptoms. if unsure, do seek medical advice early.

once ovarian cancer is suspected, the patient will be referred to a gynaecologic oncologist or medical oncologist and further investigations will be done. these often include CT scans and/or ultrasound scans to look for tumour growth(s) in the ovary(ies) and a blood test called ovarian tumour markers e.g. CA 125. The results of the investigations will indicate to the doctor the likelihood of the growth in the ovary becoming cancerous or not. Finally, surgery has to be done to remove the growth to confirm the diagnosis of cancer. Once cancer is confirmed, surgical staging (to determine the spread/extent of the cancer) is carried out at the same setting. If the cancer is found to be advanced at the time of surgery, attempts will be made to remove as much cancer as possible at the same setting. occasionally, if the cancer is deemed too advanced, chemotherapy may be given first prior to surgery. Except for very early stage ovarian cancers, almost all ovarian cancers have to be treated with a two-pronged approach: a combination of surgery and chemotherapy.

the outlook for ovarian cancer depends on the stage in which the cancer is at. Overall, the outlook is poor with five year survival of about an average of 50% as the majority of cases present late in advanced stages.

at present, there is no effective screening tool for ovarian cancer. neither routine ultrasound scan nor ovarian tumour markers blood tests are specific enough to detect ovarian cancer early.

ovarian cancer can be prevented by taking the cocs. prolonged usage over three to five years can halve one’s risk of ovarian cancer. alternatively, having more children and breast feeding can also help lower one’s risk.

Gynaecological cancers are common. Cervical cancer can be prevented by vaccination and Pap smear screening. Although endometrial cancer cannot be prevented effectively and screened, it often presents with abnormal bleeding early. Hence, it is important not to ignore these early warning signs and to seek medical attention early. Ovarian cancer remains a silent killer, so be aware of the vague symptoms of presentation. Do seek medical attention if unsure. Taking the COCs can reduce one’s risk of ovarian and endometrial cancers.


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TenderCare

Continued on page B4.

HORMONE REPLACEMENT THERAPY AND CANCER

EvIDENCE FROM LITERATURE

BREAST CANCER based on evidence from published literature such as collaborative study1, the Women’s Health Initiative (WHI)2-3 and the Million Women Study (MWS)4, causality between hRt and breast cancer has been established.

(1) COLLABORATIvE STUDY Recent but not past use of hRt, as well as the duration of hRt usage, is a risk factor for breast cancer and risk is reduced upon discontinuation of therapy. there is an increased risk of breast cancer by 2.3 percent with each additional year of HRT use.

(2) WHI this was a landmark randomised and placebo-controlled trial to ascertain hRt use in the prevention of heart disease and breast cancer in postmenopausal women. In 2002, the WHI study was terminated early due to increasing rates of heart disease5 and breast cancer.

Event Increaseinnumberofcasesforevery 10,000womenreceivingHRTyearly

BreastCancer 8

Dementia(>65years) 23

HeartAttacks 8

Strokes 8

VenousThrombolicEvents 18

the increased risk of breast cancer was evident at the second year of hRt use and its risk dissipated within two years upon discontinuation of therapy. however, no increased risk of breast cancer was reported in the ERt arm.6

INTRODUCTION TO HORMONE REPLACEMENT THERAPY

Hormone Replacement Therapy (HRT) can be prescribed in various combinations and schedules. it can be prescribed as either unopposed estrogen, known as Estrogen Replacement therapy (eRT) or combined with progestogen, known as combined hRt. there are various ways of administering oral hRt, ranging from cyclical to continuous.

HRT was first introduced in the 1940s to treat menopausal symptoms. it was portrayed to be the “cure all” for symptoms such as hot flushes, insomnia, mood swings and night sweats experienced by postmenopausal women due to estrogen deficiency. other promises of hRt include cardio protective effects and the improvement of bone health.

In the 1970s, it was reported that the use of ERt in postmenopausal women with an intact uterus resulted in significantly higher rates of endometrial cancer. this was subsequently overcome when progestogen was used in combination with estrogen in this group of women.

