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THE STAR, TUESDAY 13 FEBRUARY 2018

CANCER AWARENESS
2 Cancer Awareness THE STAR, TUESDAY 13 FEBRUARY 2018

A call for action


DEMYSTIFYING cancer and having
people recognise its impact on our
society and economy is the goal of
every awareness campaign.
Changes to diet and physical
habits in the average person could
be contributing to the rising
number of cancer cases in the
country, and we need a better way
to handle it.
Dr Saunthari Somasundaram,
president and medical director of
National Cancer Society Malaysia
(NCSM), speaks about the state of
cancer care and management in
the country.
“The foremost problem in
Malaysia is that we as a country
are more reactive towards cancer
when we should be practising
preventative measures,” she says.
Patients with the five most
common cancers in the country –
breast, colorectal, cervical, lung
and nasopharyngeal – are part of
a trend of late detection with a
majority already in stages 3 and 4
of the disease upon diagnosis.
According to Dr Saunthari,
40% of breast cancer cases, 65%
of colorectal cancer cases, 60% “For this reason, we organised thinking of cancer as a terminal for people seeking help such as its experts from countries with more
of cervical cancer cases, 90% the primary healthcare cancer illness. toll-free cancer helpline (1800 881 developed cancer care initiatives
of lung cancer cases and 60% forum on World Cancer Day to “Instead, providing back-to-work 000), e-mail (help@cancer.org.my) who will be in attendance.
of nasopharyngeal cases are shift the mindset of general support should be prioritised. A and a mobile app (Stronger than NCSM hopes to show these
presented late, which decreases practitioners and nurses, who are good support programme in a Cancer). stakeholders, including the
the patients’ survival rate. often frontliners in healthcare,” workplace would provide cancer Government, that despite cancer
“We need to realise that
healthcare shouldn’t be just about
shares Dr Saunthari.
Another pressing issue is how
survivors sufficient flexibility for
post-treatment activities such as
Making a difference being a huge problem and having
large-scale challenges, it can be
tackling existing problems and that most cancer survivors are not oncologist appointments,” adds Dr For the first time on home turf, overcome.
we shouldn’t seek healthcare only aware of their rights and do not Saunthari. NCSM will be hosting the World At the congress, countries often
when we’re sick. have legal or human resource Resource allocations to invest in Cancer Congress in Kuala Lumpur show how their struggles have
“Screening is important. If we support when it comes to returning social workers are something Convention Centre from Oct 1 to 4 resulted in huge successes against
put preventative healthcare into to work or school, according to NCSM sees merit in, to contribute this year. cancer. It could encourage
practice, the doctor, apart from NCSM. to the well-being of cancer patients. Dr Saunthari shares that it Malaysian stakeholders to adopt
treating your illness, should “This is going to be a growing As Dr Saunthari puts it, “It is a would be an excellent opportunity the courage and fortitude to invest
also be looking at your family problem because as treatment small price that will bring about a to assist the Government to achieve in cancer control.
history, ask if you’re due for your advances and if early detection huge difference to patients.” its cancer control targets, as local
annual check-up, or investigate improves, most people will survive To support cancer patients and and regional cancer management n For more information,
if your symptoms are part of a cancer, which is good news. The caregivers nationwide, NCSM has stakeholders can benefit from the call 03-2698 7300 or visit
larger problem. corporate world should stop developed several modes of contact knowledge-sharing of oncology www.cancer.org.my

