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Issue No. 05 • MICA (P) 207/10/2008 AN NCCS BI-MONTHLY PUBLICATION July / August 2009 ...HELPING R E A DERS TO ACHIEV E GOOD HE A LTH Salubris is a Latin word which means healthy, in good condition (body) and wholesome. NCCS TEAM IS GETTING THE ANSWERS FOR LIVER CANCER PAGE A2 In Other Words FOR THE LOVE OF SCIENCE SALUBRIS July / August 2009 DANIEL TAN speaks about his passion for science which led him to his research into how targeted drug works in nasopharyngeal cancer. CAROL ANG reports. Recently, the Department of Medical Oncology welcomed back two doctors. Amongst them is Dr Daniel Tan, who had been away for a nine-month fellowship programme in the UK. He is the second doctor to return from overseas, the first this year being Dr Ng Quan Sing. Five other doctors, namely, Dr Lynette Ngo, Dr John Chia, Dr Richard Quek, Dr Wong Nan Soon and Dr Ang Mei-Kim are still overseas and not due to return till 2010. D r Tan is the first oncologist from Singapore to be conferred the Young Investigator Award from the American Society of Clinical Oncology (ASCO) Cancer Foundation. This award provides funding to promising investigators planning an investigative career in clinical oncology. Recalling fondly his stint overseas, Dr Tan revealed, “In my second year of study at St Bartholomew’s and The Royal London Hospital, we had 8-week elective projects – ranging from library-based to lab-based ones – and out of curiosity, I picked the latter and ended up in the then Imperial Cancer Research Fund at Lincoln’s Inn Fields. I was fortunate to have a very good mentor who showed me how research can challenge scientific dogma, with the aim of making a difference in patient care.” Dr Tan’s enthusiasm for knowledge was so great that he even took a year out to do an intercalated BSc degree in tumour biology. It is precisely this investigative spirit and an avid interest in making new discoveries that has brought Dr Tan to his current vocation as oncologist and clinician-scientist at the NCCS. Nursing a passion for Science since he was a child, Dr Tan knew his dream job would be one that allows him to apply knowledge in a practical meaningful way. “Medicine provided the right mix of human interaction and applied science,” he said. And, at the age of 16, Dr Tan started medical school in London and now holds BSc (Hons), MBBS and MRCP qualifications. He returned in 2002 to be enrolled into national service where he spent a year in the Diving Medicine Section. In 2004, Dr Tan joined SingHealth, and undertook the rotations through various departments as a medical officer at the Singapore General Hospital. Three years later, he began his career in oncology but took off again shortly on a National Medical Research Council Fellowship to the Drug Development Unit of The Royal Marsden Hospital, a leading cancer centre in the UK, with full support and encouragement from the NCCS. For this, he gratefully acknowledges the medical oncology department for creating a highly conducive environment for personal development, where peers and seniors work towards a common goal to deliver better care and treatment options to patients – and early phase trials may be a way forward. “During my nine months there, I learnt how to innovate the design of Phase I trials, care for participating patients, as well as interact with pharmaceutical companies and collaborating overseas Phase I units in Europe and US. It was also quite an experience prescribing novel drugs available at the unit, knowing well that some of them might become the standard of care in the next five to 10 years.” He further recounted that some patients could be seen to benefit even in the context of Phase I trials, which are traditionally regarded as dose titration experimental studies. “In the era of targeted therapy, and non-invasive molecular platforms, there is now scope to rationally improve the chances of patient benefit from novel drugs, as well as gain insight to basic tumour biology.” PAGE A3 In Other Words SALUBRIS July / August 2009 “Despite the slew of exciting drugs coming through, we remain cautiously optimistic, and at the end of the day, patient care and safety remains the priority.