THE GIFT OF LIFE - National Cancer Centre Singapore

Issue No. 19 • MICA (P) 061/10/2010 

an nccs bi-monthly publication 

November / December 2011 

...helping readers to achieve good health 

Salubris is a Latin word which means healthy, in good condition (body) and wholesome. 

THE GIFT OF LIFE

Page A2 

In Other Words 

THE GIFT OF LIFE 

SALUBRIS 


At age 39, Mr Yue Keng Siang 

was practically at the peak 

of his life. He was just into 

the third year of his marriage 

and has two children, aged 

three and one. However, all 

these came crashing when 

he was diagnosed with liver 

cancer. That was in 1999. 

CHARISSA ENG reports. 

Sports and travelling are the interests 

of Mr Yue Keng Siang. He teaches 

Physical Education in a local 

institution and the outdoors are a part 

of his daily routine. To him, the greatest 

takeaway from sports is how it hones 

his fighting spirit. And, indeed, little 

did he realise that someday this spirit 

would be called into play when he was 

unexpectedly diagnosed with liver cancer 

at the prime of his life. 

Back in 1999, he was bringing his young 

daughter for her screening at Queenstown 

Polyclinic. While waiting, he decided on 

a whim to go for a blood test. Doctors 

had been nagging Mr Yue’s family to 

go for screenings since his mother was 

diagnosed with liver cirrhosis. He had 

been pushing it to the back of his mind, 

but this time he thought he might as well 

take the opportunity to go for a test. After 

all, he was already at the clinic. Since 

then, there was no turning back. 

He was overseas when he received the 

call from his doctor on his test results. 

When he returned from his trip, the 

doctor broke the news to him that he was 

suffering from stage one liver cancer. 

Mr Yue said, “At that time, I really could not believe it. 

I have not expected this at all. My thoughts were racing 

through my mind and all I could think of was the fact that 

I exercise regularly, I do not smoke and am not an alcoholic. 

How could this happen to me?”

Page A3 

In Other Words 

SALUBRIS 


It was also a shock to his family and friends. For him and his family, it was their most 

trying period. Just into the third year of marriage, with two young kids in tow, what would 

the future have in store for them now? If anything happens, what will his wife do? 

Not one to surrender easily, Mr Yue said, “I know I have got to face it so I started getting 

more positive about it.” 

With a chuckle, he recalled telling his wife: “At least I know this is how I may die and 

I can plan before I go. I just have to take it easy.” 

Mr Yue started his treatment shortly after. He went to various specialists to have more tests 

done and was advised to go for surgery to remove the cancer in his liver. He also started on six 

cycles of chemotherapy. The main cause of his cancer was due to Hepatitis B from his mother. 

Prior to that, Mr Yue had not known much about Hepatitis B and had no clue that it can lead 

to liver cancer. Fortunately, his cancer was detected early and it had not spread to other parts 

of his body. “From the day of my surgery, my lifestyle habits took a drastic change. I went 

on a strict diet of just vegetables and I do not take any red or white meat, with the exception 

of fish. I started adopting a healthy lifestyle like cutting down on my intake of fried food,” he 

said. “After the cancer cells were destroyed, I quickly went into remission.” 

“Six years later, I suffered a relapse. I was really disappointed. I had been very disciplined in 

my lifestyle choices,” said Mr Yue. He went for a second surgery in 2005 and restarted the 

entire process of keeping healthy. Barely less than 10 months later, he suffered from a second 

relapse. “Doctors told me the cancer is now growing on the other side of my liver. I also had 

signs of liver cirrhosis and they suggested that I get a transplant. Otherwise, my cancer will 

just keep coming back, given that I am a Hepatitis B carrier,” he said. 

“I decided to opt for transplant, despite the high risk involved with the transplant surgery. 

It was a chance for me to lead a ‘normal’ life,” said Mr Yue. 

He was glad to be in touch with a few patients to share with one another their 

experiences, to offer support and to learn more on liver cancer and the process of 

transplant itself. He explained, “The sharing sessions helped me a lot back then. My wife 

was reluctant for me to undergo the surgery as she was worried for me. At the sharing 

sessions, I became better-informed about liver transplant and its risks and it made me 

more confident to want to go for it.” 

“If there was a support group back then, it would have been very helpful. Fellow patients 

can meet and share experiences and offer one another some moral support. In times like this, 

knowing somebody who understands what you are going through can make a big difference 

to accepting the disease,” he explained. After an eight-month wait, a match from a donor was 

found and he underwent a liver transplant. 

Today, 11 years on after the first surgery, Mr Yue is a refreshed man. He said, 

“If you look at me today, you would not know that I have had cancer. Life is certainly 

different now as it is no longer so uncertain like in the past. I am a lucky man. I 

discovered my cancer early and I got a match for my liver. I also had an understanding 

superior who understands my need to go for treatment and checkups in the early stage.” 

In fact, Mr Yue feels so much better after 

the transplant that he is back to doing 

the things he loves. Just last month, 

he took part in the World Transplant 

Day in Sweden. This international 

event had a sporting element where 

transplant patients all over the world 

come together to compete in various 

sports. He was there competing in table 

tennis, track and field, and badminton 

and even won a silver medal in the 

badminton doubles event. 

On how cancer has changed his 

perspective on life, he said, “When you 

have cancer, your mindset and attitude 

towards it are very important. I faced a lot 

of things when I had cancer but when I 

began to accept the illness, I start to take 

it as part of my learning process.” 

“I am so grateful to be 

given the gift of life, 

I will really treasure 

this. I think in life, we 

should take it easy 

and not neglect the 

ones important to us. 

I nearly missed the 

chance to be able to 

spend time with my 

family. Now all I want 

is to spend more time 

with them.”

Page A4 

In Focus 

SALUBRIS 


IT’S THE SEASON TO BE MERRY: 

PLAYING SANTA CLAUS TO 

PATIENTS’ CHILDREN 

For the past seven years, come year end and 

the Department of Medical Oncology (DMO) in 

NCCS will be buzzing with activities that are 

not quite related to their clinical responsibilities. 

It is the time when staffs are reined in to do their 

bit to bring joy to the children of cancer patients. 