To date, HRT remains the most effective in treating symptoms due to menopause. It is currently approved for the treatment of moderate-to-severe vasomotor symptoms and the prevention of osteoporosis.

there are potential side effects with hRt. they include breast tenderness, cramping, fluid retention and blood clots (thrombosis) in veins or lungs. However, probably the most controversial and of concern would be the association of hRt use with cancer.


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Despite the fact that hormones are not able to directly cause Dna damage, they are able to stimulate cell proliferation and affect tumour growth. hence, hRt use is generally contraindicated in this group of patients.

CONCLUSIONpost-Whi era, hRt is not used for the prevention of chronic diseases such as cVD and is no longer recommended to be used to relieve menopausal symptoms in postmenopausal women. nonetheless, the benefits of hRt may outweigh their risks when used as a short term therapy for moderate to severe vasomotor symptoms and to prevent osteoporosis in women younger than 60 years and in early menopause.

guidelines from the american association of Clinical endocrinologists (AACe)11 and the north american menopause Society (NAMS)12 concur that hRt may still be appropriate albeit for a selected group of women. in addition, the american congress of obstetricians and gynecologists (ACOg) recommends that the lowest effective dose of hRt be used and for the shortest time possible to treat menopausal symptoms.

Individualised patient assessment on menopausal symptoms experienced have to be conducted prior to HRT use. At the same time, patients have to be informed of associated risks versus benefits of HRT, have treatment options discussed and to undergo appropriate monitoring if HRT is being prescribed.

By Vivianne Shih Lee Chuen Principal Clinical Pharmacist Oncology Pharmacy NCCS

REFERENCES

1. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52 705 women with breast cancer and 108 411 women without breast cancer. Lancet 1997;350:1047-59.

2. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321-33.

3. Chlebowski RT, Hendrix SL, Langer RD et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial. JAMA 2003;289:3243-53.

4. Million Women Study Collaborators. Breast cancer and hormone replacement therapy in the Million Women Study. Lancet 2003;362:419-27.

5. Manson JE, Hsia J, Johnson KC et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003;349:523-34.

6. Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 2004;291;1701-12.

7. Chlebowski RT, Anderson GL, Gass M et al. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA 2010;304:1684-92.

8. Hulley S, Furberg C, Barrett-Connor E et al. Noncardiovascular disease outcomes during 6.8 years of hormone therapy: Heart & Estrogen / progestin Replacement Study follow-up. (HERS II). JAMA 2002;288:5866.

9. Zhou B, Sun Q, Cong R et al. Hormone replacement therapy and ovarian cancer risk: a meta-analysis. Gynecol Oncol 2008.;108:641-51.

10. Neves-E-Castro M. An analysis of ovarian cancer in the Million Women Study. Gynecol Endocrinol 2007;23:410-3.

11. Cobin RH, Futterweit W, Ginzburg SB et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause. Endocr Pract 2006;12:315-7.

12. North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause 2010;17:242-55.

HORMONE REPLACEMENT THERAPY AND CANCER

TenderCare

in the eleventh year follow-up Whi7 study that was recently published, women who received combined hRt compared to placebo had a two-fold relative increase in mortality due to breast cancer. hence, combined hRt was not only associated with increased risk of breast cancer but also mortality.

(3) MWS this was a large prospective observational trial. in postmenopausal women taking combined hRt, their risk of breast cancer was twice of that compared to non-users of hRt. similarly, the risk of breast cancer increases with duration of use.

in summary, there is an increased risk of breast cancer with hRt use (higher with combined HRT than eRT) and risk increases with duration of hRt. nonetheless, this increased risk would dissipate within two years upon discontinuation of therapy.

