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Have you ever known that lung cancers come in different “sizes”? The common form of lung cancer most patients suffer from is the “large” variety, or in medical lingo, the “non-small cell” type. It would be easy to deduce, therefore, that there has to be a “small” variety, or, “small cell” type of lung cancer.

Mr. L, a gentleman in his late 60s, listened attentively and tried his best in take in the information as I explained that he had the less common small cell type of lung cancer.

“Small” versus “non-small”. Which is worse?

In this case, the “small” one actually packs a bigger punch. Small-cell lung cancer is generally more fatal.

If there ever were an Olympic Games pitting various types of cancer against one another in a competition of speed of growth, small-cell lung cancer would no doubt be a medalist. It has one of the shortest doubling time of about 80 days – time taken to double the number of cancer cells in the body – in the world of cancers. Non-small cell lung cancer typically takes around 200 days to achieve the same feat.

Most cases – around 70 percent - of small cell lung cancers are discovered only when the disease is in the advanced stage. Even in the less common scenario of patients being fortunate to have their disease diagnosed in the early stage, less than 20 percent can be permanently cured. In the advanced stage, the situation is much grimmer; these patients typically live for only 2 months without treatment. Even with the use of chemotherapy, only about a third of patients with advanced small cell lung cancer will live to see another year.

It has oft been said that not all cases of lung cancer are associated with smoking; non-smokers, too, may develop lung cancer. Not so for small cell lung cancers. Of all patients of small cell lung cancer diagnosed every year, less than 3 percent are non-smokers. Small cell lung cancer is an almost exclusively smokers’ cancer.

Given the grim outlook of small cell lung cancer, it is perhaps a blessing that small cell cancer is not very common, forming about 15 percent of all cases of lung cancer worldwide. In Singapore, the percentage is somewhat lower at about 8 percent.

But such statistics would be cold comfort for Mr. L as he faced the diagnosis of small cell lung cancer.

Mr. L underwent a specialized scan – positron-emission tomography (PET-CT) – that confirmed his worst fears: his condition of small cell lung cancer was in the advanced stage.

Had Mr. L been diagnosed with the same condition last year instead of this year, the standard treatment would have been chemotherapy with the relatively poor treatment results I alluded to. Such treatment has been the standard for more than 2 decades. While the treatment of most types of cancer have improved by leaps and bounds over the last 20 years, the treatment results of small cell lung cancer hardly budged.

Thankfully, in March and August 2020, the Health Sciences Authority of Singapore (HSA) has given the green light for two forms of immunotherapy to be used for the treatment of advanced small cell lung cancer. The addition of immunotherapy to standard chemotherapy improved the odds of patients going past the next 1 year and beyond, from round about one third to more than half.

Mr. L listened intently as I explained the scientific concept of how cancers cells in the body survive by evading attack by the body’s immune system.

Cancer cells behave like wolves in sheep’s clothing and the immune system fails to recognize them as wolves. The scientific term for this “sheep’s clothing” is PD-L1. Cancer immunotherapy utilizes artificial antibodies, known as anti-PDL1 antibodies, to strip the sheep’s clothing off the back of the cancer cells. These antibodies are infused into the patient’s body at regular intervals of about 3 weeks. Deprived of their camouflage, cancer cells become exposed to attack by the body’s immune system.

Mr. L started on his fight against cancer with a sense of hope.

After a wait of 20 years, a new dawn in the treatment of advanced small cell lung cancer has arrived. It gives me comfort today to be able to offer patients battling such a difficult disease a better treatment. And yet, a doctor’s and a researcher’s work is never done. The search for a yet better treatment for small cell lung cancer continues.

My greatest hope is… the next major breakthrough will not be another 20 years in the making.

 

Dr Wong Seng Weng
Medical Director & Consultant Medical Oncologist of The Cancer Centre (Singapore Medical Group)
Member of the Singapore Cancer Society Lung Cancer Awareness Month Committee

Category: Blog

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For many, alcohol represents leisure, happiness and celebration of special events or festivals. However, in the past few decades, there had been a growing body of evidence linking alcohol consumption and increased cancer risk. Drinking alcohol is linked to a higher risk of at least 7 types of cancer, including breast, colorectal, liver, oral cavity, pharynx, larynx, and oesophagus cancers.

In 1988, the World Health Organization has recognized alcoholic beverages are carcinogenic to humans.[1] About 5% of new cancer cases worldwide are directly attributable to alcohol consumption. Alcohol-attributable cancers in 2010 were estimated to be responsible for 337,400 deaths worldwide, predominantly among men.

However, there is generally low awareness of the relationship between alcohol consumption and cancers. According to a recent survey in US, fewer than one in three people realize that drinking alcohol is a cancer risk factor. People typically don’t associate drinking beer, wine and hard liquor with increasing their risk of developing cancer in their lifetimes. With the worrying widespread ignorance, it is vital to raise the awareness of the causal link between alcohol and cancer and prompt behaviour change to reduce alcohol consumption.

 

Is Alcohol Good or Bad for Your Health?

People may get confused about the health risks associated with drinking. On one hand, certain types of alcohol have been claimed for their potential health benefits. We’ve all heard about the heart-healthy benefits of antioxidant-rich red wine. On the other hand, other research links heavy drinking to health problems such as liver damage and stroke. It sounds like a mixed message.

