Mr Eric Chee does not have something most people have - a stomach.
The 51-year-old owner of a printing business had his stomach removed in 2006 after suffering a relapse of stomach cancer.
He was first diagnosed with the disease in 1998. He had experienced gastric pain for two years before that but had dismissed it as a minor ailment.
Dr Law Ngai Moh, consultant gastroenterologist at Raffles Hospital, said: 'In younger patients, mild stomach symptoms are usually passed off as indigestion resulting in delayed investigations and gastroscopy.'
Stomach cancer is caused by abnormal cancerous cells in the internal lining of the stomach.
Mr Chee's wife, Christina, 46, recalled his first diagnosis: 'When the doctor called and asked us to see him in his clinic, I knew it wasn't good news. I trusted in God for strength and it was not an easy time. I was then five months pregnant with our second child.'
Two days after Mr Chee was diagnosed with Stage Three cancer, he had surgery to remove 80 per cent of his stomach. His doctor had given him a 50-50 chance of survival.
He said: 'What pushed me to survive were my thoughts of my family and my faith in God.'
After his surgery, he embarked on a one-year chemotherapy treatment as his doctor at Mount Elizabeth Hospital suspected that the cancer might have affected his lymph nodes.
Mr Chee said: 'The chemotherapy made me feel like vomiting constantly. I was very tired all the time and I needed lots of rest.'
Despite his weakened condition, he continued to work. He said: 'When I discovered I had cancer, I had a two-year-old son and a little girl on the way. I was worried about how they'd survive.'
Although he only had 20 per cent of his stomach left, Mr Chee said that he had only one dietary restriction. He had to abstain from crab, which gave him indigestion. Otherwise he could still follow a normal diet.
Eight years later, cancer ravaged his stomach again and he had five-hour surgery to remove the rest of his stomach.
He said: 'I was more scared the second time around as I thought it was even more serious.'
Asked why removing the entire stomach is necessary in certain cases of stomach cancer, Dr Law said: 'It's necessary especially when the tumour is large and involves the whole stomach and nearby areas, including lymph nodes. In order to improve the cure rate, radical surgery with complete clearance of the tumour is needed.'
Mrs Chee said: 'My son Shaun, 12, was quite affected the second time around. I had a talk with him to encourage him. My daughter Ondrea, 10, wanted to be with us constantly. They learnt the value of being together as a family.'
Mr Chee was put on a soft diet after his second surgery. He had to keep to food like bread and eggs and eat every one to two hours.
For patients without a stomach, the oesophagus is directly connected to the small intestine where main digestion and absorption take place.
However, no matter how careful he was, he still ran into trouble at times. 'When I ate bread, it would expand in my digestive tract. I'd feel like throwing up but could not as I didn't have the stomach muscles to regurgitate the food.'
And he added with a laugh: 'Sometimes I'd lean over the edge of the bed to get the food out if it felt stuck in the digestive tract.'
Trial and error over the last two years has taught Mr Chee that chewing his food thoroughly, eating more vegetables and fruits and avoiding minced meat and crab are key to a smooth and easy digestion.
Mrs Chee also started him on supplements containing live enzymes and organic fibre to aid digestion. She said: 'I went to the library to do research. When friends and family recommended something, I'd read up on it and try it on myself first before giving him the pills.'
Her support proved invaluable and prompted a change in Mr Chee. Having cancer forced him to reflect on life and realise that it was not just about work but also about relationships with people around him.
He said: 'I've learnt to take it easy.'
No stomach, no problem
No stomach, no problem
Stomach cancer is the fifth and seventh most common cancer in men and women respectively, the Singapore Cancer Registry's interim report from 2001 to 2005 showed.
The disease is caused by abnormal cancerous cells in the internal lining of the stomach.
There is no single known cause but the cancer is often triggered by a cocktail of environmental and genetic factors. Chronic infection of the stomach by the bacteria called Helicobacter pylori is an important co-factor.
A history of chronic stomach ulcers, a family history of cancer of the gut or excessive smoking and drinking may put people at greater risk of developing stomach cancer.
In Mr Eric Chee's case, his father also suffered from stomach cancer.
Early symptoms of stomach cancer include dyspepsia (discomfort and pain in the upper abdomen), indigestion, bloating, vomiting and heartburn.
Late symptoms may include the vomiting of blood, passing of black stools and weight loss. People experiencing any such gut symptoms for more than a month should see a doctor immediately.
A gastroscopy is currently the best method to screen for stomach cancer. The five-minute procedure costs between $200 and $700 and involves inserting a fibre optic tube through the nose or mouth into the stomach to allow the doctor to observe the digestive tract's inner lining.
Treatment options include surgery and chemotherapy. If the tumour is large, parts of or the whole stomach may have to be removed.
Asked if people can survive without a stomach, Raffles Hospital's consultant gastroenterologist Law Ngai Moh said: 'The stomach is needed mainly for grinding food and for minor initial digestion. Main digestion and absorption take place in the small intestine.
'When a patient lacks a stomach, digestion and absorption are still possible with cautious intake of food.'
This article was first published in Mind Your Body, The Straits Times.