Managing bowel movement


HIPPOCRATES, the father of
modern medicine, said “All disease
begins in the gut” – a quote that
still holds true today.
Most individuals
A diet low in fibre but high in resort to laxatives
red meat, colon inflammation
triggered by bacterial infection, as a quick fix for
physical inactivity, alcohol abuse
and chronic laxative use are
bowel irregularity.
common causes of poor gut health. However, long-term
According to the International
Journal of Cancer, almost 40% use of laxatives
of cancer deaths, including
colon cancer, are preventable
often results
with lifestyle changes, which in decreased
include adopting a plant-based,
fibre-rich diet, regular exercise and bowel function
ensuring our bowel movements
are regular.
or lazy bowel
Based on a 2004 study published syndrome and may
lead to laxative
in the American Journal of
Gastroentology, irregular bowel
movement or constipation affects
nearly a quarter of the world’s
dependency.
population.
Most individuals resort to
laxatives as a quick fix for bowel of Nutrition.
irregularity. However, long-term Biogrow ProGut is suitable for
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bowel syndrome and may lead to intestine. Bifidobacterium with more than recommended. natural way to manage bowel
laxative dependency. The level of good bacteria in the 300 scientific publications and over Each sachet contains 2.4g soluble movement with fibre and
Therefore, prolonged laxative gut will also decrease with ageing, 130 clinical studies carried out on and insoluble fibres with one probiotics. It is available in all
use is discouraged and should be making dietary supplementation of it. billion colony-forming units (CFU) pharmacies nationwide.
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probiotics for the maintenance of Biogrow ProGut is made from intestinal function and a balanced of BB-12 has been clinically tested Legosan (Malaysia) Sdn Bhd.
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THE STAR, TUESDAY 13 FEBRUARY 2018 3
4 Cancer Awareness THE STAR, TUESDAY 13 FEBRUARY 2018

Reviewing attitudes
POPULAR media may not reflect
this reality, but childhood cancers
are highly treatable – so treatable,
in fact, that most childhood cancers

towards childhood cancers


have a 50% to 60% cure rate.
Of course, the stage of detection
and type of cancer influence the
cure rate, but due to progressively
improved cancer management
strategies and modern medicine,
the numbers keep getting better
and better.
Dr Chan Lee Lee, consultant their individual struggles and
paediatrician and paediatric
haematologist at Subang Jaya
There is less realise that they are not alone,”
says Dr Yap.
Medical Centre, shares, “The most emphasis placed In addition, public awareness

on paediatric
common childhood cancer is acute activities could help destigmatise
leukaemia, which accounts for at the fight against cancer. By taking
least a third of all cases, followed
by brain tumours, lymphoma and cancer research part in public lectures and
awareness activities, oncologists
a smattering of rare cancers such compared with can help the public approach
cancer and cancer treatment with
adult cancer in the
as cancers of the bone, soft tissue,
liver, kidney and eyes. hope instead of despair.
“Overall, the most common form
of leukaemia in children – acute country, because Dr Yap asserts, “We cannot
implement the policy but we can
lymphoblastic leukaemia – has an
80% to 90% cure rate. Some types
the percentage of influence the policymakers. We try
to tell the public what’s going on,
of lymphoma and cancers of the paediatric cancer but they have to ask themselves
kidney have good cure rates of
around 90% as well.” cases is very small some questions – when to go for
treatment, how they want to go for
According to Dr Chan, there
is less emphasis placed on
Dr Yap Beng Khiong. Dr Chan Lee Lee. compared to a lot treatment and how much they
want to detect cancer early.
paediatric cancer research diagnosis. Treatment and multidisciplinary team who are all of adult-onset “Our country’s cancer
compared with adult cancer in
the country, because the
surveillance investigations are
ongoing and, according to Dr Chan,
specialists in a field of oncology
and are dedicated to coming up cancers. infrastructure can be improved
further. Everyone can play a role.
percentage of paediatric cancer children usually adjust better to with and maintaining a working We can educate the public on what
cases is very small compared to a treatment than adults while the treatment plan for the patient.” services are available and what
lot of adult-onset cancers. parents or caregivers continue to He adds that cancer general well-being and emotional should be available, so everyone
“When raising awareness, we worry. management strategies should not health of both groups, as has a choice in what they do about
are hoping that parents come in She mentions that caregivers be limited to medical decisions. encouragement and peer support it.”
early and seek treatment instead of should seek emotional support in Organising patient and caregiver are essential.
opting for alternative therapy. We the form of survivor meetings or support groups for different types “In support groups, patients n For more information, call
hope that we can educate the cancer support groups. of cancer could contribute to the and their caregivers can share 03-5639 1212.
population on the importance of Dr Chan shares that when a new
medical advances and therapy that patient is admitted into her care,
provide children with immediate the nurses match the new family to
help and keep the cancer in check,” another so that both patients and
says Dr Chan. caregivers may find
She asserts that knowing cancer companionship in each other to
can also occur in children is ease the treatment journey.
important. Parents and guardians Cancer management uses a
should know how to recognise combination of treatment methods.
symptoms, especially if they are A good treatment plan and team
persistent, and bring their children consists of medical professionals
to the right medical professional to from a variety of disciplines such
diagnose and treat them. as paediatric oncology, radiation
“I think it is also important to oncology, oncology imaging,
highlight the fact that cancers in nuclear medicine and surgeons.
children are so treatable. The fears When it comes to treatment, not
parents have about chemotherapy much has changed over the years.
are always carried over from what What has changed, however, is the
they see in adults but, on the quality and precision of treatment.
whole, I find that children tolerate “Chemotherapy, surgery and
chemotherapy very well. Parents radiotherapy are the three main
should not be wary and should opt modalities employed in cancer
for tried and tested methods,” she treatment and have remained so
adds. for a long time,” says Dr Yap Beng
Khiong, consultant clinical
After the diagnosis oncologist at SJMC.
“A patient’s cancer treatment
The process does not end at the is now managed by a