“ Dr Daniel Tan However, beyond the high tech translational science, he added “I would say I still derived the greatest satisfaction treating patients and seeing them get better. Some of the patients I met at the hospital were also refreshingly enlightened. They participated in trials with the hope of helping others even though there was a chance that it would not benefit them,” he added. As the Young Investigator Award is given to applicants during their transition from a fellowship programme to a faculty appointment, it was shortly before he returned to Singapore that he received this honour. “To put that simply, I am trying to understand why resistance develops in drugs targeting blood vessels, as well as find out how they work in nasopharyngeal cancer which affects about 400 Singaporeans each year,” he explained. “I am glad that the proposal came through the peer-review process and was selected for funding by a highly regarded international scientific body. The most satisfying part is to have articulated an idea in the proposal and have someone take it seriously to the extent of providing funding, all in good faith,” he said. Now that Dr Tan is back, the clinicianscientist has to divide his time between the NCCS-VARI Laboratory, where he works with his mentor Prof Teh Bin Tean, and the clinic where he sees patients suffering from a range of different tumour types. The grant from the award would go into his research on ‘Delineating Clinically Relevant Targets of Anti-Angiogenic Small Molecule Tyrosine Kinase Inhibitors in Nasopharyngeal Carcinoma’. Dr Tan was upfront about his role as an oncologist. “At first, I had reservations about a lifelong career in oncology. But I soon found it to be both a privilege and an extremely fulfilling undertaking to care for cancer patients.” Indeed for someone who is developing new drugs in oncology, Dr Tan remains circumspect on the role of a physician. “Despite the slew of exciting drugs coming through, we remain cautiously optimistic, and at the end of the day, patient care and safety remains the priority. Hopefully, our research efforts will shed some light to the current gaps in understanding cancer, and ultimately translate to improved care for patients.” Off work, this 31-year-old is on a constant quest to discover new gastronomic highs. He regularly goes for runs, waxes lyrical about wine together with good friends, and challenges himself to a therapeutic game of golf, when time avails. By Carol Ang PAGE A4 In Focus SALUBRIS July / August 2009 NCCS TEAM IS GETTING THE ANSWERS FOR LIVER CANCER The NCCS team has come up with a modality to test drug combinations in laboratories and today their work has found its way to the patients who are on clinical trials. At the onset of this trial, a biopsy of the tumour from the patient was first taken and implanted into a mouse. The mouse underwent treatment with the use of one drug and its progress was monitored. Subsequently, other drugs were administered until the desired result was obtained. Thus far, the team has tested a combination of two drugs, both of which are produced by two different giant pharmaceutical companies, for liver cancer. The combination of two drugs was found to be more effective than the use of one drug. Based on this discovery, a Phase I clinical trial testing on liver cancer patients for this two-drug combination was conducted. Twenty-seven patients participated in this trial and the results were encouraging, with complete shrinkage of the tumour in a few patients. A Phase II trial will be launched on some 59 patients later this year. T he team behind this timely discovery comprises of Adjunct Professor Huynh Hung from the NCCS Humphrey Oei Institute of Cancer research (Division of Cellular and Molecular Research) and clinician investigators Dr Toh Han Chong, Head of the Department of Medical Oncology and Dr Choo Su Pin, Consultant for the Department of Medical Oncology. Professor Hui Kam Man, Director, Division of Cellular and Molecular Research at NCCS said: “We could not have achieved this without the financial support from the Singapore Millennium Fund, the National Medical Research Fund and the Singapore Cancer Syndicate. They could see the significance of our project and gave us the necessary funding to make this a reality.” The team’s success has prompted more drug companies to come together and use NCCS as a platform to best their drug combinations. More clinical trials are in the works. However, exemplary treatment methods are futile if patients are late in seeking medical attention. Majority of liver cancer fatalities could have been prevented with early detection. Thus, for NCCS’s 2nd Liver Cancer Awareness Campaign in September this year, great emphasis was placed on raising public awareness and encouraging more people to do health screenings. Although fatty liver is a benign condition, it can give rise to a wide spectrum of liver diseases, lead to inflammation and scarring of the liver and eventually, liver cancer if left undetected. The campaign is sponsored by Bayer Healthcare. To reach out to more households, public forums will be held at the Paya Lebar Kovan Community Centre on 12 and 13 September 2009. The forums will be presented in English and Mandarin. All attendees are entitled to free goodie bags and vouchers for free Hepatitis screenings at SingHealth Polyclinics. Madam Cynthia Phua, MP for Aljunied GRC, who will be launching the LiCAM campaign urged the public to go for regular medical screenings, their best defense against the disease. Dr Tan Yu Meng, Deputy Head and Senior Consultant, Department of Surgical Oncology, NCCS and Surgical Director, Liver Transplant Programme, SGH, who