CHARISSA ENG finds out what is in store for this 

year’s festive season. 

It is as early as September when 

preparation for the year-end festive 

season will begin for the staff of 

DMO as part of their annual community 

project. The work begins with raising 

funds to buy presents for children of 

cancer patients in the spirit of Christmas. 

A few of these children are themselves 

suffering from cancer. 

A/Prof Koo Wen Hsin, Deputy Director 

of NCCS, first thought of this initiative 

in 2004. He felt that the patients need 

more than just medication to help them 

in their recovery. Equally important is 

the patients’ psychological health. They 

need moral support from their family, 

friends and the community. And, what 

better time to provide this support than 

by showing the patients that they are not 

forgotten amid all the hustle and bustle 

at the year’s end? 

From then on, DMO has been continuing 

the project and never looked back. 

Department secretary Ms Ang Hui Lan, 

who was involved since its onset in 2004 

explained that the project was divided 

into a few stages, namely, the fund 

raising, recruiting of volunteers, shopping 

for presents and later, the gift wrapping 

and distribution to the children. 

Good team work helped as everyone 

chipped in to volunteer their services 

including driving to various locations in 

the heartlands to distribute the gifts. 

A/Prof Koo even roped in his friend, an 

insurance agent, to mobilise his fellow 

agents to help out. 

This year hopefully, the workload may be 

lighter as a church group from the Church 

of the Holy Family has offered to collaborate 

with the DMO. The group spokesperson 

said, “We believe in the importance of the 

work of NCCS and it seems to us that some 

of its patients face some of the sternest 

challenges life can throw at one – especially 

those who are also labouring under the 

financial burden that the costs of cancer 

treatment can present.” 

“We feel that their children should 

not be forgotten at this time, and 

we want to share with them some of 

the joy and hope of the Christmas 

season, and to remind them that 

there is light even in the dark 

periods of our lives. We got in touch 

with a medical social worker from 

NCCS and are now working on this 

project for Christmas 2011.” 

The church group is raising funds to buy 

the gifts for the children. They hope to 

raise about $1500 so that 30 children can 

smile during the festive season. The DMO 

will support them by playing Santa Claus 

wherever needed, to bring the Christmas 

mood to the children. 

From past year’s experience, the children 

have mostly very simple wishes, such 

as new school shoes and socks, book 

vouchers, bicycles, toys etc. To expedite 

shopping and delivery, the volunteers will 

be divided into three teams – one team 

to do the shopping, another team to wrap 

and label the presents and the third to 

deliver the presents. 

For Ms Ang and her colleagues, seeing the 

smiles on the young children is the best thing 

they have gained from being involved. She 

said, “It made the whole process very worth it. 

We probably caught lots of children by surprise 

that when we talked to them, some of them 

even muttered ‘Santa Claus, Santa Claus’.” 

Ms Ang hopes that everyone who has 

participated will enjoy the process and 

see for themselves how their role has 

helped and benefited the children. Her 

Christmas wish this year is for the project 

to keep moving ahead… ho, ho, ho!

GYNaeCOLOGICaL Cancers: 

TreatmeNT and ScreeNING II 

Page B1 

Looking Forward 

SALUBRIS 


Cancer of the Uterus 

Commonly referred to as cancer of the uterine lining 

also known as endometrial cancer, it is now the most 

common gynaecological cancer affecting Singapore 

women, especially postmenopausal women in their 

50s and 60s. In KK Gynaecological Cancer Centre, 

we see an average of 180 new cases per year and the 

incidence is increasing. 

By Dr Chia Yin Nin 

Head & Consultant, 

Gynaecological Cancer Unit, 

KK Women’s and Children’s Hospital 

Adjunct Assistant Professor, 

Duke’s Medical School, Singapore 

Visiting Consultant, 

National Cancer Centre Singapore 

The exact cause of this cancer is unknown. However, certain women are at higher risk 

than others: 

• Obese or overweight women 

• Women who never have children or have few children 

• Women who are sub-fertile 

• Women who started menses early and started menopause late 

• Women who have diabetes, high cholesterol or high blood pressure 

• Women with a history of irregular menses or have polycystic ovarian syndrome 

• Women with a strong family history of cancer of the uterus or cancer of the colon or 

known family history of LYNCH II syndrome 

• Breast cancer patients on Tamoxifen therapy 

The majority (80%) of cases present early with some form of abnormal bleeding: 

• Bleeding after menopause 

• Bleeding in between menses 

• Prolonged spotting after menses 

Anyone with the above symptoms should seek medical 

attention. The initial evaluation includes an ultrasound scan 

and endometrial biopsy (usually a D&C). Once the cancer is 

confirmed, the definitive treatment is a staging surgery 

(to assess the extent/spread of the cancer) and removal of 

the uterus. More advanced cancers may require additional 

treatment like radiotherapy, hormonal therapy and 

chemotherapy after the initial surgery. 

As the majority of cases present early in 

stages, the overall outlook for endometrial 

cancer is good with five year survival of 

approximately 80 percent. 

One can prevent endometrial cancer by 

having more children, by ensuring regular 

menses and by keeping an ideal body 

weight through a healthy diet and regular 

exercise. Prolonged usage of Combined 

Contraceptive Pill (COCs) and medicated 

IUD called Mirena can also reduce one’s 

risk of endometrial cancer. 

There is no effective screening tool 

for endometrial cancer. Screening is 

often deemed not cost effective as 

majority of the cases present early and 

can be relatively easily treated with 

good outcome. 

Continued on page B2.

Page B2 

Looking Forward 

SALUBRIS 


Gynaecological Cancers: 

Treatment and Screening II 

Continued from page B1. 

Ovarian cancer is often referred to as a silent killer. In the early stages, there are 

often no symptoms. By the time symptoms arise, the cancer is often in the advanced 

stages. Furthermore, symptoms of ovarian cancers are often vague and are often 

confused with gastritis, gallbladder disease or colorectal conditions. 