ENDOMETRIAL CANCERbased on data from Whi and the heart and estrogen/Progestin Replacement Study follow up (HeRS II), combined HRT has not been shown to increase risk of endometrial cancer.2,8

OvARIAN CANCERFrom a meta-analysis of observational studies9, the association of ovarian cancer with hRt seems to be stronger in ERt users compared to combined hRt users. Risk increases with increased duration of use. based on mWs, prolonged use of hRt increases ovarian cancer risk that is translated to four per 10,000 HRT users over five years.10

CAN HRT BE USED IN CANCER SURvIvORS?

at present, there is insufficient data to make recommendations on hRt use for cancer survivors.

Continued from page B3.


PAge B5

这种癌症的确切病因不明。不过，某些女性的患癌风险比其他人高：

• 肥胖或超重的女性

• 不曾生育或育有较少孩子的女性

• 患有不育症的女性

• 较早进入生理期和较迟步入更年期的女性

• 患有糖尿病、高胆固醇或高血压的女性

• 有月经失调或多囊卵巢综合征病史的女性

• 有子宫癌或、大肠癌或林奇二型(LYNCH II)综合征家族病史的女性

• 接受泰莫昔芬(Tamoxifen)治疗的乳癌患者

大多数病例(80%)在初期阶段会出现一些异常出血的情况：

• 更年期后出血

• 月经间期出血

• 长期经漏不止

任何人如果出现以上症状，应寻求治疗。初步检查包括超声波扫

描和子宫内膜活体组织检查（一般采用子宫扩张刮除术）。一旦

确诊患癌，最佳的治疗方法是进行分期手术（以评估癌症的范围/

扩散程度）和切除子宫。晚期癌症患者可能需要在进行手术后接

受额外治疗，如放射治疗、荷尔蒙疗法和化疗。

往前看妇科癌症：治疗与筛检ii

子宫癌

一般被称为“子宫内壁癌”或“子宫内膜癌”。它目

前是新加坡最常见的妇科癌症，患者通常是50岁至

60岁左右，停经后的妇女。在竹脚妇科癌症中心，

每年平均有180起新病例，而且发病率不断提高。

由于大多数病例在初期阶段就被发

现，因此整体而言，子宫内膜癌患者的

五年存活率高达80%。

多生育、确保生理期正常，以及通过健

康饮食和定期运动来维持理想体重，

都是预防子宫内膜癌的方法。长期使用

复合避孕药(COCs)和一种称为“曼月

乐”(Mirena)的含药宫内节育器，也可

以降低患子宫内膜癌的风险。

目前，医学界并没有检验子宫内膜癌的

有效筛检法。筛检常被认为不符合成

本效益，因为大多数病例能及早发现，

而且比较容易治疗和痊愈。

谢燕妮医生

竹脚妇幼医院妇科癌症部门主任兼顾问

新加坡杜克-国大医学研究院兼职助理教授

新加坡国立癌症中心客卿顾问

(子宫内膜癌)


