When things go right in treating cancer

This story was first published in The Straits Times on March 28, 2013

Serene has been under my care since 1998. She almost always comes to my clinic with her husband Richard, whose hair I have watched change from black to grey to almost all white.

In her follow-up visits these days, she spends no more than five to 10 minutes in the consultation room.

Most of that time is spent catching up with casual talk on family, recent news and local politics.

Serene, with her angelic smile and easy laughter, is always cheerful.

No one would guess that this petite 42kg lady has gone through three battles with cancer.

Her first complaints were a "blocked ear" and tightness on the left side of her face.

She was initially treated with a course of antibiotics by her general practitioner (GP).

When that did not work, he promptly referred her to an ear, nose and throat (ENT) specialist.

The ENT specialist discovered a tumour in the posterior nasal space and a biopsy (testing of a sample of cells) confirmed the diagnosis of cancer of the nasopharynx.

The tumour had invaded the base of the skull. It had also spread to the lymph nodes (small, oval glands that are part of the immune system) on the left side of the neck.

Serene was treated with chemotherapy and radiation.

That particular treatment programme is very tough because the radiation badly damages the inner lining of the oral cavity. The patient experiences severe pain in the mouth, especially when eating and swallowing.

Many need to have a feeding tube inserted through the nose into the stomach. A liquid diet can then be poured down the tube, bypassing the painful parts of the throat and directly into the stomach.

Serene experienced severe pain too, but she continued eating.

After the harrowing days of treatment were over, she enjoyed a respite that lasted eight years. She could accompany her husband when he was posted to Australia in 2001.

In 2006, she noticed a recurrent lump on the left side of the neck. A biopsy confirmed that the nasopharyngeal cancer had recurred in the neck.

The positron emission tomography-computed tomography (PET-CT) scan unexpectedly also showed that there was another tumour in the colon.

Colonoscopy was carried out. This procedure, which examines the large intestine using a flexible tube with a small camera, confirmed that there was another unrelated type of cancer in the right side of the colon.

Serene underwent surgery for colon cancer on March 2, 2006. To our relief, it was stage 1 cancer that did not require any additional treatment. This allowed us to focus on treatment for her recurrent nasopharyngeal cancer.

She started chemotherapy on March 16, exactly two weeks after her colon surgery.

Later, she also had combined chemotherapy and radiation.

She is now doing well.

Despite the advances made in treatment, cancer is still a dreaded illness because many patients do die from it.

I am often asked the question why some patients make it while others succumb.

In my experience, three factors are important in affecting outcome. The first is medical.

In Serene's case, the GP who first saw her did not attempt to "hold on to the case", but promptly referred her to a specialist after one course of antibiotics failed to resolve her symptoms.

The ENT specialist also did his job well. He saw the tumour, confirmed the diagnosis of cancer and referred her to cancer specialists.

Then there are the backroom doctors whom patients almost never meet. The pathologists make the final diagnoses by examining the tumour specimens under the microscope. The radiologists review all the radiological images to determine the extent of cancer spread.

One must never underestimate the important roles played by these unsung heroes.

The second factor is the patient herself and the psycho-social support she receives.

Serene is a fighter. Both in her first and second battle against nasopharyngeal cancer, she never thought of giving up.

Richard is the testimony of true love. He has always been there for her. I cannot recall any visit when he was not by her side.

Serene was a lab technician and Richard, an employee. The cost of medical care through the years must have been substantial. Thankfully, that has never strained their relationship.

Herein lies the importance of early financial planning for one's health-care needs.

The enhanced Medishield plans offered by all the major insurance companies in Singapore truly provide good value.

The third factor is perhaps the most important. It is faith. It may be religion, for those who believe in one.

Serene was blessed in many ways. Most patients with recurrent nasopharyngeal cancer do not do well. She responded well to the second round of treatment and has remained cancer-free for seven years since her relapse.

She went for a PET-CT scan because she had cancer recurrence on the left side of the neck. As a result, her colon cancer was detected fortuitously and early.

So faith, a strong heart and good teamwork from doctors made the difference for Serene.

But really, who knows? In life, so many things can go wrong.

Thankfully for Serene, she is alive today because everything went right.

Dr Ang Peng Tiam is the medical director of Parkway Cancer Centre. He has been in practice for 30 years. In 1996, he was awarded Singapore's National Science Award for outstanding contributions to medical research.

This story was first published in The Straits Times on March 28, 2013

To subscribe to The Straits Times, please go to