Common symptoms include: 

• Abdominal bloatedness and distension 

• Indigestion or ‘wind’ 

• Sensation of fullness after a meal 

• Palpable abdominal mass 

• Urinary symptoms e.g. frequency of urination 

• Bowel symptoms e.g. constipation 

• Unilateral leg swelling 

It is hence important that women around the perimenopausal age group do not 

ignore such symptoms. If unsure, do seek medical advice early. 

Cancer of the Ovary 

Ovarian Cancer, though less common compared 

to endometrial cancer, is the most deadly. 

The majority of cases present late in advanced 

stages. In Singapore, the incidence rate is 

about 15.2 per 100,000 per year. It mostly 

affects women aged between 40 and 60. 

In KK Gynaecological Cancer Centre, we see 

an average of 120 new cases per year. 

Again, like endometrial cancer, the exact cause 

of it is unknown. Certain women are, however, 

at higher risk than others: 

• Women who never have any children 

• Women who are sub-fertile 

• Women who started menses early and 

started menopause late 

• Women with a strong family history of 

breast and/or ovarian cancer or known 

family history of BRCA syndrome or 

LYNCH II syndrome 

Once ovarian cancer is suspected, the patient will be referred to a gynaecologic 

oncologist or medical oncologist and further investigations will be done. These 

often include CT scans and/or ultrasound scans to look for tumour growth(s) in the 

ovary(ies) and a blood test called ovarian tumour markers e.g. CA 125. The results of 

the investigations will indicate to the doctor the likelihood of the growth in the ovary 

becoming cancerous or not. Finally, surgery has to be done to remove the growth 

to confirm the diagnosis of cancer. Once cancer is confirmed, surgical staging (to 

determine the spread/extent of the cancer) is carried out at the same setting. If the 

cancer is found to be advanced at the time of surgery, attempts will be made to 

remove as much cancer as possible at the same setting. Occasionally, if the cancer 

is deemed too advanced, chemotherapy may be given first prior to surgery. Except 

for very early stage ovarian cancers, almost all ovarian cancers have to be treated 

with a two-pronged approach: A combination of surgery and chemotherapy. 

The outlook for ovarian cancer depends on the stage in which the cancer is at. 

Overall, the outlook is poor with five year survival of about an average of 50% as 

the majority of cases present late in advanced stages. 

At present, there is no effective screening tool for ovarian cancer. Neither routine 

ultrasound scan nor ovarian tumour markers blood tests are specific enough to 

detect ovarian cancer early. 

Ovarian cancer can be prevented by taking the COCs. Prolonged usage over three to 

five years can halve one’s risk of ovarian cancer. Alternatively, having more children 

and breast feeding can also help lower one’s risk. 

Gynaecological cancers are common. Cervical cancer can be prevented by 

vaccination and Pap smear screening. Although endometrial cancer cannot be 

prevented effectively and screened, it often presents with abnormal bleeding 

early. Hence, it is important not to ignore these early warning signs and to seek 

medical attention early. Ovarian cancer remains a silent killer, so be aware 

of the vague symptoms of presentation. Do seek medical attention if unsure. 

Taking the COCs can reduce one’s risk of ovarian and endometrial cancers.

Hormone Replacement 

Therapy and Cancer 

Page B3 

Tender Care 

SALUBRIS 


Introduction 

to Hormone 

Replacement Therapy 

Hormone Replacement Therapy (HRT) 

can be prescribed in various 

combinations and schedules. It can be 

prescribed as either unopposed estrogen, 

known as Estrogen Replacement Therapy 

(ERT) or combined with progestogen, 

known as Combined HRT. There are 

various ways of administering oral HRT, 

ranging from cyclical to continuous. 

HRT was first introduced in the 1940s 

to treat menopausal symptoms. 

It was portrayed to be the “cure all” 

for symptoms such as hot flushes, 

insomnia, mood swings and night 

sweats experienced by postmenopausal 

women due to estrogen deficiency. 

Other promises of HRT include cardio 

protective effects and the improvement 

of bone health. 

In the 1970s, it was reported that the use 

of ERT in postmenopausal women with 

an intact uterus resulted in significantly 

higher rates of endometrial cancer. This was 

subsequently overcome when progestogen 

was used in combination with estrogen in 

this group of women. 

To date, HRT remains the most 

effective in treating symptoms 

due to menopause. It is currently 

approved for the treatment of 

moderate-to-severe vasomotor 

symptoms and the prevention 

of osteoporosis. 

There are potential side effects with 

HRT. They include breast tenderness, 

cramping, fluid retention and blood clots 

(thrombosis) in veins or lungs. However, 

probably the most controversial and of 

concern would be the association of HRT 

use with cancer. 

Evidence from Literature 

Breast Cancer 

Based on evidence from published literature such as Collaborative Study 1 , the Women’s 

Health Initiative (WHI) 2-3 and the Million Women Study (MWS) 4 , causality between HRT 

and breast cancer has been established. 

(1) Collaborative Study 

Recent but not past use of HRT, as well as the duration of HRT usage, is a risk factor for 

breast cancer and risk is reduced upon discontinuation of therapy. There is an increased 

risk of breast cancer by 2.3 percent with each additional year of HRT use. 

(2) WHI 

This was a landmark randomised and placebo-controlled trial to ascertain HRT use in the 

prevention of heart disease and breast cancer in postmenopausal women. In 2002, the WHI 

study was terminated early due to increasing rates of heart disease 5 and breast cancer. 

Event 

Increase in number of cases for every 

10,000 women receiving HRT yearly 

Breast Cancer 8 

Dementia (>65 years) 23 

Heart Attacks 8 

Strokes 8 

Venous Thrombolic Events 18 

The increased risk of breast cancer was evident at the second year of HRT use and its risk 

dissipated within two years upon discontinuation of therapy. However, no increased risk 

of breast cancer was reported in the ERT arm. 6 

Continued on page B4.

Page B4 

Tender Care 

SALUBRIS 


Hormone Replacement 

Therapy and Cancer 

Continued from page B3. 

In the eleventh year follow-up WHI 7 study 

that was recently published, women who 

received combined HRT compared to 

placebo had a two-fold relative increase 

in mortality due to breast cancer. Hence, 

combined HRT was not only associated 

with increased risk of breast cancer but 

also mortality. 