However, when it comes to cancer risk, the message is getting clearer and clearer that all types of alcoholic beverages increase the cancer risk. No type of alcoholic drink is better or worse than another, regardless of whether it is wine, beer or spirits. It is the alcohol itself that leads to the higher risk of cancers. Drinking and smoking together are even worse.

 

Does only heavy drinking increase the risk of cancers?

Risk of cancers increases with the amount of alcohol consumed. Heavy drinking does damage your cells and can increase your chances for cancer. However, light drinkers also aren’t off the hook. Just a small glass of wine a day has been proven to increase the risk for cancers in the pharynx and oesophagus, as well as female breast cancer. American Institute for Cancer Research also found that postmenopausal breast cancer risk increases by about 11 percent for each standard drink a day. Recently, an Australian research team reported that even low-level drinking — just one or two drinks per day - can increase a man's risk of developing prostate cancer by 8 percent compared to not drinking at all.

 

Are the links between Asian flush and cancer actually real?

Going red after alcohol is not a sign of strong qi (energy flow), but rather an indication that your body is not metabolising alcohol efficiently, a phenomenon so called “Asian flush”. It is caused by a failure to break down one of the toxic by-products of alcohol metabolism called acetaldehyde. The build-up of acetaldehyde causes uncomfortable side effects such as a red face.

Although many people are familiar with the flush, only a few understand that Asian flush is more than just an inconvenient outlook, but also a red flag indicating higher cancer risk. In fact, it has been reported that someone with Asian flush is 6-10 times more likely to develop oesophagus cancer from drinking alcohol than someone who does not have alcohol flush.

It would be better to avoid alcohol if you have Asian flush. But if you do drink, do so in moderation.

 

What is suggested serving size for an alcoholic drink?

The Health Promotion Board suggests that men should drink no more than two standard drinks a day, and women, no more than one. A standard alcoholic drink is defined as a can (330 ml) of regular beer, half a glass (175 ml) of wine or 1 nip (35 ml) of spirit. The serving sizes for alcoholic beverages for men and women are different because women are more vulnerable than men due to slower metabolic process of alcohol. As a result, the alcohol stays in a woman’s body longer than a man’s. And the longer large amounts of alcohol stay in your body, the higher your risk for brain and organ damage, as well as cancer.

The "one or two standard drinks" limit is not an average; you can't drink 10 drinks in a single day, then nothing the rest of the week and tell yourself you're still following the guidelines.

Keep in mind that even moderate alcohol consumption isn't risk-free.

 

Bottom line

There is no level of alcohol consumption that's completely safe.

The less alcohol you drink, the lower your risk of cancer.

Not drinking is the safest choice.

Category: Blog

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Singtel-Singapore Cancer Society Race Against Cancer (RAC) 2016 is a race to save lives. RAC 2016 aims to raise funds for cancer treatment subsidies, welfare assistance, cancer rehabilitation, hospice care, free cancer screenings, research and public education initiatives.

Category: Blog

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Diabetes and cancer are different diseases. Both are complex, with multiple subtypes. Yet, numerous studies suggest the two diagnoses are closely linked in many ways. People with diabetes are more likely to be diagnosed with cancer than those without diabetes. In fact, diabetes, primarily type 2, is associated with increased risks for several cancers, including pancreatic, liver, uterine, colon, postmenopausal breast, and bladder cancers. Although type-2 diabetes is associated with a decreased risk for prostate cancer, it does not eliminate the possibilities of aggressive forms of prostate cancer. Meanwhile, people with diabetes have a higher risk of dying from cancer compared which those without the disease.

 

There are three possible links between diabetes and cancer:

1. Insulin Resistance

One possible link is associated with insulin resistance which is a hallmark of Type-2 diabetes. Insulin is a growth factor with predominantly metabolic action but it can have mitogenic effects that can lead to cancer.

2. High Glucose Levels

Researchers are also exploring the possible connection between high blood glucose and cancer.  Cancer cells are adept at absorbing glucose from the blood with no need for insulin. Since cancer runs on glucose, high blood glucose levels may help fuel the growth of cancer cells.

3. Inflammation

The third suspect is inflammation. Diabetes is usually characterised by chronic inflammation, which increases production of free radicals that can damage DNA and induce cancer.

 

Because the diabetes-cancer link is statically significant and clinically important, a move towards a healthier lifestyle should be part of preventive measures to reduce the mortality and morbidity of both the diseases. The lifestyle changes might involve:

  • Aim for a healthy level of body fat, especially at the abdominal area
  • Eat a diet rich in vegetables, fruits, whole grains and beans
  • Limit red meat consumption and avoid processed meat
  • Drink alcohol in moderation
  • Exercise regularly and limit sedentary time

 

Besides the lifestyle changes, it would be necessary for diabetic patients to work with their health care providers to see what types of cancer screening are needed. At the Singapore Cancer Society, we offer cancer screening services such as pap smear screening, mammogram screening and FIT kit at no charge for eligible Singaporeans and PR. We also organise various talks on nutrition and cancer awareness for the public and cancer survivors. For more information, visit www.singaporecancersociety.org.sg

Category: Blog

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Colorectal cancer is the most common cancer in Singapore with both men and women at equal risk. Most colorectal cancers are found in people aged 50 and above. People with a personal or family history of colorectal cancer or polyps, or those with inflammatory bowel disease, are more likely to develop this cancer. Low fibre intake, a high fat diet, smoking, a sedentary lifestyle, and obesity are linked to a higher risk of having colorectal cancer.

Category: Blog