JOHAN STEPS INTO THE doctor’s offi ce after getting an elaborate series of health tests done some weeks back. He had been having minor but consistent health issues for months, but at a juncture, his conditions worsened to an extent that prompted him to undergo doctor-recommended tests. Now, the results are out. He waits for the doctor’s verdict. He’s not expecting to hear anything out of the ordinary. “It can’t be so bad,” he muses. “They were just coughs and the occasional short of breaths.”He pre-empts his next actions: listen to what the doctor has to say, pick
up his meds and life goes on. What the doctor has to say shakes Johan to the bone: “I’m afraid you
Post-diagnosis, the questions are typical across the board: Where did I go wrong? Have I been ignoring the symptoms for the past six months? What can I do now? Here's what you need to know.
WHAT IS CANCER?
Simply put, cancer is a condition when your body cells get are damaged or altered causing them to mutate, grow and divide uncontrollably. They then invade other tissues in the body. Any part of your body can be affected as there are more than 100 types of cancers known to date. Cancer is the number two killer globally and the third leading cause of premature deaths in Malaysia. According to the National Cancer Registry of Malaysia (NCSM), some 21,773 Malaysians are diagnosed with cancer per year but there exists an estimate of almost 10,000 cases that are unregistered. A 2008 statistical report from the World Health Organization (WHO) shows that the fi ve most common cancers in Malaysia are of the lung, colorectal, nasopharynx, stomach and
liver variety.Dr Saunthari Somasundaram, President of the NCSM further highlights that out of all of these, lung cancer leads the mortality rate, made up of 19,410 cases.
“According to estimates, there are about 90,000-100,000 people in Malaysia living with cancer at any one time,” says Somasundaram. “Breast, lung and colorectal cancers are increasing every
year and one-fourth of all Malaysians are at risk of developing cancer.” To put it into perspective, according to Somasundaram, a person is diagnosed with cancer every 12 minutes in Peninsular Malaysia alone — a truly terrifying prospect. Moreover, cancer does not discriminate. Regardless of your gender, race or religion, the only thing that matters is that fl imsy concept of probability.
But the good news is the power to change this probability is in your hands. As suggested by The American National Cancer Institute (ANCI), some risk factors for cancer can be avoided. Inheriting
certain genes is one of the factors that you can’t change, but others such as tobacco exposure, poor diet, alcohol, inadequate exercise or being overweight, are what the ANCI calls as modifi able or avoidable risk factors. Ultimately, revamping your lifestyle to eliminate or control these modifi able risk factors can lower your chances of getting cancer and hopefully, prevent one-third of cancer cases.
WHAT CAUSES CANCER?
ALCOHOL
What it can cause: Mouth, throat, oesophagus, breast, bowel, liver cancers That daily dosage of alcohol may be good for the mood after a hard day’s work, but the long-term consequences aren’t as sweet. “Alcohol is a carcinogen,” says Timothy Naimi MD MPH, a physician and researcher at the Boston University School of Medicine. “And it does increase your risk. That’s the bottom line.”
Although not everyone who drinks will develop cancer, scientists have found that some derivatives of the disease are more common in people who drink more alcohol than others. You don’t even have to be drinking until drunk to be affected, according to Cancer Research UK. We don’t expect you to give up drinking completely, but, as recommended by most health organisations, you should limit your consumption to a maximum of two glasses a day. One glass equates to: 350ml of beer, 150ml of wine, or 45ml of strong liquor. Be warned though – even with this recommendation of moderate drinking, you are still at risk of increasing your cancer odds.
TOBACCO
What it can cause: Lung, oesophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach and cervix cancers Are you familiar with that awkward feeling of having idle fi ngers in between rounds when you are out drinking, and so you pick up a cigarette for a puff or 45? What you end up with there is a killer combo for cancer. As reported by WHO, tobacco use is the single greatest risk factor for cancer mortality worldwide, accounting for 22% of cancer deaths per year. Another hard fact is that the impression you might have of smoking lights being a safer option is moot. It doesn’t matter the type of cigarettes you smoke — lights, hand-rolled or menthol — because the risk is always there in fact; the American Cancer Society (ACS) has identifi ed that hand-rolled or menthol cigarettes might even be worse.