PAge B6

往前看妇科癌症：治疗与筛检ii

卵巢癌

虽然卵巢癌比子宫内膜癌较少见，但它是

最致命的，因为大多数病例在晚期阶段才

被发现。在新加坡，每年每10万人中，就

有大约15.2人患卵巢癌。多数患者是40岁至60岁的女性。在竹脚妇科癌症中心，

每年平均有120起新病例。

跟子宫内膜癌一样，卵巢癌的确切病因

不明。不过，某些女性的患癌风险比其他

人高：

• 不曾生育的女性

• 患有不孕症的女性

• 较早进入生理期和较迟步入更年期的女性

• 有乳癌及/或卵巢癌或乳腺癌基因(BRCA)综合征或林奇二型综合征家族病史的女性

卵巢癌通常被称为“无声杀手”。初期阶段通常没有任何症状。等到症状出现

时，病情已进入晚期。此外，卵巢癌的症状非常模糊，也经常同胃炎、胆囊疾

病或结肠直肠病况混淆。

常见症状包括：

• 腹部胀气和鼓胀

• 消化不良或胀风

• 饭后有饱足感

• 腹部明显有肿块

• 泌尿系统症状，如频尿

• 排便症状，如便秘

• 一条腿浮肿

因此，围绝经期年龄层的女性千万不可忽视这些症状。如果不确定，应及早向

医生咨询。

如果怀疑患上卵巢癌，病人将被转介给妇科肿瘤医生或肿瘤内科医生，进一步

进行检验。这些检验包括电脑断层扫描及/或超声波扫描，以检测卵巢是否有

肿瘤，以及一种称为“卵巢肿瘤标记物”的血液检查，如癌抗原125 (CA125)。检验结果将能显示卵巢的肿瘤演变成恶性肿瘤的可能性。最后，医生必须动手

术切除肿瘤，以确定诊断。一旦确诊患癌，医生会同步进行分期手术（以评估

癌症的范围/扩散程度）。如果动手术时发现癌症已进入晚期，医生会尽量切除

肿瘤。有时候，如果癌症已进入晚期，医生可能会让病人先接受化疗，然后才

进行手术。除了非常初期阶段的卵巢癌外，几乎所有卵巢癌都必须采用双管齐

下的方法——手术和化疗。

卵巢癌的痊愈情况，须视癌症所处的阶段而定。由于大多数病例到了晚期才被

发现，因此整体而言，患者的五年存活率平均约为50%。

目前，医学界并没有任何有效的卵巢癌筛检法。即使是接受例常的超声波扫描

或“卵巢肿瘤标记物”血液检查，都无法及早发现卵巢癌。

卵巢癌可以通过服用复合避孕药来预防。长期使用三至五年，可使患卵巢癌的

风险减半。此外，多生育和母乳喂养也有助于降低患癌风险。

妇科癌症很常见。子宫颈癌可以通过注射疫苗和子宫颈抹片检查

法来预防。尽管子宫内膜癌无法有效预防或筛检，但患者通常会

在初期阶段出现异常出血情况。所以，千万不要忽视这些早期的

警告信号，而且要及早寻求治疗。卵巢癌仍是“无声杀手”，所以

要注意一些模糊症状。如果不确定，应向医生咨询。服用复合避孕

药，可降低患卵巢癌和子宫内膜癌的风险。

(卵巢肿瘤)

(子宫) (韧带)

(健康卵巢)

(卵巢恶瘤) (健康卵巢)

(输卵管)


pagE b7

荷尔蒙替代疗法简介

“荷尔蒙替代疗法”(Hormone Replacement Therapy，简称HRT) 可根据不同的组合和时

间表来进行。医生可以使用非对抗性雌激素的“雌激素替代疗法”(estrogen Replacement therapy，简称eRT)，或是结合孕激素的“综合荷尔蒙替代法”(Combined HRT) 来治疗。

口服荷尔蒙替代疗法有多种服用法，从周期性到持续性皆有。

荷尔蒙替代疗法在1940年代开始采用于治疗更年期症状。它被视为“万灵药”，可用来治疗停

经后女性因雌激素不足而出现的潮热、失眠、情绪波动和盗汗等症状。荷尔蒙替代疗法的其他

宣称功效包括预防心血管疾病和改善骨骼健康。

到了1970年代，有报道指出，如果子宫完好的停经后女性使用雌激素替代疗法，患上子宫内

膜癌的机率明显提高。不过，如果孕激素和雌激素一起使用，患癌风险则会大幅降低。

到目前为止，荷尔蒙替代疗法仍是治疗更年期症状的最有效方法。它目前是获准治疗中度到重

度血管舒缩症状和预防骨质疏松症的方法。

荷尔蒙替代疗法具有潜在副作用，包括乳房胀痛、抽筋、水肿，以及静脉或肺部出现血块

（血栓症）。不过，最具争议性和值得关注的是使用荷尔蒙替代疗法与癌症的关系。

温柔呵护

研究报告的论据

乳癌一些已发表的研究报告，如协作研究 (Collaborative Study) 1

、妇女健康倡议 (Women’s Health Initiative，简称WHI) 2-3

和百万妇女研究 (Million Women Study，简称MWS) 4

的论据显示，荷尔蒙替代疗法与乳癌的因果关系是成立的。

(1)协作研究

近期但不是过去使用荷尔蒙替代疗法，以及使用的时间，是罹患乳癌的风险因素。患病风险会随着疗程停止而降低。每多使用荷尔蒙替代疗法一年，患上乳癌的风险就会增加2.3%。