spearheads the Liver Cancer Awareness Month Committee said, “Early detection is the best solution for liver cancer as often by the time the patients are brought to our attention it is too late for treatment. Hence, we hope to raise public awareness so that they will come forward and take advantage of the free screening.” The campaign will focus on information on the latest treatment methods and care for liver cancer patients, the risk of Hepatitis and how to avoid contracting fatty liver. Fatty liver is a condition that is likely to become more common among affluent Singaporeans. It is expedited when fat accumulates in Hepatocytes, or tiny sacs of liver cells. With greater public awareness and improved cancer treatments, liver cancer patients may look ahead with lighter hearts as NCCS brings its research work from the bench to the bedside. ADVANCES IN RADIOTHERAPY IN THE MANAGEMENT OF EARLY PROSTATE CANCER PAGE C1 Under The Microscope SALUBRIS July / August 2009 INTRODUCTION Prostate cancer is a cancer whose incidence has been steadily increasing over the last 35 years. It is typically found in men older than 50 years but its incidence varies greatly around the world. In Singapore, it is now the 3rd most common male cancer. By Dr Terence Tan Sr Consultant Radiation Oncologist, Dept of Radiation Oncology, NCCS Early prostate cancer refers to cancer confined to the prostate (stage I & II) and these may be managed by surgery, radiotherapy or active surveillance. Locally advanced prostate cancer on the other hand is best treated by a combination of androgen suppression therapy and radiotherapy. This article looks at advances in the use of radiotherapy in the management of localised prostate cancer. DOSE IMRT It is now generally accepted that there is a doseresponse curve for prostate above the conventionally given 66 Gy. Studies from the Memorial SloanKettering Cancer Center and M.D. Anderson Cancer Center have shown that patients have improved relapse-free survivals when given doses above 70 Gy. While studies into the delivery of even higher doses are on-going, the current recommendation is for doses of at least 74 Gy (minimum tumour dose) to be delivered. Intensity modulated radiotherapy is a very sophisticated form of radiation where the cross-sectional exposure of each treatment beam is not uniform as in the past but is varied by computer control (intensity-modulated) such that parts of the beam passing through sensitive normal structures have reduced exposure rates while parts which pass through tumour and not normal tissues have higher exposure rates. Dose escalation studies began in the era of 3-D conformal radiotherapy and it was noted that while increases in the total dose delivered to the tumour improved disease-free survival, rectal and bladder morbidity rates also increased. That was until the advent of Intensity Modulated Radiation Therapy (IMRT). In this way, when a number of such treatment beams are arrayed around the patient, the high-dose treatment volume can be made to envelope the tumour target volume very conformably while sparing the surrounding normal tissues to a degree even greater than the previously used 3-D conformal techniques. Even within the treatment volume, it is possible to vary the dose (dose-paint), giving for example a radical dose to the tumour proper while delivering a lesser prophylactic dose to the draining lymphatics, all within the same treatment session. The availability of this technology has made dose escalation to very high levels possible with even less side-effects. IMRT has been in use at the National Cancer Centre Singapore (NCCS) since 2001. Continued on page C2. PAGE C2 Under The Microscope SALUBRIS July / August 2009 ADVANCES IN RADIOTHERAPY IN THE MANAGEMENT OF EARLY PROSTATE CANCER Continued from page C1. IMAGE GUIDED RADIOTHERAPY The prostate is a very mobile organ. Its position varies from day to day depending on the contents in the rectum and bladder. In the past, the uncertainty of the prostate’s position was dealt with by using larger treatment volumes. But this would mean a greater volume of normal tissue being irradiated. However, if the position of the prostate can be determined before each treatment, then smaller margins can be applied in the treatment volume. Methods of prostate localisation include ultrasound and the use of fiducial markers implanted within the prostate. In the latter method, images taken using the treatment machine’s on-board imaging device are compared with the images obtained during treatment planning. If the prostate is found to have shifted, then adjustments are made to align the radiation beam with the organ. This procedure is critical to IMRT as it helps ensure that the high-dose volume is accurately delivered to the prostate while the smaller margins required helps reduce the side-effects even when high doses are given. The most accurate method currently available is Dynamic Targeting Image Guided Radiotherapy