(3) MWS 

This was a large prospective observational 

trial. In postmenopausal women taking 

combined HRT, their risk of breast cancer 

was twice of that compared to non-users 

of HRT. Similarly, the risk of breast cancer 

increases with duration of use. 

In summary, there is an increased 

risk of breast cancer with HRT use 

(higher with combined HRT than ERT) 

and risk increases with duration of 

HRT. Nonetheless, this increased risk 

would dissipate within two years upon 

discontinuation of therapy. 

Endometrial cancer 

Based on data from WHI and the Heart 

and Estrogen/Progestin Replacement 

Study follow up (HERS II), combined HRT 

has not been shown to increase risk of 

endometrial cancer. 2,8 

Ovarian cancer 

From a meta-analysis of observational 

studies 9 , the association of ovarian cancer 

with HRT seems to be stronger in ERT 

users compared to combined HRT users. 

Risk increases with increased duration 

of use. Based on MWS, prolonged use of 

HRT increases ovarian cancer risk that is 

translated to four per 10,000 HRT users 

over five years. 10 

Can HRT be used in 

Cancer Survivors? 

At present, there is insufficient data to 

make recommendations on HRT use for 

cancer survivors. 

Despite the fact that hormones are not 

able to directly cause DNA damage, they 

are able to stimulate cell proliferation and 

affect tumour growth. Hence, HRT use is 

generally contraindicated in this group 

of patients. 

Conclusion 

Post-WHI era, HRT is not used for the 

prevention of chronic diseases such as 

CVD and is no longer recommended to 

be used to relieve menopausal symptoms 

in postmenopausal women. Nonetheless, 

the benefits of HRT may outweigh their 

risks when used as a short term therapy 

for moderate to severe vasomotor 

symptoms and to prevent osteoporosis 

in women younger than 60 years and in 

early menopause. 

Guidelines from the American Association 

of Clinical Endocrinologists (AACE) 11 

and the North American Menopause 

Society (NAMS) 12 concur that HRT may 

still be appropriate albeit for a selected 

group of women. In addition, the 

American Congress of Obstetricians and 

Gynecologists (ACOG) recommends that 

the lowest effective dose of HRT be used 

and for the shortest time possible to treat 

menopausal symptoms. 

Individualised patient assessment 

on menopausal symptoms 

experienced have to be conducted 

prior to HRT use. At the same 

time, patients have to be informed 

of associated risks versus benefits 

of HRT, have treatment options 

discussed and to undergo 

appropriate monitoring if HRT is 

being prescribed. 

By Vivianne Shih Lee Chuen 

Principal Clinical Pharmacist 

Oncology Pharmacy 

NCCS 

References 

1. Collaborative Group on Hormonal Factors in 

Breast Cancer. Breast cancer and hormone 

replacement therapy: collaborative reanalysis 

of data from 51 epidemiological studies of 

52 705 women with breast cancer and 108 

411 women without breast cancer. 

Lancet 1997;350:1047-59. 

2. Writing Group for the Women’s Health 

Initiative Investigators. Risks and benefits 

of estrogen plus progestin in healthy 

postmenopausal women. Principal 

results from the Women’s Health 

Initiative randomized controlled trial. 

JAMA 2002;288:321-33. 

3. Chlebowski RT, Hendrix SL, Langer RD et 

al. Influence of estrogen plus progestin on 

breast cancer and mammography in healthy 

postmenopausal women: the Women’s 

Health Initiative Randomized Trial. 

JAMA 2003;289:3243-53. 

4. Million Women Study Collaborators. 

Breast cancer and hormone replacement 

therapy in the Million Women Study. 

Lancet 2003;362:419-27. 

5. Manson JE, Hsia J, Johnson KC et al. Estrogen 

plus progestin and the risk of coronary heart 

disease. N Engl J Med 2003;349:523-34. 

6. Women’s Health Initiative Steering 

Committee. Effects of conjugated equine 

estrogen in postmenopausal women with 

hysterectomy: the Women’s Health 

Initiative randomized controlled trial. 

JAMA 2004;291;1701-12. 

7. Chlebowski RT, Anderson GL, Gass M et al. 

Estrogen plus progestin and breast cancer 

incidence and mortality in postmenopausal 

women. JAMA 2010;304:1684-92. 

8. Hulley S, Furberg C, Barrett-Connor E et 

al. Noncardiovascular disease outcomes 

during 6.8 years of hormone therapy: Heart 

& Estrogen / progestin Replacement Study 

follow-up. (HERS II). JAMA 2002;288:5866. 

9. Zhou B, Sun Q, Cong R et al. Hormone 

replacement therapy and ovarian cancer 

risk: a meta-analysis. Gynecol Oncol 

2008.;108:641-51. 

10. Neves-E-Castro M. An analysis of ovarian 

cancer in the Million Women Study. Gynecol 

Endocrinol 2007;23:410-3. 

11. Cobin RH, Futterweit W, Ginzburg SB 

et al. American Association of Clinical 

Endocrinologists medical guidelines for 

clinical practice for the diagnosis and 

treatment of menopause. Endocr Pract 

2006;12:315-7. 

12. North American Menopause Society. 

Estrogen and progestogen use in 

postmenopausal women: 2010 position 

statement of the North American Menopause 

Society. Menopause 2010;17:242-55.