(2)妇女健康倡议

这是为了确定荷尔蒙替代疗法可预防停经后女性患上心脏病和乳癌，而展开的一项标志性随机安慰剂对照试验。由于罹患心脏病5和乳癌的机率不断增加，这项研究提前在2002年终止。

疾病每年每1万名女性接受荷尔蒙替代疗法的病例增幅

乳癌 8

失智症（65岁以上） 23

心脏病 8

中风 8

静脉血栓事件 18

在使用荷尔蒙替代疗法后的第二年，患上乳癌的风险明显增加，但疗程停止后的两年内，患癌风险将消除。使用雌激素替代疗法则不会增加患上乳癌的风险。6

近期发表的《妇女健康倡议》第11年跟进研究7显示，同安慰剂相比，接受综合荷尔蒙替代疗法的女性因罹患乳癌而死亡的比率增加两倍。由此可见，综合荷尔蒙替代疗法不仅跟患乳癌风险增加有关，而且跟死亡率也有关。

(3)百万妇女研究

这是一项大规模预期性观测研究。使用综合荷尔蒙替代疗法的停经后女性，患上乳癌的风险比非使用者高出一倍。同样的，患乳癌的风险会随着使用时间的增加而提高。

总的来说，使用荷尔蒙替代疗法会提高患乳癌的风险（综合荷尔蒙替代疗法比雌激素替代疗法更高），而且患癌风险会随着荷尔蒙替代疗法使用时间的增加而提高。尽管如此，疗程停止后的两年内，患癌风险将消除。

荷尔蒙替代疗法与癌症

子宫内膜癌根据妇女健康倡议和心脏与雌激素/孕激

素替代研究跟进 (Heart and estrogen/progestin Replacement study follow up，简称HeRS II)的数据，综合荷尔蒙替代