Every patient is different


CANCER management services rather than have the patient l Radiation oncology – and children. A branch of radiology,
involve treating each patient as shuttled around from hospital to Radiation oncology is applied as l Stem cell transplantation – interventional oncology
an individual, due to the vast hospital due to the lack of curative treatment for cancer. Stem cell transplants can be used deals with the diagnosis
diversity in cancer typology and necessary facilities,” says Dr Yap. It is also used palliatively to to treat cancer. Stem cell and treatment of cancer and
how cancer develops in each The three main branches of relieve symptoms for patients in transplants are most often used cancer-related problems using
person. cancer management are medical advanced stages of cancer. for cancers affecting the blood or targeted, minimally invasive
As every treatment centre may oncology, surgical oncology and immune system, such as procedures performed under
provide different approaches and radiation oncology. A good In addition to a solid leukaemia, lymphoma and image guidance.
services to cancer management, treatment centre should have background in the multiple myeloma. Biopsies, which involve
patients should research and well-equipped facilities in these aforementioned cancer l Oncopathology service – removing body tissues to screen
explore their options before three areas. treatment areas, here are This specialised and for presence or extent of a
undergoing treatment. l Medical oncology – This some other services that could comprehensive laboratory disease, are part of a technique
According to Dr Yap Beng discipline involves using a positively impact cancer service plays a crucial role in employed under interventional
Khiong, consultant oncologist at combination of chemotherapy, management. supporting patient care by oncology.
Subang Jaya Medical Centre, a hormonal therapy, biological l Haematology-oncology – providing accurate, timely l Oncologic imaging –
good centre should preferably therapy and targeted therapy that Experts in this area are involved diagnoses, which in turn An important aspect of
have a wide range of facilities is tailored to each cancer patient in the diagnosis, treatment and contribute to positive therapeutic multidisciplinary management
for diagnosis and treatment, to treat their disease. prevention of blood diseases and implications. of cancer, oncologic imaging
manned by multidisciplinary l Surgical oncology – cancer as well as research. l Nuclear medicine – This applications include early
teams to support patients’ Surgeons specialising in cancer Haematology-oncology includes medical specialty involves the screening for cancer, diagnosing
treatment plans. management contribute to a diseases such as anaemia, application of radioactive and staging of cancer, treatment
“It is important to realise that patient’s treatment plan when it haemophilia, sickle cell disease, substances in the diagnosis and planning, tumour response
cancer treatment has to be involves removing tumours or thalassaemia, leukaemia treatment of diseases. monitoring and cancer
delivered in a timely manner cancerous tissue. and lymphoma in adults l Interventional oncology – recurrence.
THE STAR, TUESDAY 13 FEBRUARY 2018 Cancer Awareness 5

