School nerd now wields 'invisible blades'


Dr Lee Kuo Ann

AGE: 43

OCCUPATION: Consultant radiation oncologist at Parkway Cancer Centre

Dr Lee confesses to being a nerd when he was in school. With his twin interests in computers and physics, radiotherapy seemed a natural choice for him.

But it was not until a patient in his ward at Singapore General Hospital (SGH) was referred for radiotherapy that he discovered this field of medicine.

Then a medical officer, he immediately applied for a six-month attachment and traineeship in radiotherapy at SGH.

Radiotherapy is one of three conventional treatment options for treating cancer, with the other two being surgery and chemotherapy.

Dr Lee is married to a 40-year-old stay-at-home mother. They have two daughters aged 12 and 10.

I specialise in treating cancer with radiation because...

Just as Moore's Law dictates that computing power doubles every four years, we see significant improvements in radiotherapy technology roughly every five years.

Clearer imaging technology, such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT), has allowed tumours to be located precisely.

The body cells are fascinating because...

Thousands of complex molecules and biochemical processes help cells to identify and repair DNA damage that occurs on a daily basis.

If not for these processes, cancer would afflict everyone from a young age.

One little known fact about radiation oncology is...

Patients do not become radioactive after treatment and do not have to be kept away from other people. Also, radiotherapy is not "heaty" and does not cause cancer cells to spread.

Radiotherapy treatment is typically delivered over one to seven weeks and involves lying still for 10 to 20 minutes each day while the therapy machine rotates around the patient, emitting painless X-rays.

If I were to give an analogy for what I do, I would be...

A battle strategist. Planning for radiotherapy is akin to planning for a battle.

Using the patient's CT scan, I identify and outline the tumour (enemy) coordinates as well as that of the normal organs (civilians).

Then, I decide on the type and strength of radiation, angle of fire and duration of treatment to ensure that the cancer is destroyed with minimal collateral damage.

X-rays and gamma rays are my invisible blades with which I use to "cut" the tumour.

A typical day for me starts...

At 7am when I wake up. By 8.30am, I am at work at one of these three hospitals: Gleneagles, Mount Elizabeth and Mount Elizabeth Novena.

About two-thirds of the day is spent with patients in the clinic or ward. I spend a lot of time with first-time patients to make sure they have a good understanding of their condition and treatment.

For patients who have started radiotherapy, I see them weekly to check on side effects, if any.

After treatment is completed, I see them every few months to check on the regression of their cancer.

The remainder of the day is spent on radiotherapy computer planning which, in a complex case, can take three to six hours. During these times, I work late into the night. Otherwise, I am usually home by 7pm.

Weekends are spent with my family, attending church and maybe going for a swim, a game of bowling or a movie.

I have come across all types of cases…

Most patients are in their 50s or 60s. But I have also treated elderly people in their 90s, as well as children as young as 11/2 years old.

The most common types of cancer I treat are that of the breast, lung, nasopharynx, rectal, head and neck.

Several times a year, I may receive patients with anal, skin, stomach, liver or testicular cancer. I have also seen tumours so rare that only a few such cases are reported each year.

I love patients with...

A positive spirit and faith. They are an encouragement even to those caring for them.

I remember an elderly Filipino woman with advanced breast cancer who could hardly walk or talk without oxygen. Tumours in her chest had caused her to be perpetually breathless. Even though she knew that her prognosis was poor, she always had a smile on her face.

Radiotherapy to the chest helped to lessen her breathlessness, but only for a few weeks, and she later succumbed to the disease back in the Philippines. I was touched when her husband flew back to Singapore to thank me and my colleagues.

Patients who get my goat are...

Those whose disease are potentially curable, but who refuse treatment due to the fear of side effects - only to return when the cancer has become worse.

For instance, there was a patient with nasopharyngeal cancer who was offered radiotherapy in another hospital more than a year ago. But he fell off the radar out of denial or fear.

Had he been treated then, he would have had a 90 per cent chance of being cured with limited side effects.

By the time he sought treatment with me this year, the cancer had invaded the skull, brain and nerves of the eye. He is still receiving treatment, but he risks having more side effects and his cancer is also more likely to return.

Things that put a smile on my face are...

Being pounced on and hugged by my daughters when I come home from work every day.

Also, when my wife pampers me with her homemade ice cream, such as dark-chocolate orange liqueur, hazelnut and chendol ice cream.

It breaks my heart when...

It is not possible to cure everyone. Still, whenever a patient suffers a cancer recurrence, I feel crushed.

I wouldn't trade places for the world because...

I am satisfied when I see the joyful faces of patients when their cancer goes into remission.

My best tip...

Go for regular cancer screening, get adequate insurance coverage and enjoy life.

If you know someone undergoing radiotherapy, encourage him to eat and drink adequately, and to minimise dry skin by avoiding prolonged direct sun exposure and by moisturising the skin regularly.

This article was first published on July 17, 2014.
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