疗法并不会增加患子宫内膜癌的风险。2,8

卵巢癌根据一些观测研究9的综合分析，雌激素替代

疗法使用者患上卵巢癌的风险，比综合荷尔

蒙替代疗法使用者更高。患癌风险也会随着

使用时间的增加而提高。百万妇女研究显示，

长期使用荷尔蒙替代疗法，会增加患卵巢癌

的风险。换句话说，每1万名荷尔蒙替代疗法

使用者中，有4人在5年内会面对患癌风险。10

癌症幸存者能否使用荷尔蒙替代疗法？目前，医学界没有足够的数据显示癌症幸存者可

以使用荷尔蒙替代疗法。虽然荷尔蒙不会直接

导致脱氧核糖核酸 (DNA)受损，但它会刺激细

胞增生和影响癌细胞生长。因此，这类病人一般

上是不被允许使用荷尔蒙替代疗法的。

总结妇女健康倡议研究结束后，荷尔蒙替代疗法没有

被用来预防心血管疾病等慢性疾病，也不再被建

议用来缓解停经后女性的更年期症状。不过，当

荷尔蒙替代疗法被用于为60岁以下提早进入更

年期的女性治疗中度到重度血管舒缩症状和预

防骨质疏松症的短期疗程时，则利大于弊。

美国临床内分泌学家协会 (American association of clinical Endocrinologists，简称AACe) 11 和北美更

年期协会 (North American menopause society，简称NAMS) 12 的指导准则都认

同，除了特定组别的女性外，荷尔蒙替代疗法

还是适合使用的。另外，美国国会妇产科学会

(American Congress of Obstetricians and gynecologists，简称ACOg)也建议

使用最低有效剂量的荷尔蒙替代疗法和最短时

间，来治疗更年期症状。

在使用荷尔蒙替代疗法前，医生必须先评估个

别病人的更年期症状。与此同时，医生也必须告

诉病人有关荷尔蒙替代疗法的利弊，以及跟病

人讨论治疗选项。如果决定采用荷尔蒙替代疗

法，病人也必须接受适当监督。

参考文献，请参阅第b4页

以上文章由施丽娟提供肿瘤药学首席临床药剂师新加坡国立癌症中心


PAge B8

Outreach UPCOMING PUBLIC EDUCATION ACTIVITIES/PROgRAmmES

Event Name Date and Time

Supportgroup:NPC(Nasopharyngeal/NoseCancer)

Managing the Side Effects of Radiotherapy and Chemotherapy

6January2012,Friday7pm to 9pmsession will be conducted in English

LungSupportiveCareProgramme

Exercising Right

13January2012,Friday2.30pm to 4.30pmsession will be conducted in mandarin

malaySupportgroup–SinarHarapan

What is This Feeling?

14January2012,Saturday2.30pm to 4pmsession will be conducted in malay

PatientAmbassadorTraining

Issues in Grief & Managing Emotions

21January2012,Saturday9am to 12pmsession will be conducted in English

LookgoodFeelBetter(forLadiesonly) 27January2012,Friday2pm to 5pmsession will be conducted in English

mandarinSupportgroup

Your Cancer Journey

27January2012,Friday6pm to 8pmsession will be conducted in mandarin

Supportgroup–griefinRecovery(forsurvivingspouse)

Agreement between Expectations and Yearnings – Key to Satisfactory Post Loss

27January2012,Friday7pm to 9pmsession will be conducted in English

STEERSeries

Brushes in action

4February2012,Saturday9.30am to 1pmsession will be conducted in English

TheRevivalConnection(forAdvanced&RecurrentCancers)

Lunar New Year Get-Together

4February2012,Saturday1pm to 3pmsession will be conducted in English

Supportgroup:NPC(Nasopharyngeal/NoseCancer)

Nutrition – Your Kitchen, Your Pharmacy

10February2012,Friday7pm to 9pmsession will be conducted in English

malaySupportgroup–SinarHarapan

A Psychological Way of Managing Your Symptoms

11February2012,Saturday2.30pm to 4pmsession will be conducted in malay

Venue:Function Room, level 4 national cancer centre singapore

To register, please call: Patient Support at 6436 8117 / 6436 8126 or Cancer helpline at 6225 5655 Mon – Fri: 8.30am – 5.30pm


Page a5

SaLUBRISNovember / December 2011

PeopleFrOmasPIrINGF1raCer TOLIFe-savINGsUrGeON

Besides spending hours in the operating theatres, he also initiated the first-ever Liver Cancer Support group in Singapore with the help of his co-chair, Dr Chan Chung Yip, Consultant of the Singapore general Hospital. The support group was launched during the Liver Cancer awareness Month event held at IMM garden Plaza in September.

He initiated this support group after being approached by many patients enquiring about the availability of a support group for liver cancer patients. Realising the importance and need of having a support group to help patients and caregivers during and after their cancer journey, Dr Lee escalated his idea to his seniors and fellow colleagues, who were very supportive of it.

“I hope that this group provides a platform for liver cancer patients to come together and share their stories. Through this, they will be able to better prepare themselves for the treatment that lies ahead, and the kind of changes they may expect.

I also hope that through this support group, we can help dispel myths about liver cancer and its treatments. Most importantly, our liver cancer survivors are able to impart hope to newly diagnosed liver cancer patients,” said Dr Lee.

By Mark Ko

Today, Dr Lee Ser Yee, a consultant with the National Cancer Centre Singapore, is pleased with that choice. His passion for his work has been rewarded by his receiving of the Young Surgeon’s award from the College of

Surgeons of the academy of Medicine, Singapore.

after graduating from medical school, Dr Lee chose to become a cancer surgeon because it combines two of his interests – surgery and oncology. Most importantly, cancer is one of the leading causes of death in Singapore. To him, it is immensely satisfying to be part of a team of specialists to combat this killer disease. No amount of glamour and thrills from speeding on a race track can grant him as much satisfaction as saving lives.