where treatment machines are equipped with an on-board CT facility which is used to do scans of patients each day before treatment. These scanned images are the most accurate representation of the shape and position of a patient’s tumour or involved organ at the time of treatment. Adjustments based on these images help maximise the dose to the targeted organ while minimising the damage to the surrounding normal tissues. Gold fiducial markers have been used in the treatment of prostate cancer here since 2004 and NCCS installed its first dynamic targeting IGRT machine in 2007. HORMONES Prostate cancer is generally a hormone-responsive disease and there is much experience in the use of hormones in the treatment of advanced or metastatic disease. There is now also evidence to show that in selected patients the addition of androgen suppression therapy to radiotherapy improves disease-free survival and possibly even overall survival. BRACHYTHERAPY Brachytherapy is a method of radiation where radioactive seeds are implanted into the prostate to effect treatment from within. In the past, its use was limited by the inability to properly implant these radioactive sources into the prostate. With improvement in technology, we now have good imaging equipment to plan as well as monitor the placement of the seeds and modern devices which facilitates very good implantation transperineally with the use of needles. The advantage of this method of treatment is that much higher radiation doses can be concentrated in the prostate while sparing the surrounding tissue. THE FUTURE – CHARGED PARTICLE IRRADIATION? Charged particles such as protons or carbon ions can be focused even much more highly compared to photons and have the potential for even greater relative sparing of the surrounding normal tissues. Their biological effectiveness is also higher than the usual x-rays used in radiotherapy. This makes dose escalation to even higher doses feasible with even lesser morbidity to surrounding normal tissues. They, however, require very expensive facilities and are available in only very few research centres around the world. With the accumulation of experience from these centres and hopefully with technology becoming more affordable with time, it is hoped that such treatment would become more widely available for the treatment of prostate as well as other cancers in the future. RATIONAL APPROACH TO TESTICULAR SWELLING Conditions of the scrotum and its contents often worry the individual enough to seek medical attention. Most scrotal conditions are benign and self-limiting, but it is important to diagnose the odd testicular malignancy that is potentially fatal if missed. The clinician evaluating should differentiate benign from malignant diseases, pursue a cost-effective diagnostic evaluation, and initiate appropriate urological referral when indicated. Patients with a palpable mass in the testis should be suspected of having testicular cancer; especially if there is a previous history of undescended testis, even if surgically repaired. Differential causes of testicular swelling include torsion and infection. When the swelling can be felt separate from the testis, differential diagnoses to consider include incarcerated hernia, spermatocele and varicocele. Acute pain in the testis suggests torsion. Painful enlargement may be due to scrotal abscess. Pain and tenderness adjacent to the testis may be due to epididymitis or a varicocele. Tenderness of the testis itself may reflect orchitis. However, an underlying neoplasm should always be considered. Accurate diagnosis requires a careful history and structured physical examination, including urinalysis. Radiological studies such as scrotal ultrasound and Doppler blood flow are performed in selected patients with uncertain diagnosis. PAGE C3 Spotlight SALUBRIS July / August 2009 By Dr Lee Fang Jaan Registrar, Dept of Urology Dr Tan Yeh Hong Consultant, Director of Endourology, Director of Laparoscopy, Dept of Urology Singapore General Hospital Examination of the scrotum is best performed with patient standing. A warm room and warm examining hands helps as cold temperature causes contraction of the dartos and cremasteric muscle and elevation of the testis toward the external inguinal ring. The left testis usually lies lower than the right and the scrotal sac is hypoplastic when its gonad is absent. Palpation is carried out by systematically examining the testis, epididymis, and cord for size and consistency. The exact nature and location of scrotal mass should be determined. When transilluminated, fluid filled structures (e.g. hydrocele) radiate a reddish glow. Testicular pain should always be considered an emergency. Evaluation should not be delayed if testicular damage from torsion of the spermatic cord and subsequent ischemia are to be avoided. Differentiation between testicular torsion and epididymitis is usually possible on the basis of the presentation and physical