What about e-cigarettes? Marketed as an alternative to ‘real’ cigarette smoking, this device vaporises nicotine along with other fl avourings to be inhaled via the mouth and is claimed to be healthier because it doesn’t contain tobacco. Being relatively new, the long-term safety of this product is still unknown but a study carried out by the US Food and Drug Administration (FDA) found cancer-causing substances in half the e-cigarettes samples tested. A new report from France’s National Consumer Institute also discovered a signifi cant amount of
carcinogenic molecules in the vapour produced by some models of e-cigarettes. So drill this into your head: there is no such thing as a safe smoke. Get rid of your tobacco habits and steer clear of cigarette and other smoking alternatives.
POOR DIET & OBESITY
What it can cause: Oesophagus, colorectal, breast, kidney cancers Among the most overlooked risk factors for cancer (compared to the likes of cardiovascular and other health complications), your diet and exercise habits are, on the contrary, integral considerations pertaining to your liability in contracting the big C. Watch your portion sizes, especially if your food is high in calories, fats and added sugar, suggests the ACS. Eat healthy – limit processed and red meats, plus make sure you have at least 2 1/2 cups of fruit and vegetables each day. Up your intake of foods with antioxidants; unstable molecules known as free radicals in the body attack cells and these damaged cells may lead to cancer. Antioxidants neutralises the free radicals so that they are, well… not so radical.
Another source of food you should look up is cruciferous vegetables like broccoli, caulifl ower, cabbage, brussel sprouts, bok choy and kale. The American Institute for Cancer Research states that these nonstarchy vegetables have strong protective effect for mouth, pharynx, larynx oesophagus and stomach cancers. Lab studies suggest that components of these vegetables have shown the ability to stop the growth of cancer cells in various cell and tissue.
COUCH POTATO SYNDROME
What it can cause: Bowel, breast, other obesity-related cancers Sitting around like a sloth is a no-no as gunk builds up in your body’s system. On top of eating right, being physically active can greatly increase your chances of curbing obesity which in turn reduces your odds of life-threatening cancers. You might think this is stating the obvious but there’s more to it than just managing your weight. According to Cancer Research UK, being active can reduce the amount of insulin in our blood. Scientists think that insulin can signal cells to multiply and because cancer starts when cells multiply out of control, lowering insulin levels can stop some types of cancer from developing.
The Centres for Disease Control and Prevention recommends a minimum of 150-minutes of moderate-intensity exercise each week for adults. Moderateintensity, according to Dr Karen Basen- Engquist, director of MD Anderson’s Center for Energy Balance in Cancer Prevention and Survivorship, means exercising at the intensity enough to make your heart rate go up and an increased breathing pattern.
ENVIRONMENT
What it can cause: Skin, lung, bladder cancer We don’t live in isolation. Your body has to endure things the outside world is throwing at it and sure, it can take a bit of grit but long term exposures to harmful radiation and substances may take toll on the body. If you frequently fi nd yourself out in the sun, UV radiation should be your biggest cause for concern. A guideline report Cancer and the Environment prepared by the American National Institutes of Health explains, UV radiation causes premature aging of the skin and DNA damage that can lead to melanoma and other forms of skin cancer, to which fairer skin types are more susceptible.
The best thing you can do when you are out in the sun is to cover up with clothes and apply sunscreen 30 minutes before heading out. The ACS recommends sunscreens with broad spectrum protection against UVA and UVB with sun protection factor of 30 or higher. Pollutants in the air can also increase your risk, scientists say. In 2012, WHO panel of experts concluded that diesel engine fumes can cause lung cancer and there are also some evidence pointing towards bladder cancer. It is advised that those who are within the proximity of areas that produce heavy diesel fumes, especially those who work or live in heavy industrial zones, to actively try to minimise the exposure.