Looking
beyond the cure
CANCER can affect anyone at any
age. For children with cancer,
however, outcomes are more The incidence
promising. With medical advances
and extensive research, childhood
of ischaemic heart
cancer cases in Malaysia have a disease is five
times higher in
high cure rate, with children living
healthily into adulthood.
One in every 6,500 individuals
aged 18 and below has cancer. In
childhood cancer
Malaysia, approximately 800 new survivors and
their risk of stroke
cases are seen annually. Cancer is
the leading cause of death in
children and adolescents in most
developed countries.
is eight times
The specialists who treat higher compared
to age-matched
childhood cancers – paediatric
oncologists – are aware of the long-
term side effects of cancer
treatment in childhood. In addition peers.
to curing patients, paediatric
oncologists attempt to achieve a Dr Hany Ariffin
balance between improving cure
rates and reducing late effects from
treatment. are direct toxic effects from the more commonly occur later in caused early-onset hypertension,” particular matter is called
“There are always side effects of drugs used in cancer treatment,” life. says Dr Hany. childhood cancer survivorship,
the various cytotoxic agents and says Dr Hany Ariffin, professor of “Clearly, there is some element According to her, the incidence and there is a lot of work being
drugs that are used in cancer paediatrics at Universiti Malaya. of premature or accelerated ageing of ischaemic heart disease is five done to investigate its cause and
treatment for children. Patients Paediatric oncologists have come that occurs in these childhood times higher in childhood cancer prevention.
can lose their hair, develop mouth to realise that childhood cancer cancer survivors, because it is not survivors and their risk of stroke is “We are trying to help people
ulcers or, due to intake of steroids, survivors have a much higher rate something that is directly related to eight times higher compared to who are currently experiencing
gain a lot of weight. These are or much earlier development of the drugs they received during age-matched peers. symptoms of premature ageing,
transient side effects. age-related morbidities, she adds, treatment decades ago. Dr Hany also mentions that the and prevent children undergoing
“However, some of these drugs as reflected in results from various “Some drugs do directly exact biological mechanisms cancer treatment now from the
also contribute to direct damage to studies. contribute to injury in certain linking premature ageing and condition in the future,” says
certain organs. Certain drugs can These include diabetes, organs, but it is quite intriguing to cancer treatment in childhood are Dr Hany.
cause heart muscles to weaken, hypertension and cardiovascular think that something a child still being studied.
some affect nerve health – these disease – all morbidities that received 35 years ago has now “The area of research on this > TURN TO PAGE 8
6 Cancer Awareness THE STAR, TUESDAY 13 FEBRUARY 2018

A serious threat
to the nation
COLORECTAL cancer is highly
treatable if detected early.
However, because the standard
screening age in Malaysia is 50
and patients are often unaware of
the prevalence of colorectal
cancer, the disease is often
overlooked, resulting in diagnosis
at later stages.
“General awareness of
colorectal cancer is quite low and
I don’t think people realise that it
is one of the most common
malignancies not just all over the
world, but especially in
Malaysia,” says Datin Dr Wendy
Lim, consultant gastroenterologist
and hepatologist at Sunway
Medical Centre.
“The important thing to know
is that it is preventable.”
Dr Lim shares that colorectal
General
cancer is the second most awareness of
colorectal cancer
common cancer among men in
Malaysia and the third most
common cancer among women,
according to a 2003-2005 study by is quite low and I
the Health Ministry on cancer don’t think people
realise that it is one
incidence in peninsular Malaysia.
“People are happy to screen for
breast, cervical or prostate
cancer, but when we ask them to of the most common colonoscopies should be done by a general colonoscopy only once benign and non-benign lesions.”
screen for colorectal cancer,
there’s always that moment of
malignancies not just trained gastroenterologist who has
extensive experience in endoscopy
every 10 years.
“Stool tests and sigmoidoscopies
She continues, “I hope we can
inform the public that colorectal
hesitation. When it involves all over the world, and is skilled in detecting and (lower large intestine and rectum cancer is more common than we
procedures such as testing stool
samples or undergoing a but especially in removing polyps.
She adds that, for now,
examinations) are annual, and
virtual colonoscopies can be done
think, and that men and women
are equally affected. As mentioned
colonoscopy, they tend to shy
away,” she adds.
Malaysia. Malaysians aged 40 and up should
commit to regular screening for
once every five years,” asserts Dr
Lim.
before, there is a certain aversion
to the topic of colorectal cancer,
“We want to get people Datin Dr Wendy Lim colorectal cancer. “Of course, technology plays a but we need to be more open about
thinking about their own risk. So “It is not a hugely demanding part as well. There are advanced the rising risk of this disease.”
much depends on people coming task. Someone with an average risk gadgets such as wide-angled, high-
forward and asking after such as ones for breast cancer, with no family history of colorectal resolution colonoscopes that can n For more information,
screening methods to protect where if you discover a lump, cancer would be subject to a help us differentiate between call 03-7491 1394.
themselves from the risk of cancer has already developed,