“Havingcancerisnotnecessarilyadeathsentence.Therehavebeenimprovementsinthetreatmentofcancerandonecanstillleadafulfillinglifeafterappropriatetreatment.moreimportantly,patientshaveadedicatedteamofcancerspecialistsandparamedicalstaffwhoareheretowalkwiththemeverystepofthewayontheirjourneytorecovery,”hesaid.

The complexity of surgery thrills Dr Lee. Challenging as it is, it also demands a good knowledge of anatomy, innovation and hours of training and practice to be competent. “It is immensely satisfying because you can literally put your hands on the problem to deal with it and in some situations, it is the definitive treatment for the patient,” he added.

During his apprenticeship, Dr Lee had the privilege to train under many accomplished surgeons. One of them is Director of NCCS, Prof Soo Khee Chee. Dr Lee is full of praise for his mentor. “Prof Soo is tireless in his efforts to help patients, raise standards of healthcare and medical research in Singapore, as well as to impart skills and knowledge to younger surgeons like myself. He has been tremendously inspiring to work with.”

Many people would agree that the job of a Formula One racer is possibly one of the most exacting jobs in the world. after all, not many jobs would give you that kind of high-speed thrill and spill of racing at neck-breaking speeds in the full view of glamorous TV cameras broadcast worldwide. This is not to mention, the paycheck that goes with the job.

Hence in his early days, a young Lee Ser Yee had thought of getting himself in the F-1 driver’s seat. But his hopes were dashed after learning that the training and equipment would cost a big money chest.

Spurred on by his inclination for Science, love for helping people and doing things with his hands, he turned to his next passion to become a surgeon. Dr Lee Ser Yee (left) receiving the

Young Surgeon’s Award.


PAge A6

Adayofsportingfuninaidofcancerresearch

more than a hundred warm-hearted partners and business associates of prudential singapore were greeted with beautiful weather on 27 September as they teed-off and golfed for the cancer cause, raising $250,000 in aid of the ncc Research Fund.

PRUDENTIAL GOLF CHARITY RAISES$250,000FORNCCRESEARCH FUND

Community

Dr Tan Hiang Khoon, Director for Division of Community Outreach and Philanthropy at NCCS.

Guest-of-Honour Prof Tan Ser Kiat, Group CEO of SingHealth and Board member of NCC Research Fund, receiving the cheque from CEO of Prudential Singapore, Kevin Holmgren.

From left: Patrick Teow, Chief Distribution Officer of Prudential Singapore, Prof Tan Ser Kiat, Group CEO of SingHealth and Board member of NCC Research Fund, Benny Tay, Organising Chairman of Prudential Golf Charity, A/Prof Koo Wen Hsin, NCCS Deputy Director.

This was part of prudential Singapore’s 80th anniversary celebrations this year, which

revolves around giving back to the community. “With this gesture, we hope to help nccs’ efforts in the development of cancer treatment methods,” said Kevin holmgren, chief Executive officer of prudential singapore.

the day of golfing excitement showcased the skills of participants and culminated in an elegant dinner that featured an array of attractive prizes. guest-of-honour professor tan ser Kiat, group cEo of singhealth, who is also a board member of the ncc Research Fund, received the cheque and presented tournament prizes and tokens of appreciation to the participants.


pagE a7

Community

Dr Tan Hiang Khoon, Director for Division of Community Outreach and Philanthropy at NCCS.

Guest-of-Honour Prof Tan Ser Kiat, Group CEO of SingHealth and Board member of NCC Research Fund, receiving the cheque from CEO of Prudential Singapore, Kevin Holmgren.

From left: Patrick Teow, Chief Distribution Officer of Prudential Singapore, Prof Tan Ser Kiat, Group CEO of SingHealth and Board member of NCC Research Fund, Benny Tay, Organising Chairman of Prudential Golf Charity, A/Prof Koo Wen Hsin, NCCS Deputy Director.