findings. Continued on page C4. Testicular pain should always be considered an emergency. Evaluation should not be delayed if testicular damage from torsion of the spermatic cord and subsequent ischemia are to be avoided. PAGE C4 Spotlight SALUBRIS July / August 2009 RATIONAL APPROACH TO TESTICULAR SWELLING Continued from page C3. Some 90% of testicular torsions occur in men younger than 30 years old. A teenager with sudden onset scrotal pain and a normal urinalysis most likely has testicular torsion. Unrelieved torsion (longer than six hours) leads to testicular ischemia and atrophy. A delay in diagnosis longer than 12 hours will result in irreversible damage. Testicular torsion can be confirmed by Doppler ultrasound (greater than 90% sensitivity, 70% specificity). However, if in doubt, scrotal exploration and detorsion should always be performed. The common anatomical defect is high “investment” of the tunica vaginalis – the so called bell-clapper deformity. This inherent defect is usually bilateral, and detorsion should always be followed by testicular fixation (orchiopexy) of both gonads. If epididymitis or epididymo-orchitis is diagnosed especially with the finding of pus cells and bacteria on urine microscopy, the patient can be treated with a course of bactrim and doxycycline for two weeks. The etiology is commonly bacterial infection of the urinary tract. In sexually active young adults especially when associated with urethritis, chlamydial and neisseria gonorrhoeae infection must be considered. It is prudent to review the patients after treatment for resolution of symptoms and signs. If in doubt, an ultrasound scrotum should be ordered. An underlying testicular malignancy must still be a consideration. Testicular cancer is the most frequent cancer in young men (15 to 35 years of age). Cryptorchidism is a well-known risk factor even after orchiopexy. Testicular tumours usually present as painless lumps, but some men (20-25%) develop scrotal pain as a result of bleeding caused by rapid tumour growth and necrosis. Most tumours are discovered as hard testicular lumps detected on self examination. Reactive hydrocele may make appreciation of a testicular lesion difficult. Scrotal ultrasound is an excellent modality for the assessment of testicular mass. Testicular cancers are typically non-homogenous with hypoechoic areas. Testicular microcalcifications are associated with a high propensity for developing seminomas and warrants regular ultrasound surveillance. More than 95% of testicular tumours originate from germ cells. Germ cell tumours can be seminomas or nonseminomatous germ cell tumours. Seminomas are more likely to be confined to the testis (stage I) and are exquisitely radiosensitive. Nonseminomatous germ cell tumours consist of embryonal cell carcinomas, yolk sac tumours, or teratomas, alone or mixed with other elements. Sertoli cell tumours, Leydig cell tumours, and lymphomas are the most-common non-germ cell tumours. In men older than 60 years, most tumours are nonHodgkin’s lymphoma, with a predilection for bilateral involvement. Tumour markers are helpful in the diagnosis, staging and management of malignant testicular tumours. α-fetoprotein (AFP) is often associated with embryonal carcinoma, whereas β-subunit of human chorionic gonadotropin (β-hCG) elevations occur with choriocarcinomas. However, many testicular cancers are mixed germ cell in origin and tumour marker elevation is variable. Persistent elevation of tumour markers post orchiectomy suggests the presence of metastatic disease. However, there is a 25% false-negative marker elevation rate. Avoidance of scrotal skin violation is mandatory when obtaining histological diagnosis. The lymphatics of the testes drain primarily into the retroperitoneal para-aortic and inter-aortocaval lymph nodes while the scrotal skin lymphatics drain into the inguinal nodes. Trans-scrotal needle biopsy or orchiectomy is therefore contraindicated. Suspected testicular tumours should be explored via an inguinal incision with early control of the spermatic cord to prevent vascular or lymphatic dissemination. Further treatment is based on histological assessment of the tumour and staging consisting of computed tomography (CT) scanning and chest x-ray. A false-negative rate on 20 to 25% occurs in the presence of non-enlarged (smaller than 1.5cm) but microscopically involved retroperitoneal lymph nodes. Treatment modalities include retroperitoneal lymphadenectomy, external beam radiation to the retroperitoneum and chemotherapy, alone or in combination. 