Coffee break with Dr Jennifer Leong, consultant clinical oncologist.
16 January 2021
INTERVIEWER
Do oncologists have to be good at mathematics?
DR JENNIFER LEONG
That’s what they didn’t tell you. But not maths exactly— you have to be good in visualisation. You need to have a 3D mind. Especially for clinical oncologists.
INTERVIEWER
As opposed to medical oncologists?
DR JENNIFER LEONG
A medical oncologist treats cancer with drugs. For a clinical oncologist however, the training consists of learning about drugs and radiotherapy. Most doctors who failed their clinical oncology exams because of the radiotherapy part, because you can’t just study and memorise to get it right.
The crucial attribute of a good radiotherapist is knowing where, when, and how to deliver the beams correctly so that you can simultaneously kill the cancer and avoid hurting the patient.
INTERVIEWER
What about targeted therapy?
DR JENNIFER LEONG
You inject or you ingest the drug, and it travels in your body to find the target proteins or enzymes that are telling the cancer to grow.
INTERVIEWER
They know how to find their way to the targets?
DR JENNIFER LEONG
They are very good. They will try to find their way along the bloodstream, and when they see the targets they bind to the targets and turn off the signals. The doors of the targets will close and with the signals blocked, the tumour grows less.
INTERVIEWER
It sounds magical.
DR JENNIFER LEONG
The bulk of the job goes to scientists. In a way it is so much easier for doctors because all we need to do is to evaluate a drug’s safety and usefulness, and administer it to the patient. My job as an oncologist is to see, when scientists present data of their drugs to us, whether I could believe the data.
INTERVIEWER
By decoding numbers and charts.
DR JENNIFER LEONG
Yes. One of the five key components in the oncology exam that we must master was statistics. Statistics is very important so that we can really decipher how the trial for the drug is designed, and we must be able to identify manipulated data.
We are obligated not to take any research at face value, because even the simplest misstep in decision-making can affect a patient’s life. So to be a good oncologist you also have to be a good statistician, to be able to interpret graphs critically and correctly.
INTERVIEWER
What are the other four key components?
DR JENNIFER LEONG
Pharmacology (the study of drugs), molecular biology (the study of your cell at the molecular level), radiobiology (the study of how radiation affects your body).
Radiobiology is frequently what makes or breaks the oncologist. As a radiation oncologist you must know, whenever you press the turn-on button, what this particular radiation kills and how it kills.
The last component is pathology (the study of the many types of cancer, their diagnoses, and their patterns).
INTERVIEWER
That’s a lot of study.
DR JENNIFER LEONG
There’s no end. My life was all about studying during every single day of the five-year Masters Degree. I went home every night exhausted from hospital work, and the studying only began then.
INTERVIEWER
Do you have a cancer you want to focus on?
DR JENNIFER LEONG
I am passionate about treating all cancer sites. Albeit as a woman I’m a bit more predisposed to gynecological cancer. I find myself able to relate deeply to breast cancer patients, how the disease affects your existential identity as a woman.
INTERVIEWER
Does sexual freedom increase the likelihood of women’s cancer?
DR JENNIFER LEONG
I find it unfair to pass judgment on cancer patients based on what their particular types of cancer can infer about their lifestyles or moral values. Even when a lung cancer patient continues to smoke after he or she is diagnosed, we still must do everything we can to save the patient without any bias.
Only one sexually transmitted disease— HPV is associated with cervical cancer, some head and neck cancer, and oral cancer. No other cancer is caused by sexual activity.
INTERVIEWER
So other gender-specific cancers are predominantly caused by genetics.
DR JENNIFER LEONG
Family history is very important. I have treated some very young ovarian cancer patients who were in their 30s. They were supposed to be at the prime of their lives. Ovarian cancer is particularly troublesome because it is quite aggressive, and the symptoms are so vague.
INTERVIEWER
Can an ovarian cyst become a cancer?
DR JENNIFER LEONG
No one can really tell. A cyst can become malignant as time goes on, or it can just stay cystic. If someone has a cyst that is causing enough stress, my advice is to remove it.
INTERVIEWER
Remove the womb?
DR JENNIFER LEONG
If you can’t remove it you monitor it. Doing yearly ultrasounds to check if the cyst changes in pattern or in size. If it becomes threatening then the woman should have the womb (the uterus) removed.
INTERVIEWER
Is hysterectomy a tough conversation to initiate?
DR JENNIFER LEONG
Whenever you need to tell young patients that they may become infertile or sterile, it‘s always difficult.
Stage one ovarian cancer can be cured by removing just a part of the ovary, so fertility may be able to stay intact.
For cervical cancer the typical treatment is a hysterectomy. In selected cases when the tumour is very small, the surgeon may be able to do what is called a trachelectomy to remove part of the cervix, so that the patient can still have babies.
For a lot of women who haven’t had children, the idea of becoming barren is always a struggle. When they get diagnosed with cancer, they may want to know how long after the treatment can they start or continue to try for a baby. Following that, they may become worried that if they have really gotten pregnant, would all the hormonal fluctuations in the body lead to recurrent or more cancer. These are the questions that we need to discuss on a case-by-case basis.
