Common Questions on Cancer

29 June 2022

This excerpt is transcribed from a virtual talk with Sunway Medical Centre, Sunway City Consultant Clinical Oncologist, Dr Ivan Shew

My relative currently has stage IIIB lung cancer, suffers from diabetes, has received chemotherapy and radiotherapy, and is currently receiving immunotherapy. He is considering switching to Traditional Chinese Medicine (TCM) treatment after immunotherapy is completed. What is the efficacy of the treatment?

Basically, his treatment plan is the best it can be. All he as to do now is to track your condition and regulate your body. After undergoing the whole course of cancer treatment, there is no problem to receive Chinese medicine as a complementary treatment, which can improve quality of life or reduce the side effects of cancer treatment. If a patient chooses to use TCM as an adjunctive treatment, he or she may consult their specialist and be referred to a TCM practitioner.

Which treatment option is suitable for tongue cancer? Many people believe that death is quicker after treatment, is this true?

Tongue cancer is a type of head and neck cancer and is difficult to treat. Surgery is the only way to cure tongue cancer. For patients with stage I to III tongue cancer, we would usually recommend surgery to remove it if conditions permit as it is difficult to control the disease in the long term with chemotherapy, radiotherapy or immunotherapy.

So surgery is used first, followed by chemotherapy or radiotherapy as an adjuvant treatment to eradicate the remaining cancer cells. However, there are more problems associated with tongue cancer removal, such as loss of taste buds, inability to speak and difficulty in swallowing, depending on the location of the tongue cancer and the extent of the surgery.

For stage IV tongue cancer, surgery cannot cure the disease, only because the cancer cells have metastasised to other parts of the body and can only be controlled by immunotherapy, targeted therapy or chemotherapy.

Many people say that breast tests are more likely to cause breast cancer. Are there any risks undergoing a mammogram?

Yes, there is. Mammograms are low-dose radiation, but scientists have calculated and weighed the pros and cons of the test and assessed the patient's needs before doing a mammogram. If the tumour is detected early enough at 1 to 2 cm, it can be treated in time and the treatment may be a simple local excision or breast-conserving surgery.

A few women in my mother's family have had fibroid, haematoma, skin cancer and breast cancer. What do children with a family history need to be aware of?

There is a link between uterine and breast cancer, and people with a family history of these two types of cancer need to be especially careful because these people are twice or more likely to develop cancer than the general population.

If the report shows a genetic variant, then you will need to be screened frequently, usually once every two years for women, or once every six months for women in this category, or even a mastectomy, as in the case of American actress Angelina Jolie.

Skin cancer is less likely to be hereditary and the risk factors for this cancer are all related to sun exposure, which is uncommon in Malaysia and mostly suffered by foreigners.

If my sister has liver cancer, will other family members develop the same cancer? Or are they predisposed to other cancers?

It depends on the cause of your cancer because some people with liver cancer have risk factors for hepatitis B, hepatitis C or liver abnormalities leading to cirrhosis, which can lead to liver cancer. So it depends on whether you have the same risk factors as your sister.

If you have hepatitis B, you need to have blood tests; for hepatitis C, you need to use medication; risk factors such as alcoholism, fatty liver and obesity can lead to cirrhosis, which evolves into liver cancer. So if you know your sister's risk factors for liver cancer, then you can prevent liver cancer too.

My mother has seven family members with cancer, including breast and liver cancer, and I am the eighth to have cancer.

There is no direct relationship between breast cancer and liver cancer, although breast cancer has a high genetic predisposition. You can have a genetic test done to screen your daughter for genetic variants and assess her risk of cancer.

Genetic testing is not available in every hospital, but it is becoming more common and similar medical services are now available on the internet, even as part of a certain medical check-up. However, for healthcare professionals, this is an inappropriate marketing practice because of the problems that can arise.

If you have an abnormality in your genetic test report, you will have to report it to your insurance specialist and your premiums may be increased or your medical policy may not cover it. You may also suffer from stress and psychological pressure due to the abnormality.

Therefore, I would recommend that you choose to have your genetic test done through formal channels such as major government hospitals and private hospitals. Generally, before the genetic test is done, you will be given a genetic counselling session and informed of the pros and cons of the test, followed by counselling once the report is available.

If you do genetic testing for your daughter and if the genetic test report does show a genetic variant, your daughter may encounter some difficulties in purchasing a medical policy. This way, your daughter will not encounter any obstacles in purchasing insurance.

What kind of check-ups should I have after the age of 40? How can I be screened to detect cancer?

Blood tests are not sufficient to detect cancer. For men, depending on their own and family medical history, colon tests, stool tests and urine tests may be required after the age of 40. For women, mammograms and pap smears are recommended. Of course, this depends on whether you have a specific family medical history.

It has been reported that the recurrence rate of triple-negative breast cancer can be greatly reduced by using Chinese and Western treatments. Is this true?

It depends on the stage of the cancer. Stage IV cancer is incurable. For stages I to III, I would use chemotherapy, immunotherapy or surgery as the treatment option, and then use Chinese medicine as an adjuvant treatment depending on the patient's preference and symptoms.

What treatments are available for stage IV gastric cancer? Is immunotherapy suitable?

Depending on the pathology report of the patient, some patients with gastric cancer may be treated with chemotherapy and immunotherapy. Some older patients who are too old for chemotherapy can be treated with immunotherapy alone, but the results are not as good as they could be if they were given alone.

What do you think about Natural Killer (NK) cell immunotherapy?

This is one of the types of immunotherapy, but the efficacy data are still at the research stage and it is not yet used clinically. At this stage, it is only used in one case of cancer. In some cases of advanced lung cancer or breast cancer, NK therapy is used experimentally (usually in research projects and free of charge) and if it works, a case report is written. In medical data, this therapy may have some efficacy, but only in individual cases and therefore is not convincing and cannot be compared to the data from large clinical trials.

NK cell immunotherapy is one of the treatments of the future, but at the moment we cannot say for sure that it will be effective in treating a particular cancer (as there are many times when current treatment options may be better). We need more data and clinical trials to determine the efficacy of NK cell immunotherapy, so I would advise you to consult your specialist.

Source: Sin Chew Daily