妇科癌症 : 治疗与筛检 II 

Page B5 

往前看 

SALUBRIS 


子宫癌 

一般被称为 “ 子宫内壁癌 ” 或 “ 子宫内膜癌 ”。它目 

前是新加坡最常见的妇科癌症 , 患者通常是 50 岁至 

60 岁左右 , 停经后的妇女。在竹脚妇科癌症中心 , 

每年平均有 180 起新病例 , 而且发病率不断提高。 

谢燕妮医生 

竹脚妇幼医院妇科癌症部门主任兼顾问 

新加坡杜克 - 国大医学研究院兼职助理教授 

新加坡国立癌症中心客卿顾问 

这种癌症的确切病因不明。不过 , 某些女性的患癌风险比其他人高 : 

• 肥胖或超重的女性 

• 不曾生育或育有较少孩子的女性 

• 患有不育症的女性 

• 较早进入生理期和较迟步入更年期的女性 

• 患有糖尿病、高胆固醇或高血压的女性 

• 有月经失调或多囊卵巢综合征病史的女性 

• 有子宫癌或、大肠癌或林奇二型 (LYNCH II) 

综合征家族病史的女性 

• 接受泰莫昔芬 (Tamoxifen) 治疗的乳癌患者 

大多数病例 (80%) 在初期阶段会出现一些异常出血的情况 : 

• 更年期后出血 

• 月经间期出血 

• 长期经漏不止 

任何人如果出现以上症状 , 应寻求治疗。初步检查包括超声波扫 

描和子宫内膜活体组织检查 ( 一般采用子宫扩张刮除术 )。一旦 

确诊患癌 , 最佳的治疗方法是进行分期手术 ( 以评估癌症的范围 / 

扩散程度 ) 和切除子宫。晚期癌症患者可能需要在进行手术后接 

受额外治疗 , 如放射治疗、荷尔蒙疗法和化疗。 

( 子宫内膜癌 ) 

由于大多数病例在初期阶段就被发 

现 , 因此整体而言 , 子宫内膜癌患者的 

五年存活率高达 80%。 

多生育、确保生理期正常 , 以及通过健 

康饮食和定期运动来维持理想体重 , 

都是预防子宫内膜癌的方法。长期使用 

复合避孕药 (COCs) 和一种称为 “ 曼月 

乐 ”(Mirena) 的含药宫内节育器 , 也可 

以降低患子宫内膜癌的风险。 

目前 , 医学界并没有检验子宫内膜癌的 

有效筛检法。筛检常被认为不符合成 

本效益 , 因为大多数病例能及早发现 , 

而且比较容易治疗和痊愈。

Page B6 

往前看 

SALUBRIS 


妇科癌症 : 治疗与筛检 II 

( 子宫 ) ( 韧带 ) 

( 输卵管 ) 

卵巢癌通常被称为 “ 无声杀手 ”。初期阶段通常没有任何症状。等到症状出现 

时 , 病情已进入晚期。此外 , 卵巢癌的症状非常模糊 , 也经常同胃炎、胆囊疾 

病或结肠直肠病况混淆。 

常见症状包括 : 

• 腹部胀气和鼓胀 

• 消化不良或胀风 

• 饭后有饱足感 

( 卵巢恶瘤 ) ( 健康卵巢 ) 

• 腹部明显有肿块 

• 泌尿系统症状 , 如频尿 

• 排便症状 , 如便秘 

• 一条腿浮肿 

( 健康卵巢 ) 

( 卵巢肿瘤 ) 

因此 , 围绝经期年龄层的女性千万不可忽视这些症状。如果不确定 , 应及早向 

医生咨询。 

卵巢癌 

虽然卵巢癌比子宫内膜癌较少见 , 但它是 

最致命的 , 因为大多数病例在晚期阶段才 

被发现。在新加坡 , 每年每 10 万人中 , 就 

有大约 15.2 人患卵巢癌。多数患者是 40 

岁至 60 岁的女性。在竹脚妇科癌症中心 , 

每年平均有 120 起新病例。 

跟子宫内膜癌一样 , 卵巢癌的确切病因 

不明。不过 , 某些女性的患癌风险比其他 

人高 : 