Reducing mortality rates


developing colorectal cancer. colorectal cancer screening is more
“There are a lot of studies about preventing cancer from
looking at exactly when it developing.
happens and when exactly the “If polyps are found while

from colorectal cancer


risk increases. The age at which screening, they can be removed
colorectal cancer occurs in almost immediately. Polyps are
Malaysians is much lower often non-cancerous growths, but
compared to Western patients, so are pre-cancerous, which means
what we are advocating for is some can develop into cancer.”
that screening begins at 40 in this She adds that since the risk of CONSULTANT gastroenterologist people can choose one or a about colonoscopies, and
country.” colorectal cancer increases from and hepatologist Datin Dr combination they are most understandably so. For your
age 40 onwards, screening people Wendy Lim opines that having comfortable with. gastroenterologist to perform an
Nipping it in the bud at an earlier age could help detect
the disease in its earlier stages and
every hospital treat each
colorectal cancer case the way
“For instance, if you are of
average risk, you don’t
ideal scan of your colon, the colon
first has to be cleansed and
Implementing a nationwide lead to better prognoses for it does in notifying the Health necessarily have to go for a emptied. Colon preparation, or
screening programme can help patients. Ministry of infectious disease colonoscopy if you are squeamish “prep” as it is known, is an
medical professionals detect “In a way, screening will not only cases would be helpful in about the process. essential step to emptying the
cancer early in the population. decrease mortality rates but also contributing to a comprehensive “Research the various colon.
Colorectal cancer screening result in substantial cost savings to cancer registry. screening methods, explore Below are some myths about
tests can also find pre-cancerous the nation’s healthcare by avoiding “Information on screening preferred and alternative colonoscopies debunked, so you
growths or lesions and remove putting patients through expensive procedures should be methods, and choose the ones may undergo screening for
them, reducing patients’ risk of chemotherapy, radiotherapy and transparent, and since there most suited to you,” says Dr Lim. colorectal cancer with peace of
developing the disease. palliative care as well as reducing are several methods available, Many people are concerned mind.
It is common in Malaysia for loss of productivity from patients’
colorectal cancer cases to get inability to work,” shares Dr Lim. Myth Fact
picked up a lot later compared
to people in similar age groups
in countries with nationwide
Looking out for indicators I have to drink a large amount of Most prescribed laxative solutions now are taken in split doses, allowing you
laxative solution to empty my bowel to drink half the solution the night before and the other half the morning of
screening programmes. “Unfortunately, there are little to during prep. your procedure.
In those countries, people are no visible symptoms for colorectal
given notice once they turn 50 to cancer. That is why we currently I cannot eat or drink anything but Clear liquids and food low in fat and fibre are completely fine to consume
undergo screening for colorectal push for people to undergo water during prep. during prep. Anything from clear broth to popsicles are allowed, as long as
cancer. These notices include test screening from age 50. nothing is artificially dyed red, blue or purple. It is advisable to stop eating or
kits that recipients have to return “There are some who present drinking four hours before your procedure, however.
to screening facilities with stool with bleeding in their stool or
smear samples. black stool. Abdominal pain, Colonoscopies can be painful. Most patients are either fully or lightly sedated during the procedure, and
Those with negative screening unexplained weight loss and loss of the flexible scope minimises the chance of you feeling any pain. Some slight
results are given the all-clear and appetite are also some indicators discomfort is to be expected.
will start receiving test kits people should take notice of. If
annually. Those who are tested someone comes in with these My colon may be perforated during Colonoscopies are extremely safe when performed by highly trained and
positive, however, are referred to symptoms, we forgo the stool test the procedure, so it is too risky. experienced professionals. Your risk of experiencing a perforated colon
hospitals for a colonoscopy. and go straight to the colonoscopy,” during a colonoscopy is less than 0.2%.
According to Dr Lim, this national says Dr Lim. I will be passing gas for days after the Air is introduced into the colon during a colonoscopy for the gastroenterolo-
initiative for a screening Patients should also ask procedure. gist to better view the intestinal walls. You can expect to be passing gas for a
programme is what we lack in questions and be informed about while after the procedure, but it should not last for days.
Malaysia. the different screening procedures
“As opposed to screening tests available. For instance,
THE STAR, TUESDAY 13 FEBRUARY 2018 7
8 Cancer Awareness THE STAR, TUESDAY 13 FEBRUARY 2018