40th SMA National Medical Convention PAGE A5 BREAKING THE MYTHS ABOUT CANCER Community SALUBRIS July / August 2009 In recent years, the number of cancer patients and high-risk groups have been on the rise. Consequently, more cancer prevention methods are finding their way to the media, having evolved from a wide variety of sources ranging from official cancer research centres to the good neighbour next door. While it is good to have choices, the same cannot be said for making flawed choices, which are a waste of time and money better spent on prevention methods that are actually effective. T o dispel mistaken notions about cancer prevention, the 40th SMA National Medical Convention based its theme on “Cancer Prevention – Breaking the Myths”. The National Cancer Centre Singapore (NCCS) was one of the few institutions to collaborate with the Singapore Medical Association to organise this event. Madam Halimah Yacob, MP for Jurong GRC, was the Guest-Of-Honour to the event held at Suntec City Convention Centre on 11 July 2009. As cancer is the principal cause of death in Singapore, the convention sought to provide objective insights on cancer prevention, with the consequential goal of reducing the number of cancer patients and cancer-related deaths in the long run. To expand its outreach to the general public, the morning public seminar was held in three concurrent sessions in English, Malay and Mandarin. Dr Wong Zee Wan, Senior Consultant from the Department of Medical Oncology, was one of the speakers representing NCCS. The afternoon session began with a lunchtime seminar, followed by the medical symposium for healthcare professionals. Dr T. Agasthian, Senior Consultant from the Department of Surgical Oncology, spoke on behalf of NCCS. A wide variety of topics was covered during the convention: PUBLIC SEMINAR • Does altering your eating habits change the risk of cancer? • Getting a friend to stop smoking • New cancer screening techniques LUNCH SYMPOSIUM • HPV Vaccination for Cervical Cancer Prevention in Singapore – Are we a leader or a lagger? • Cancer vaccines of the Past, Present and Future MEDICAL SYMPOSIUM • Cervival Cancer: to vaccinate or not to vaccinate? • Screening Lung Cancer: useful or harmful? • Decision making in cancer screening in the elderly • The era of individualising cancer management PAGE A6 People SALUBRIS July / August 2009 10 YEAR DEVOTION WINS SISTER CHIEW CHENG FONG RECOGNITION “Surprised, but an honour” were her first words when Sister Chiew Cheng Fong learnt that she was among this year’s National Day Awards recipients. The National Day Awards are a means of recognising various forms of merit and service to Singapore. For her 30-year-long devotion to nursing, Cheng Fong has been conferred the Efficiency Medal. I nstituted in 1969, the Efficiency Medal may be awarded to any of the following persons for exceptional efficiency or exceptional devotion to duty or for work of special significance: • any public officer; • any officer employed by any statutory authority (other than a Town Council); • any person in the service of any organisation, association or body rendering services in the field of education; or • any person employed in any company which is wholly-owned by the Government and which is carrying on business mainly as an agent or instrumentality of the Government. With her years in nursing, Cheng Fong has tended to countless patients and touched the hearts of many. She believes that a crucial ability of a nurse is interpersonal interaction with patients. Creating bonds and forming relationships with patients enables her to understand their feelings better and hence help them soothe their sufferings through effective ways apart from medical attention. A model nurse extends a helping hand or listening ear to all patients whenever possible. When asked what challenges nurses face in today’s society, she said, “Patients’ expectations are different now compared to the past. They are now smarter and more knowledgeable thanks to the extensive amount of information available.” Her advice to patients however is: “They need to sieve through it as well as speak to their healthcare professionals for clarification.” Yet for someone who has displayed such enthusiasm towards an arduous career path, her reason for taking up nursing was unexpectedly casual. “After finishing my ‘A’ Levels, the first job that I saw in the papers was a nursing one. Hence, I just applied for it,” came her straightforward reply. No motivations, no inspirational stories. Despite the feeble attachment, she has never looked back since that day and is now the senior nurse clinician of the operating theatre / endoscopy suite at NCCS. Cheng Fong has been with NCCS since 1999 when the centre first opened its doors. Recounting the early days, she cited the establishment of the Ambulatory Treatment Unit (ATU) as one of her most memorable experiences. As the person who commissioned the ATU and the Operating Theatre (OT), she had been under intense pressure, but the outcome was worth all her trouble. “It was a real challenge. Getting to know people, equipments and liaising with vendors.” Come November, she is due to receive her medal. But nevertheless, she will not let the recognition swell her ego and will continue to dutifully offer her services to her patients. By Joshua Tan WHERE DID YOUR FINGERPRINTS