• 不曾生育的女性 

• 患有不孕症的女性 

• 较早进入生理期和较迟步入更年期的 

女性 

• 有乳癌及 / 或卵巢癌或乳腺癌基因 

(BRCA) 综合征或林奇二型综合征家族 

病史的女性 

如果怀疑患上卵巢癌 , 病人将被转介给妇科肿瘤医生或肿瘤内科医生 , 进一步 

进行检验。这些检验包括电脑断层扫描及 / 或超声波扫描 , 以检测卵巢是否有 

肿瘤 , 以及一种称为 “ 卵巢肿瘤标记物 ” 的血液检查 , 如癌抗原 125 (CA125)。 

检验结果将能显示卵巢的肿瘤演变成恶性肿瘤的可能性。最后 , 医生必须动手 

术切除肿瘤 , 以确定诊断。一旦确诊患癌 , 医生会同步进行分期手术 ( 以评估 

癌症的范围 / 扩散程度 )。如果动手术时发现癌症已进入晚期 , 医生会尽量切除 

肿瘤。有时候 , 如果癌症已进入晚期 , 医生可能会让病人先接受化疗 , 然后才 

进行手术。除了非常初期阶段的卵巢癌外 , 几乎所有卵巢癌都必须采用双管齐 

下的方法 —— 手术和化疗。 

卵巢癌的痊愈情况 , 须视癌症所处的阶段而定。由于大多数病例到了晚期才被 

发现 , 因此整体而言 , 患者的五年存活率平均约为 50%。 

目前 , 医学界并没有任何有效的卵巢癌筛检法。即使是接受例常的超声波扫描 

或 “ 卵巢肿瘤标记物 ” 血液检查 , 都无法及早发现卵巢癌。 

卵巢癌可以通过服用复合避孕药来预防。长期使用三至五年 , 可使患卵巢癌的 

风险减半。此外 , 多生育和母乳喂养也有助于降低患癌风险。 

妇科癌症很常见。子宫颈癌可以通过注射疫苗和子宫颈抹片检查 

法来预防。尽管子宫内膜癌无法有效预防或筛检 , 但患者通常会 

在初期阶段出现异常出血情况。所以 , 千万不要忽视这些早期的 

警告信号 , 而且要及早寻求治疗。卵巢癌仍是 “ 无声杀手 ”, 所以 

要注意一些模糊症状。如果不确定 , 应向医生咨询。服用复合避孕 

药 , 可降低患卵巢癌和子宫内膜癌的风险。

荷尔蒙替代疗法与癌症 

Page B7 

温柔呵护 

SALUBRIS 


荷尔蒙替代疗法简介 

“ 荷尔蒙替代疗法 ”(Hormone Replacement Therapy, 简称 HRT) 可根据不同的组合和时 

间表来进行。医生可以使用非对抗性雌激素的 “ 雌激素替代疗法 ”(Estrogen Replacement 

Therapy, 简称 ERT), 或是结合孕激素的 “ 综合荷尔蒙替代法 ”(Combined HRT) 来治疗。 

口服荷尔蒙替代疗法有多种服用法 , 从周期性到持续性皆有。 

荷尔蒙替代疗法在 1940 年代开始采用于治疗更年期症状。它被视为 “ 万灵药 ”, 可用来治疗停 

经后女性因雌激素不足而出现的潮热、失眠、情绪波动和盗汗等症状。荷尔蒙替代疗法的其他 

宣称功效包括预防心血管疾病和改善骨骼健康。 

到了 1970 年代 , 有报道指出 , 如果子宫完好的停经后女性使用雌激素替代疗法 , 患上子宫内 

膜癌的机率明显提高。不过 , 如果孕激素和雌激素一起使用 , 患癌风险则会大幅降低。 

到目前为止 , 荷尔蒙替代疗法仍是治疗更年期症状的最有效方法。它目前是获准治疗中度到重 

度血管舒缩症状和预防骨质疏松症的方法。 

荷尔蒙替代疗法具有潜在副作用 , 包括乳房胀痛、抽筋、水肿 , 以及静脉或肺部出现血块 

( 血栓症 )。不过 , 最具争议性和值得关注的是使用荷尔蒙替代疗法与癌症的关系。 

研究报告的论据 

乳癌 

一些已发表的研究报告 , 如协作研究 (Collaborative Study) 1 

、妇女健康倡议 (Women’s Health Initiative, 简称 WHI) 2-3 

和百万妇女研究 (Million Women Study, 简称 MWS) 4 

的论据显示 , 荷尔蒙替代疗法与乳癌的因果关系是成立的。 

(1) 协作研究 

近期但不是过去使用荷尔蒙替代疗法 , 以及使用的时间 , 是罹患乳癌的风险因素。患病风险会随着疗 

程停止而降低。每多使用荷尔蒙替代疗法一年 , 患上乳癌的风险就会增加 2.3%。 

(2) 妇女健康倡议 

这是为了确定荷尔蒙替代疗法可预防停经后女性患上心脏病和乳癌 , 而展开的一项标志性随机安慰 

剂对照试验。由于罹患心脏病 

5 

和乳癌的机率不断增加 , 这项研究提前在 2002 年终止。 

疾病 

每年每 1 万名女性接受荷尔蒙替代疗法的病例增幅 

乳癌 8 

失智症 (65 岁以上 ) 23 

心脏病 8 

中风 8 

静脉血栓事件 18 

在使用荷尔蒙替代疗法后的第二年 , 患上乳癌的风险明显增加 , 但疗程停止后的两年内 , 患癌风险将 

消除。使用雌激素替代疗法则不会增加患上乳癌的风险。 6 

近期发表的《妇女健康倡议》第 11 年跟进研究 

7 

显示 , 同安慰剂相比 , 接受综合荷尔蒙替代疗法的女 

性因罹患乳癌而死亡的比率增加两倍。由此可见 , 综合荷尔蒙替代疗法不仅跟患乳癌风险增加有关 , 

而且跟死亡率也有关。 

(3) 百万妇女研究 

这是一项大规模预期性观测研究。使用综合荷尔蒙替代疗法的停经后女性 , 患上乳癌的风险比非使 

用者高出一倍。同样的 , 患乳癌的风险会随着使用时间的增加而提高。 

总的来说 , 使用荷尔蒙替代疗法会提高患乳癌的风险 ( 综合荷尔蒙替代疗法比雌激素替代疗法更高 ), 

而且患癌风险会随着荷尔蒙替代疗法使用时间的增加而提高。尽管如此 , 疗程停止后的两年内 , 患癌 

风险将消除。 

子宫内膜癌 

根据妇女健康倡议和心脏与雌激素 / 孕激 

素替代研究跟进 (Heart and Estrogen/ 

Progestin Replacement Study follow 

up, 简称 HERS II) 的数据 , 综合荷尔蒙替代 

疗法并不会增加患子宫内膜癌的风险。 2,8 

卵巢癌 

根据一些观测研究 

9 

的综合分析 , 雌激素替代 

疗法使用者患上卵巢癌的风险 , 比综合荷尔 

蒙替代疗法使用者更高。患癌风险也会随着 

使用时间的增加而提高。百万妇女研究显示 , 

长期使用荷尔蒙替代疗法 , 会增加患卵巢癌 

的风险。换句话说 , 每 1 万名荷尔蒙替代疗法 

使用者中 , 有 4 人在 5 年内会面对患癌风险。 10 

癌症幸存者能否使用荷尔蒙替 

代疗法 ? 

目前 , 医学界没有足够的数据显示癌症幸存者可 

以使用荷尔蒙替代疗法。虽然荷尔蒙不会直接 

导致脱氧核糖核酸 (DNA) 受损 , 但它会刺激细 

胞增生和影响癌细胞生长。因此 , 这类病人一般 

上是不被允许使用荷尔蒙替代疗法的。 

总结 

妇女健康倡议研究结束后 , 荷尔蒙替代疗法没有 

被用来预防心血管疾病等慢性疾病 , 也不再被建 

议用来缓解停经后女性的更年期症状。不过 , 当 

荷尔蒙替代疗法被用于为 60 岁以下提早进入更 

年期的女性治疗中度到重度血管舒缩症状和预 

防骨质疏松症的短期疗程时 , 则利大于弊。 

美国临床内分泌学家协会 (American 

Association of Clinical 

Endocrinologists, 简称 AACE) 11 和北美更 

年期协会 (North American Menopause 

Society, 简称 NAMS) 12 的指导准则都认 

同 , 除了特定组别的女性外 , 荷尔蒙替代疗法 

还是适合使用的。另外 , 美国国会妇产科学会 

(American Congress of Obstetricians 

and Gynecologists, 简称 ACOG) 也建议 

使用最低有效剂量的荷尔蒙替代疗法和最短时 

间 , 来治疗更年期症状。 

在使用荷尔蒙替代疗法前 , 医生必须先评估个 

别病人的更年期症状。与此同时 , 医生也必须告 

诉病人有关荷尔蒙替代疗法的利弊 , 以及跟病 

人讨论治疗选项。如果决定采用荷尔蒙替代疗 

法 , 病人也必须接受适当监督。 

参考文献 , 请参阅第 B4 页 

以上文章由施丽娟提供 

肿瘤药学首席临床药剂师 

新加坡国立癌症中心

Page B8 

Outreach 

SALUBRIS 


Upcoming Public Education 

activities / Programmes 

Event Name 

Date and Time 

Support Group: NPC (Nasopharyngeal/Nose Cancer) 

Managing the Side Effects of Radiotherapy and Chemotherapy 

Lung Supportive Care Programme 

Exercising Right 

Malay Support Group – Sinar Harapan 

What is This Feeling? 

