1. Diagnosis and work up of cancer
Is this lump cancerous? Is blood in my stools worrying for cancer? The workup for unusual symptoms at our centre involves a medical consult followed by careful, appropriate testing. Patients diagnosed with cancer will need the latest modern imaging methods including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) scanning (whole body PET/CT or PET/MRI scans) and high resolution ultrasound. Biopsy of suspected cancerous tumours can be done by endoscopy, bronchoscopy, ultrasound-guided, CT scan guided or MRI-guided procedures. Whole body PET CT scan and PET MRI scans have also helped make diagnosis easier. It has the advantage of sometimes picking up a site to biopsy that is easier or less invasive to approach. Patients will welcome a less invasive or minimally invasive procedure. To this end, some biopsy procedures are done as outpatient, day surgery or with an overnight stay.
2. Treatment of cancer as inpatient or outpatient
Our outpatient day infusion facility centres at Gleneagles Medical Centre, Mount Elizabeth Novena Specialist Centre, Mount Elizabeth Orchard Medical Centre and Mount Alvernia Hospital are centrally located in Singapore. We provide outpatient consultations at our clinics and treatment at our infusion treatment centres with our highly trained nurses and staff.
3. Cancer screening, genetic counselling and testing
Our doctors are senior consultant medical oncologists, experts in the field of oncology.
While practicing general oncology, the multi-disciplinary team also specialises in the following areas:
– Breast cancer such as Her2 positive breast cancer, triple negative or hormone responsive breast cancer
– Lung cancer such as small cell carcinoma and non-small cell carcinoma
– Gastrointestinal Cancer such as colon cancer, rectum cancer, stomach cancer, oesophageal cancer
– Liver cancer or hepatocellular carcinoma
– Pancreatic cancer
– Kidney cancer, ureter cancer and bladder cancer
– Prostate Cancer
– Testicular Cancer such as seminoma, non-seminomatous germ cell tumour
– Ear, Nose and Throat (ENT) Cancer such as nasopharyngeal cancer (NPC), thyroid cancer, mouth cancer, throat (pharynx, larynx) cancer
– Gynaecological cancers including ovary cancer, uterus (endometrial) cancer, fallopian tubecancer, cervix cancer, primary peritoneal cancer
– Soft tissue and Bone sarcomas
– Haematological malignancies such as Lymphoma
– Multiple Myeloma
– Cancer Genetics
(Some of the terms used to classify different cancers can be confusing, and knowing “what cancer is that” is useful.)
Some newly diagnosed cancer patients may require a multi-modality approach comprising chemotherapy, surgery, radiotherapy and in some situations, innovative treatments that have been established through extensive medical research. Through participation in international clinical trials, our team is able to treat patients with these new and innovative therapy that are still under investigation.
Working with an ecosystem comprising top medical professionals in hospitals across Singapore, our team will recommend a range of treatment options. According to individual needs, preferences and budgetary requirements, patients may receive one or more of the following:
Surgery is often the first step in cancer diagnosis and surgical resection of cancers remains the cornerstone of treatment for many types of cancers.. An example of when this is used is in the treatment of liver cancer. Because the liver has the ability to regenerate when part of it is removed, this treatment can be successfully applied. In patients with colon cancer that has spread to the liver or lungs this can also provide significant benefit. We work closely with surgeons providing you with the best surgical expertise available in Singapore.
Recent advances in chemotherapy have definitely improved treatment outcomes for patients, and at the same time minimized side effects such as hair loss, sore mouth, nausea, and vomiting. Conventional chemotherapy are anti-cancer drugs (chemotherapeutic agents) given as part of a standardised chemotherapy regimen. Chemotherapy can be given as induction chemotherapy, chemo radiation, adjuvant chemotherapy, curative chemotherapy, high dose chemotherapy with stem cell rescue, and, palliative chemotherapy. It is given in early or advanced cancer as a pill, injection or topically.
Radiation therapy works by using special energy waves to damage the DNA in cancer cells, thereby destroying the cancer cells. The new mode of radiation therapy is to kill enough cancer cells to maximize the probability of cure and minimize the side effects. There are various types of radiation therapy including external and internal radiation and intensity modulated radiotherapy. Sometimes radiotherapy is given together with chemotherapy to maximise its effectiveness. The team will prescribe the best treatment option based on the patient condition.
The growth of some cancer cells is hormone dependent, such as breast and prostate cancers. When cancer arises in breast or prostate tissue, its growth and spread may be caused by the hormones in the body. Hormone therapy as a cancer treatment involves taking medications which interfere with the activity of the hormones or stop the production of hormones. Our specialist may recommend a tumour hormone receptor test to determine the best treatment options and to learn more about the tumor.
Targeted therapy (or molecular targeted therapy) is designed to treat only certain malignant tumour cells bearing particular cellular signals, thus minimizing damage to normal, healthy cells. Such signals that corrupt a normal cell to become cancerous may be growth signals, angiogenesis (new blood vessel formation) signals, signals to avoid cell death (apoptosis) or signals to invade and spread. Drugs that have been developed can include monoclonal antibodies or small molecule inhibitors. These drugs occasionally do have potentially serious side effects that need to be managed properly for them to be used. We regularly use such therapies together or in sequence with conventional chemotherapy. Recognizing that each person responds differently to treatment, our team uses sophisticated technology with good quality control, to monitor and individualize a patient’s treatment. to modify it if necessary.
Immunotherapy for cancer treatment has been used by our oncology specialists for many years, from monoclonal antibodies, interferons, to recent immune checkpoint inhibitors such as Keytruda (pembrolizumab) , Opdivo (nivolumab) and Ipilimumab (Yervoy).
Our bodies meet the challenge of infections, cancers and other external agents by developing a complex immune system. The genetic and cellular changes that makes cancer what it is, provides the immune system with the means to generate T cell responses that recognize and eradicate cancer cells (The Cancer Immunity Cycle). Immunotherapy (immune system therapy) is harnessing the natural ability of our immune system to combat cancer. As complex as our immune system is, immunotherapies work in different ways. Some are drugs that enhance or boost the immune system in a general way, while others zoom in to activate immune cells or attack specific types of tumour. Being powerful medications, immunotherapy drugs can have serious side effects in some patients and need to be given in a supervised setting. Recognising who might benefit from such treatment from tumour testing and patient assessment is important to exploit the benefits of the drugs.