GO? PAGE A7 People SALUBRIS July / August 2009 Most of us assume that our fingerprints are permanent and unique. One can hardly dispute this, considering that fingerprints have always been regarded as the most reliable method of identification. H ence, the government agencies would seek your fingerprint if you want to apply for an identity card, or a passport. Those who are illiterate can use their fingerprint to open a bank account. Not only that, convicted criminals are fingerprinted so that they can be tracked down for any future offences. For most of us, the fingerprint is like our shadow. It goes with you wherever you are. But this was not to be for an Indonesian travelling abroad to visit his relatives. Mr S (as he chose to remain anonymous) turned up at a United States airport with no fingerprints when the border security checked him to verify his identity. The 62-year-old was detained for four hours as he tried to explain his predicament. Eventually he was released when the authorities determined that he was not a security threat. PROMOTIONS Where did Mr S’s fingerprints go? His doctor, Senior Consultant Dr Tan Eng Huat of the Department of Medical Oncology, National Cancer Centre Singapore, shed light on this mystery. But this does not mean that patients should refrain from travelling abroad. Dr Tan has a simple remedy that will ease some of the inconveniences they would experience with security authorities: carry a doctor’s letter on oneself at all times, especially when they are travelling. For more than three years, Mr S, who was diagnosed with Metastatic Nasopharyngeal Carcinoma, has been on a course of orally-administered cytotoxic drug Capecitabine. The drug, also known as Xeloda, is commonly used for the treatment of metastatic breast cancer and cancers of the colon, head and neck and stomach. The spin-off for the whole saga however saw Dr Tan and his colleague Dr Choo Su Pin in the centre of a media storm when the news was reported in the Annals of Oncology, a monthly journal published on behalf of the European Society for Medical Oncology. The drug spawns some dermatological damages such as blistering on the hand and foot in up to 40 per cent of the patients. More severe side effects include peeling and bleeding on palms and soles of feet. Over time, their fingerprints vanish. From Colombia to the UK and Europe, the world’s news media hounded the two doctors for a story for more than a week. By Carol Ang NAME TITLE Dr Yap Swee Peng Radiation Oncology, Acting Director, Public & Patient Education Dr Lim Soon Thye Deputy Head, Medical Oncology Dr Toh Chee Keong Senior Consultant, Medical Oncology Dr Tham Chee Kian Associate Consultant, Medical Oncology RUN FOR HOPE 2009 PAGE A8 NCC Foundation SALUBRIS 22nd November, Sunday, East Coast Park, Angsana Green July / August 2009 Run For Hope (RFH) is an annual charity leisure run organised by the NCC Foundation in conjunction with the Four Seasons Group (Four Seasons Hotel and The Regent) in benefit of the NCC Research Fund. T he press conference for RFH’09 took place on 25th June at The Regent and was hosted by the following panel of speakers: • Prof. Soo Khee Chee, Director, National Cancer Centre Singapore • Eugene Sng, Programme Director, NCC Foundation • James Lee, Chairman, Run For Hope 2009; Finance Director, The Regent • Devin Otto Kimble, Managing Director, Brewerkz • Ezzy Wang, Cancer Survivor, Run For Hope Champion For the first time, the microbrewery restaurant Brewerkz crafted a special “Hope Beer” to help raise funds for cancer research at NCCS. The malty tasteful brew was unveiled at the press conference; for every pint of Hope Beer sold at Brewerkz restaurants in Singapore from June to November, one dollar will go to the NCC Research Fund. Editorial Advisors Dr Kon Oi Lian Prof Soo Khee Chee Executive Editors Ms Carol Ang Ms Veronica Lee Mr Sunny Wee This year’s event also witnessed another first – the endorsement of Mr Ezzy Wang as the champion ambassador. Ezzy is a cancer survivor at NCCS; with his sunshine personality, positive attitude and active lifestyle, Ezzy’s involvement provides a refreshing and humanistic perspective to Run For Hope. We look forward to seeing you at the leisure run. Do come with your family and friends to make a collective statement to fight cancer with a joyful and hopeful spirit. Please visit our website for more photos, registrations and donations details: www.runforhopesingapore.org Contributing Editor Dr Wong Nan Soon Medical Editor Dr Tan Min-Han Members, Editorial Board Ms Audrey-Anne Oei Ms Sharon Leow Ms Flora Yong Members, Medical Editorial Board Ms Lita Chew Dr Mohd Farid Dr Melissa Teo Dr Teo Tze Hern Dr Deborah Watkinson Dr Richard Yeo SALUBRIS is produced with you 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 [email protected]. NATIONAL CANCER CENTRE SINGAPORE Reg No 199801562Z 11 Hospital Drive Singapore 169610 Tel: (65) 6436 8000 Fax: (65) 6225 6283 www.nccs.com.sg