Patient Ambassador Training 

Issues in Grief & Managing Emotions 

Look Good Feel Better (for Ladies only) 

Mandarin Support Group 

Your Cancer Journey 

Support Group – Grief in Recovery (for surviving spouse) 

Agreement between Expectations and Yearnings – Key to Satisfactory Post Loss 

STEER Series 

Brushes in action 

The Revival Connection (for Advanced & Recurrent Cancers) 

Lunar New Year Get-Together 

Support Group: NPC (Nasopharyngeal/ Nose Cancer) 

Nutrition – Your Kitchen, Your Pharmacy 

Malay Support Group – Sinar Harapan 

A Psychological Way of Managing Your Symptoms 

6 January 2012, Friday 

7pm to 9pm 

Session will be conducted in English 


2.30pm to 4.30pm 

Session will be conducted in Mandarin 

14 January 2012, Saturday 

2.30pm to 4pm 

Session will be conducted in Malay 

21 January 2012, Saturday 

9am to 12pm 



2pm to 5pm 



6pm to 8pm 

Session will be conducted in Mandarin 


7pm to 9pm 


4 February 2012, Saturday 

9.30am to 1pm 



1pm to 3pm 


10 February 2012, Friday 

7pm to 9pm 



2.30pm to 4pm 

Session will be conducted in Malay 

Venue: 

Function Room, Level 4 


To register, please call: 

Patient Support at 6436 8117 / 6436 8126 or Cancer helpline at 6225 5655 

Mon – Fri: 8.30am – 5.30pm

From asPIrING F1 racer 

TO LIFe-savING surgeON 

Page A5 

People 

SALUBRIS 


Many people would agree that the job of a Formula One racer is 

possibly one of the most exacting jobs in the world. After all, not 

many jobs would give you that kind of high-speed thrill and spill 

of racing at neck-breaking speeds in the full view of glamorous TV 

cameras broadcast worldwide. This is not to mention, the paycheck 

that goes with the job. 

Hence in his early days, a young Lee Ser Yee had thought of getting 

himself in the F-1 driver’s seat. But his hopes were dashed after learning 

that the training and equipment would cost a big money chest. 

Spurred on by his inclination for Science, love for helping people 

and doing things with his hands, he turned to his next passion to 

become a surgeon. 

Dr Lee Ser Yee (left) receiving the 

Young Surgeon’s Award. 

Today, Dr Lee Ser Yee, a consultant with the National Cancer Centre 

Singapore, is pleased with that choice. His passion for his work has been 

rewarded by his receiving of the Young Surgeon’s Award from the College of 

Surgeons of the Academy of Medicine, Singapore. 

After graduating from medical school, Dr Lee chose to become a cancer surgeon 

because it combines two of his interests – surgery and oncology. Most importantly, 

cancer is one of the leading causes of death in Singapore. To him, it is immensely 

satisfying to be part of a team of specialists to combat this killer disease. No 

amount of glamour and thrills from speeding on a race track can grant him as much 

satisfaction as saving lives. 

“Having cancer is not necessarily a death sentence. There have 

been improvements in the treatment of cancer and one can still 

lead a fulfilling life after appropriate treatment. More importantly, 

patients have a dedicated team of cancer specialists and 

paramedical staff who are here to walk with them every step of 

the way on their journey to recovery,” he said. 

The complexity of surgery thrills Dr Lee. Challenging as it is, it also demands a 

good knowledge of anatomy, innovation and hours of training and practice to be 

competent. “It is immensely satisfying because you can literally put your hands on 

the problem to deal with it and in some situations, it is the definitive treatment for 

the patient,” he added. 

During his apprenticeship, Dr Lee had the privilege to train under many 

accomplished surgeons. One of them is Director of NCCS, Prof Soo Khee Chee. 

Dr Lee is full of praise for his mentor. “Prof Soo is tireless in his efforts to help 

patients, raise standards of healthcare and medical research in Singapore, as well 

as to impart skills and knowledge to younger surgeons like myself. He has been 

tremendously inspiring to work with.” 

Besides spending hours in the operating 

theatres, he also initiated the first-ever Liver 

Cancer Support Group in Singapore with 

the help of his co-chair, Dr Chan Chung Yip, 

Consultant of the Singapore General Hospital. 

The support group was launched during the 

Liver Cancer Awareness Month event held at 

IMM Garden Plaza in September. 

He initiated this support group after being 

approached by many patients enquiring about 

the availability of a support group for liver cancer 

patients. Realising the importance and need 

of having a support group to help patients and 

caregivers during and after their cancer journey, 

Dr Lee escalated his idea to his seniors and 

fellow colleagues, who were very supportive of it. 

“I hope that this group provides a platform 

for liver cancer patients to come together 

and share their stories. Through this, they 

will be able to better prepare themselves for 

the treatment that lies ahead, and the kind of 

changes they may expect. 

I also hope that through this support group, we 

can help dispel myths about liver cancer and its 

treatments. Most importantly, our liver cancer 

survivors are able to impart hope to newly 

diagnosed liver cancer patients,” said Dr Lee. 

By Mark Ko

Page A6 

Community 

SALUBRIS 


PRUDENTIAL GOLF CHARITY 

RAISES $250,000 FOR NCC 

RESEARCH FUND 

A day of sporting 

fun in aid of 

cancer research 

More than a hundred 

warm-hearted partners 

and business associates of 

Prudential Singapore were 

greeted with beautiful 

weather on 27 September 

as they teed-off and golfed 

for the cancer cause, 

raising $250,000 in aid of 

the NCC Research Fund. 

