Ask the expert: Keeping abreast of cancer

Ask the expert: Keeping abreast of cancer
A patient undergoing mammogram to detect early stages of breast cancer.
PHOTO: Changi General Hospital

Dr Sue Lo is senior consultant medical oncologist with The Harley Street Heart & Cancer Centre

How will you explain to the auntie next door what your speciality is?

I am a doctor specialising in treating cancer patients.

Cancer is a complex illness, and patients require a group of doctors to treat them to achieve the best outcome.

The main doctors involved include the radiologists (X-ray doctors), pathologists (who look at cells to make the cancer diagnosis), surgeons (doctors who cut out the tumour), radiation oncologists (who kill cancer cells with radiation) and medical oncologists (doctors who give chemotherapy or medicine to kill the cancer cells).

I am among the group of doctors who give chemotherapy. In other words, I am a medical oncologist.

Tell us about the spectrum of patients you see.

I have a range of patients. The majority of whom have been diagnosed with cancer, and I treat them with medicine.

I do a lot of counselling as well, as cancer patients and their families require a lot of psychological support.

I also have a group of healthy patients who come for regular cancer screening tests as they are at high risk because of their genes, for example.

Although we know that up to 33 per cent of cancer are preventable by adopting a healthy lifestyle, routine screening and vaccination, there is still 66 per cent of cancer that cannot be prevented.

I concentrate on women's cancers, including breast, ovarian, cervical, and uterine cancers, as well as gastrointestinal cancers, such as colon and stomach cancers.

One in three people will have a diagnosis of cancer, so it is inevitable that all of us will come across someone close who has been affected.

What is breast cancer?

This means the cancer cells originated from breast tissue.

There are many different sub-types of breast cancers. How breast cancer is treated depends on the staging - or how early it is discovered - and whether they respond to certain hormones for example.

Cancer is classed as early stage if it has not spread to other parts of the body such as the bones, lungs, liver and brain. The majority of early-stage breast cancers are curable.

Metastatic breast cancer means that it has spread to other parts of the body such as the liver, lungs, bones or brain.

We also call metastatic breast cancer Stage IV breast cancer. Less than 20 per cent of patients will be alive five years after they are diagnosed with metastatic breast cancer.

Why are some metastatic breast cancers not found sooner?

Breast cancer usually presents as a painless lump in the breast.

Most patients are not aware, especially if they do not do self-examination or go for regular mammographic screening.

Patients may not realise they have an abnormal lump if it is very small.

But the smallest lumps can be very aggressive, and they can spread to other parts of the body before growing to a noticeable size.

Do men get breast cancer too? When should they seek help?

Breast cancer is rare in men - around 1 in 100 men get breast cancer.

I have treated several men with breast cancer.

It is hard for men to accept the diagnosis, as breast cancer is commonly associated as 'women cancer'.

But it is important for men to know that early stage breast cancer is curable, and they should seek medical help if they notice any lumps in the breast, bloody discharge from the nipple, or any skin changes.

What does it mean when a doctor says metastatic breast cancer is not curable but treatable?

We can now treat certain metastatic breast cancer like a chronic illness - think diabetes and hypertension, for instance.

Patients continue with their 'normal' lifestyle such as working, travelling, looking after their family, while receiving regular therapy, so we view cancer as treatable - it can be controlled for a long time - it is not curable, in other words, we can never get rid of it completely.

What is in the arsenal when you fight metastatic breast cancer?

There are many different weapons that we can use in the fight.

There are different types of breast cancer. We treat each type differently.

For example, some breast cancers respond to drugs that block or reduce the levels of oestrogen in the body. These drugs are called hormonal therapy.

But whatever drugs we use, cancer cells will eventually become resistant (the treatment stops being effective), so cancer scientists are constantly researching into newer drugs to combat this resistance.

The latest drug that just became available here for this purpose is Ibrance (Palbociclib).

This drug, when used in combination with some of the currently available hormonal therapy, increases the duration of the effectiveness of the treatment.

Around 20 per cent of breast cancers have a receptor called HER2.

This responds well to another type of targeted therapy that seems to have fewer side effects compared to conventional chemotherapy.

Another 20 per cent of breast cancers do not have hormone or HER2 receptors.

For this group of patients, we would need to treat with chemotherapy.

Dr Sue Lo is senior consultant medical oncologist with The Harley Street Heart & Cancer Centre

juditht@sph.com.sg


This article was first published on October 02, 2016.
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