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Cancer treatment in Singapore - changes in the last three decades

Parkway Cancer Centre's Dr Ang Peng Tiam talks about the changing paradigm of cancer management.
Parkway Cancer Centre's Dr Ang Peng Tiam talks about the changing paradigm of cancer management. PHOTO: PARKWAY CANCER CENTRE

This is part of a series relating to the “Understanding Cancer And Beyond 2018” seminar, held by The Straits Times and Parkway Cancer Centre at Raffles City Convention Centre on Aug 4, 2018

If you throw a stone, there is a good chance you might hit a cancer patient or survivor. The scourge of cancer is so pervasive that it has brought more and more people to equip themselves with knowledge to help them deal with the disease as best they can. In this regard, Parkway Centre Cancer Centre (PCC) has constantly strived to do our part in educating the public on the subject.

The gist of PCC’s recent “Understanding Cancer and Beyond 2018” seminar pertains to the changes and developments in the management of cancers over the past three decades. And who better to help us learn more about the evolution of cancer management in Singapore than pioneer oncologist Dr Ang Peng Tiam?

The Changing Paradigm of Cancer Management

Dr Ang, Medical Director and Senior Consultant, Medical Oncology, kicked off the seminar by giving the audience an overview of how the scope of cancer management in Singapore has evolved, and shared his thoughts on what the changes mean for patients.

According to Dr Ang, when he started in the field of oncology in 1986, there were literally only a handful of medical oncologists in Singapore. Due to limited resources, like drugs, equipment and manpower, cancer was more or less a death sentence then. “You get cancer, you die,” he put it very succinctly. “But now, because of extensive cancer research, there’s much more we can offer patients. In fact, there are hundreds of chemotherapy drugs to treat all sorts of cancers. You name the cancer, you’ve got a set of drugs to kill those particular cancer cells.”

 

Dr Ang’s keen interest in research has, over the years, resulted in the publication and presentation of more than 100 papers and abstracts. Among the findings he has made was a significant one in the field of immunotherapy, where laboratory tests revealed that cancer cells possess the capability of “camouflaging” themselves as “friendly forces”, and thus become unidentifiable as “enemies”.

When Surgery is No Longer the Only Option

With a better understanding of the cancer genetics and the expanding armamentarium of modern medicine, the advancement of cancer management has grown by leaps and bounds. Better  understanding of oncogenesis and breakthroughs in immunotherapy have resulted in new and better options in the treatment and care for cancer patients.

Oncogenesis explores the molecular basis of how normal cells transform into cancer cells. Immunotherapy is a form of cancer treatment that enhances the body’s natural defenses to fight cancer — thereby stopping or slowing the growth of cancer cells, preventing cancer from spreading to other parts of the body, and allowing the immune system to destroy cancer cells.

In addition to new cytotoxic chemotherapy agents, the understanding of molecular genetics have contributed towards major breakthrough in new classes of drugs which include targeted therapy, monoclonal antibodies and immunotherapy.

Technological advances have resulted in invention of new machines which generate radiofrequency to heat or cryotherapy to freeze local tumors, resulting in the death of the cancer cells. These techniques are particularly advantageous in cases where surgery could pose significant risks for the patient. They can be deployed to kill limited number of localized malignant tumours that may have spread to the liver, lungs and bones, eliminating the need for surgery. In certain cases, they could be combined with chemotherapy and radiotherapy to improve the chances of cure.

Other vital elements of the armamentarium includes diagnostic equipment, and new generations of drugs that offer benefits like greater effectiveness, lower toxicity and reduced side effects.

The Best Care Can Make a Big Difference

PCC’s multi-disciplinary approach is another critical aspect in the provision of patient-centric care. Medical specialists involved in diagnosis and treatment, such as the medical oncologist, pathologist, medical geneticist, radiation technologist and surgeon must trust each other and work as a team in order to deliver the best care for the patient.

“We believe in treating patients, not the disease,” said Dr Ang emphatically. The advancements in cancer management have indeed enabled marked improvements in the prevention, early detection, and treatment of early and advanced stages of the cancer, resulting in improved quality of life and prolonging meaningful life and chances of cure. In short, what this means is good news: cancer is no longer an inevitable death sentence.