Providing support and strength


> FROM PAGE 5 “Those in urban areas know too distress parents, especially when
much, but those in rural areas lack its effects on their child are barely
She also advises that managing, awareness! The foremost problem visible. Some people approach her
preventing and treating diabetes, in this country when it comes to about alternative therapy, says Dr
hypertension and cardiovascular cancer detection and prevention is Hany.
disease is already a huge burden that people are afraid,” says the She advises that the use of
on any country’s national health MAKNA representative. traditional medicine along with
budget. She adds that some people she prescribed treatment should be
If these survivors are developing meets are under the impression done carefully, but it does not
said chronic diseases at an age that cancer is a death sentence, mean they cannot complement
when they are supposed to be and that Malaysians are slowly but each other.
actively contributing to the surely moving away from that Parents should be frank with
economy, the implications to the mindset with many organisations their child’s oncologist about their
country’s earning could be serious. encouraging cancer screening, desire to try out alternative
“In our country, the main focus early detection and prevention. medicine so they can have honest
for many years had been on curing “In my experience, when we go conversations about the child’s
patients. Only when we started to rural areas to spread cancer treatment.
curing more and more children did awareness and give public talks, “Alternative therapy is a popular
we realise that something is people are much more inclined to thing, but no alternative methods
happening to our survivors. Now, participate in the screening have been proven to be able to
we have shifted to thinking about services we provide. Reception is treat cancer. Delaying medical
how the treatment could affect more favourable when people treatment to try out other options
them in the long run when we know what is happening,” she only results in allowing the cancer
design treatment plans and and heed its advice throughout understanding about the range of concludes. to advance and decreasing the
strategies,” shares Dr Hany. treatment. treatment options and potential At times, the slow progress of a child’s chances to be cured,” says
However, while professionals risks associated with those choices certain treatment plan could Dr Hany.
Helping develop cancer handle the medical part, the
caregiver of a child with cancer
before giving their approval for
tests and procedures.
care
While medical professionals
can help ease the child’s treatment
journey by taking care of
themselves first.
Learning to communicate with
their young patients is also
important for caregivers.
Finding proof in genes
strive to find a balance between The MAKNA representative Giving the child too much WHEN data gathering for measuring telomeres tells us
long-term physical effects and shares that support systems should information on the disease and childhood cancer survivorship our biological age.
standard cancer treatment, the be more visible to the public. treatment methods will took off, researchers started Dr Hany Ariffin, professor of
emotional impact on a child with “Support groups have a unnecessarily burden him, measuring a structure in the paediatrics at Universiti Malaya
cancer should also be considered. significant impact on the cancer especially when the information is DNA called the telomere. shares that the telomere
Cancer can take its toll on management journey because by attained from too many sources Our cells replenish by lengths of childhood cancer
both patients and caregivers everyone sharing their ordeal or with opposing views. It also constantly copying themselves, survivors aged 26 who were
emotionally, physically or experience, we can all learn from confuses the caregiver. but telomeres get shorter each otherwise healthy, when
financially. A representative from one another,” says the MAKNA A support group can help if both time a cell copies itself. compared to published data,
the National Cancer Council representative. caregiver and patient are feeling Eventually, telomeres shorten were similar to people with a
(MAKNA) shares that it is always Moreover, caregivers are often overwhelmed, and reassure them too much to function, and chronological age of 40-70,
advisable for patients and tasked with making medical that all parties involved are causes our cells to age. As indicating a measure of
caregivers to trust their team of decisions for their child, and they working towards one thing – opposed to chronological age, premature ageing.
cancer management professionals need to have a complete curing the child.