Guest-of-Honour Prof Tan Ser Kiat, Group CEO of SingHealth and Board member of NCC 

Research Fund, receiving the cheque from CEO of Prudential Singapore, Kevin Holmgren. 

This was part of Prudential 

Singapore’s 80th anniversary 

celebrations this year, which 

revolves around giving back to the 

community. “With this gesture, we hope 

to help NCCS’ efforts in the development 

of cancer treatment methods,” said Kevin 

Holmgren, Chief Executive Officer of 

Prudential Singapore. 

The day of golfing excitement showcased 

the skills of participants and culminated 

in an elegant dinner that featured an array 

of attractive prizes. Guest-of-Honour 

Professor Tan Ser Kiat, Group CEO 

of SingHealth, who is also a Board 

member of the NCC Research Fund, 

received the cheque and presented 

tournament prizes and tokens of 

appreciation to the participants. 

From left: Patrick Teow, Chief Distribution Officer of Prudential Singapore, Prof Tan Ser Kiat, 

Group CEO of SingHealth and Board member of NCC Research Fund, Benny Tay, Organising 

Chairman of Prudential Golf Charity, A/Prof Koo Wen Hsin, NCCS Deputy Director.

Page A7 

Community 

SALUBRIS 


Golfing action and bonding. 

Dr Tan Hiang Khoon, Director for Division 

of Community Outreach and Philanthropy 

at NCCS. 

Thanking Prudential Singapore, 

the organising committee 

initiated by Agency Force 

Alliance (a group of Prudential 

Singapore’s Agency Leaders), 

sponsors, donors and 

participants at the dinner for 

their big-hearted support, 

Director for Division of 

Community Outreach and 

Philanthropy at NCCS, 

Dr Tan Hiang Khoon said, 

“Donating to research can be 

likened to buying insurance; 

investing for the future. At times, 

the returns (in research) are 

received sooner than expected, 

benefiting or protecting you 

and your loved ones.” 

Organisations who would like to 

support the cancer cause through such 

corporate events are welcome to contact 

the NCCS Community Partnership at 

CommunityPartnership@nccs.com.sg. 

We will be pleased to work with you. 

By Adeline Teo 

Division of Community Outreach 

& Philanthropy 

NCCS

Page A8 

Community 

SALUBRIS 


Fun way to raising 

awareness on liver canceR 

Raising awareness on 

liver cancer is no easy 

task. This is especially 

when there are so many 

competing activities in 

September, from the 

lantern festival to the F-1. 

But the decision to create awareness 

the fun way for this year’s 4th Liver 

Cancer Awareness Month (LiCAM) 

proved to be a success. Held on 17 Sept 

at the IMM Garden Plaza, the day-long fun 

and games, and on-stage entertainment drew 

a steady crowd. At the close of the day, an 

estimated 500 people turned up at the event. 

Jointly organised by the National Cancer 

Centre Singapore (NCCS) and the Singapore 

General Hospital (SGH), the event attracted 

families with young children in tow as well 

as weekend shoppers who joined in the 

activities with a number of them walking 

home with prizes from the lucky draws. 

“We did a public exhibition this year, 

wanting to approach public education and 

raise awareness in a different way, rather 

than just by didactic lectures alone,” said 

Dr Tan Hui Hui, co-chairperson for the 

LiCAM committee and Consultant with SGH. 

The other co-chairman is Dr Chan Chung 

Yip, who is also a Consultant with SGH. 

The draw for the children was the 

colouring contest, balloon sculpting 

and magic show. The adults signed 

up for the quiz and those who could 

answer a list of written questions 

correctly went home with a goodie 

bag each. To answer the questions, 

they had to view the exhibition of 

informational posters and learn 

about liver cancer. To entertain the 

crowd, there was a traditional Indian 

dance by the Jurong Jewels, and 

singing performances by a number 

of cancer survivors. 

To add a dash of colour, young children 

could pose in a surgeon’s scrub against 

a backdrop of an operating theatre. 

And it was all for free. 

The key highlight of the event was the 

launch of the first Liver Cancer Support 

Group by Dr Lee Ser Yee, Associate 

Consultant from NCCS and Chairman 

of the Liver Cancer Support Group. 

The group will help patients and their loved 

ones cope with their condition before, during 

and after treatment. Members can also use 

this platform to share their experiences and 

journey together with their family. 

“With this support group, we hope to 

provide our patients and their families 

with additional resource for the best care. 

Patients and their loved ones can use this 

opportunity to speak to other patients to 

understand the treatment process as well as 

their journey to recovery,” said Dr Lee. 

Among the upcoming events and activities 

include creating a Facebook page where 

patients can access more information 

and a Christmas party at the end of this 

year. The pioneers in the group include 

survivors Messrs Judson Guo Ji Quan, 

Jumaat bin Zahari, Yue Keng Siang and 

Zulkifli bin Samsuri. 

By Mark Ko 

Editorial Advisors 

Prof Kon Oi Lian 

Prof Soo Khee Chee 

Executive Editors 

Ms Charissa Eng 

Ms Veronica Lee 

Mr Sunny Wee 

Contributing Editor 

Dr Wong Nan Soon 

Members, Editorial Board 

Mr Mark Ko 

Ms Sharon Leow 

Dr Shiva Sarraf-Yazdi 

Ms Jenna Teo 

Medical Editor 

Dr Richard Yeo 

Members, Medical Editorial Board 

Ms Lita Chew 

Dr Mohd Farid 

Dr Melissa Teo 

Dr Teo Tze Hern 

Dr Deborah Watkinson 

is produced with you 

Salubris in mind. If there are other 

topics related to cancer that you would like to read about 

or if you would like to provide some feedback on the 

articles covered, please email to salubris@nccs.com.sg. 


Reg No 199801562Z 

11 Hospital Drive Singapore 169610 

Tel: (65) 6436 8000 Fax: (65) 6225 6283 

www.nccs.com.sg

THE GIFT OF LIFE - National Cancer Centre Singapore

Create successful ePaper yourself

Delete template?

Save as template?