Golfing action and bonding.

Thanking Prudential Singapore, the organising committee initiated by Agency Force Alliance (a group of Prudential Singapore’s Agency Leaders), sponsors, donors and participants at the dinner for their big-hearted support, Director for Division of Community Outreach and Philanthropy at NCCS, Dr Tan Hiang Khoon said, “Donating to research can be likened to buying insurance; investing for the future. At times, the returns (in research) are received sooner than expected, benefiting or protecting you and your loved ones.”

organisations who would like to support the cancer cause through such corporate events are welcome to contact the nccs community partnership at [email protected]. We will be pleased to work with you.

By Adeline Teo Division of Community Outreach & Philanthropy NCCS


PAge A8

SALUbRIS is produced with you in mind. If there are other

topics related to cancer that you would like to read about or if you would like to provide some feedback on the articles covered, please email to [email protected].

NATIONAL CANCER CENTRE SINGAPOREReg No 199801562Z

11 Hospital Drive Singapore 169610 Tel: (65) 6436 8000 Fax: (65) 6225 6283 www.nccs.com.sg

EditorialAdvisors

prof Kon oi lian prof soo Khee chee

ExecutiveEditors

ms charissa Eng ms Veronica lee mr sunny Wee

ContributingEditor

Dr Wong nan soon

members,EditorialBoard

mr mark Ko ms sharon leow Dr shiva sarraf-yazdi ms Jenna teo

medicalEditor

Dr Richard yeo

members,medicalEditorialBoard

ms lita chew Dr mohd Farid Dr melissa teo Dr teo tze hern Dr Deborah Watkinson

Community FUN WAY TO RAISING AWARENESS ON LIvER CANCER

But the decision to create awareness the fun way for this year’s 4th liver Cancer Awareness Month (LiCAM)

proved to be a success. held on 17 sept at the imm garden plaza, the day-long fun and games, and on-stage entertainment drew a steady crowd. at the close of the day, an estimated 500 people turned up at the event.

Jointly organised by the national cancer Centre Singapore (NCCS) and the Singapore general Hospital (SgH), the event attracted families with young children in tow as well as weekend shoppers who joined in the activities with a number of them walking home with prizes from the lucky draws.

“We did a public exhibition this year, wanting to approach public education and raise awareness in a different way, rather than just by didactic lectures alone,” said Dr tan hui hui, co-chairperson for the licam committee and consultant with sgh. the other co-chairman is Dr chan chung yip, who is also a consultant with sgh.

Raising awareness on liver cancer is no easy task. this is especially when there are so many competing activities in september, from the lantern festival to the F-1.

the draw for the children was the colouring contest, balloon sculpting and magic show. the adults signed up for the quiz and those who could answer a list of written questions correctly went home with a goodie bag each. to answer the questions, they had to view the exhibition of informational posters and learn about liver cancer. to entertain the crowd, there was a traditional indian dance by the Jurong Jewels, and singing performances by a number of cancer survivors.

to add a dash of colour, young children could pose in a surgeon’s scrub against a backdrop of an operating theatre. and it was all for free.

the key highlight of the event was the launch of the first liver cancer support group by Dr lee ser yee, associate consultant from nccs and chairman of the liver cancer support group.

the group will help patients and their loved ones cope with their condition before, during and after treatment. members can also use this platform to share their experiences and journey together with their family.

“With this support group, we hope to provide our patients and their families with additional resource for the best care. patients and their loved ones can use this opportunity to speak to other patients to understand the treatment process as well as their journey to recovery,” said Dr lee.

among the upcoming events and activities include creating a Facebook page where patients can access more information and a christmas party at the end of this year. the pioneers in the group include survivors messrs Judson guo Ji Quan, Jumaat bin Zahari, Yue Keng Siang and Zulkifli bin Samsuri.

By Mark Ko

salubris november/december 2011

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