INTERVIEWER
What about getting cancer while already pregnant?
DR JENNIFER LEONG
I’ve had a patient who had breast cancer while being pregnant. The main thing to do is to try to remove the tumour first. Because pregnant patients cannot receive radiation, oftentimes the doctor would advise to remove the entire breasts unless faced with strong refusal. There is always a real concern that some undetected cancer might be hidden in presumably non-cancerous regions, that may get the chance to spread further along in the pregnancy.
After the mastectomy, the oncologist decides whether the woman needs or does not need chemo depending on the post-surgery report. There are some chemo drugs that can be taken safely during pregnancy.
INTERVIEWER
Can the baby inherit the cancer?
DR JENNIFER LEONG
There are neonatal cancers but they are not directly influenced by the mother’s cancer. Baby cancer is rare but it happens. I’ve seen cancer that arose during the first year of a baby’s life.
INTERVIEWER
How do parents find out?
DR JENNIFER LEONG
The baby starts to not eat very well, becomes very irritable when you change its diapers or when you touch its tummy. The cancer is painful to them so they would cry. They can’t tell you how they’re feeling, so they just keep crying. It’s very sad.
However, the good thing about paediatric cancer is that they are usually very highly curable. Their prognoses are very good, meaning that as long as you give them treatment at an early stage they almost always have a very high chance of getting cured.
INTERVIEWER
Is it because children do better at receiving aggressive treatment?
DR JENNIFER LEONG
They are very resilient and they have a pure kind of strength to make them bounce back easier. I suppose there is a logic behind that.
INTERVIEWER
Oncology feels like one of the most emotionally overwhelming jobs one can have.
DR JENNIFER LEONG
It does feel that way. Most times you need to act as a counsellor, a pillar of strength, and moral support for your patients. You need to keep your composure when the patient is depressed, or when the family members are crying.
Having empathy in this kind of situation is a must. I would ask myself what I would feel if I’m in their shoes, so I never rush the conversation and I always give them time to recollect themselves or to release their doubts, worries, and pent-up feelings. But all in all you still have to maintain your composure. It’s not easy.
INTERVIEWER
Does maintaining composure all the time exhaust you?
DR JENNIFER LEONG
It does. My work is very taxing. So when I go home I want to empty my mind completely. My husband always says I have to watch more intellectual shows, but he doesn’t know that my mind is stretched to its max at work already! So instead I like to watch shows that are fun and don’t take much thinking, like sitcoms, rom-coms, and korean dramas.
You can always still discuss work with colleagues outside of work. But with such a demanding job, I find a craving to have some me time, some outlet to get away from all that serious stuff when I can afford to. To keep yourself balanced you have to have a hobby, a passion unrelated to medicine, something.
INTERVIEWER
What is your hobby?
DR JENNIFER LEONG
I used to swim a lot, but this has been put on the back bench after I’ve had kids. I like to read.
INTERVIEWER
Even though you already do so much reading at work?
DR JENNIFER LEONG
Well yeah. In my free time I like to read biographies. I’m trying to get my hand on the Barack Obama book. I like to read about women who have made it; I find them very inspiring. Successful businesswomen usually have very good life tips, especially working mothers. I like to learn from their stories on how they managed it all.
I hope I can always finish a book I bought, but I usually don’t.
INTERVIEWER
You are quite the feminist.
DR JENNIFER LEONG
I agree that I am pro-women. If I find there’s a local business run by a single mother (like how sometimes they make handicrafts and sell them in supermarkets), I would automatically become such a sucker for it. I always want to buy from them, because I believe that women should support each other.
INTERVIEWER
How do you yourself cope as a busy working mum?
DR JENNIFER LEONG
I have two kids now. My daughter is 4 years old, who talks as much as I do, and my son is 16 months old. We have a nanny who has grown quite close to us. I try to find more time for my children, because everyone keeps telling me that when they are younger you should spend more time with them, before they grow up and it becomes uncool to spend time with you anymore.
My son is very close to his dad. But yesterday for some reason, he kept coming up to me and trying to make me cuddle him. It felt so nice!
When I was practising in a government hospital it was constantly super hectic, to the point that for months on end when I reached home after work the kids were already asleep. It really makes you start questioning, and see how your time management actually matches your choices in life.
INTERVIEWER
How did your children feel about it?
DR JENNIFER LEONG
My daughter was used to not seeing me on weekdays. I still feel very bad to this day. It spurs me to try to spend a little more time with them whenever I can.
INTERVIEWER
By modifying your workload?
DR JENNIFER LEONG
The workload needs to be within your control and needs to not overspill beyond your capacity to manage it. The good thing about private practice is that you can distinctly feel that time is in your grasp, and you get more freedom to schedule how many cases you know you can confidently deal with. This makes you plan better for your own life, and by doing so the patients can get the best out of you too.
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