FORECASTING CANCER
Your move is to detect the cancer as early as possible as this offers you the best chances to beat it. The only problem is that cancer is often invisible to the naked eye. While the cancer might be deep inside your body and happening at a molecular level, new technologies have allowed us to penetrate through tissues and bones and make detection in the earliest stage. Let’s look at Malaysia’s top fi ve killers.
LUNGS
Early signs: Usually none, but should you experience persistent coughing, sometimes with blood, take caution as it is often a pointer that it could be cancer-related. The National Cancer Council (MAKNA) highlights the following as other symptoms — shortness of breath, chest pain, hoarseness of voice, repeated bouts of pneumonia or bronchitis and loss of weight and appetite. False positives: Pneumonia. Both pneumonia and tumour appear white in chest X-ray. Do another X-ray 4-6 weeks later.The test: Biopsy.
PROSTATE
Early signs: No specifi c symptoms but according to the Care report by Universiti Putra Malaysia, some men will experience symptoms such as burning sensation during urination, presence of blood in urine, frequent urination especially at night, finding it diffi cult to start or hold back the fl ow and pain in lower back, hips, upper thighs, shoulders or other bones. Seek professional advice to confirm.False positives: Some of the early signs above could be a false alarm. Urination problems such as frequency, poor urine flow or urgency can be associated with the narrowing of the urethra or enlargement of the prostate. The test: A rectal exam can tell irregularities in your prostate, and high PSA (prostate specifi c antigen) level — a spiked score can be a sign of infection which can be treated with antibiotics. Biopsy to confirm.
COLORECTAL
Early signs: A bloody discharge. Most of the time, this is the only symptoms you’ll receive. Take it seriously and get yourself checked. False positives: If you are under 50, the cause might be non-cancerous, such as haemorrhoids or peptic ulcers. Again, take it seriously. See a doctor. The test: A colonoscopy. While at it, polyps can be removed too.
OESOPHAGUS
Early signs: Shows no symptoms until at later stage. The most common later symptom is when you experience diffi culty in swallowing, that you feel like food is stuck in your throat or chest. It gets worse as days go by. This is called dysphagia. False positives: Acid refl ux or gastroesophageal refl ux disease (GERD) with often leads to chest pain such as a burning sensation in the chest or pressure is rarely a cancer signal. The test: Endoscopy or X-ray.
PANCREAS
Early signs: Most will show signs of jaundice, which is the yellowing of the eyes and skin. At later stage, you’ll start experiencing abdominal or back pain as the cancer is getting large enough to put
pressure on other organs. You’ll start to lose appetite and weight. False positives: Early clue like blood clots, deep venous thrombosis (DVT) or pulmonary embolism (PE) may be a sign, but could also be caused by other things. Get yourself checked. The test: A CT scan is preferred by most doctors. MRI is used less often but may provide more information.
THE TREATMENTS
There are three main ways to manage cancer, namely surgery, chemotherapy and radiotherapy, and the treatment(s) the patient receives would be dependent on the type and stage of the disease. Receiving more than one type of treatment, ie combined therapy, is common but whatever the course, all these treatments have similar goals:
(1) to cure the cancer by killing or removing all cancer cells,
(2) preventing or delaying the cancer from recurring, and/or
(3) to treat the cancer symptoms if the cancer cannot be cured.
SURGERY
This is one of the main treatments for cancer and usually used to treat a localised cancer. It is basically the removal of a cancer tumour along with some normal tissue surrounding the cancer for security, provided the cancer is targeted and has not spread.
CHEMOTHERAPY
Literally, it is killing cancer cells with cytoxic drugs. There are many different kinds of chemotherapy drugs; you may have just one or a mixture of the drugs. Whether chemotherapy is suitable for you depends on certain factors your doctor would have to determine, such as type, origin, stage of cancer and your general health. As pointed out by the ACS, there is also a high risk of you developing leukaemia — a type of blood cancer — with this treatment.
RADIOTHERAPY
Cancer Research UK estimates that about 40% of cancer patients have radiotherapy as part of their treatment. The treatment utilises radiation — usually X-ray — to destroy cancer cells by damaging the DNA within the cells. The radiation can be given in 2 ways: from outside the body (externally) or from within the body (internally). This treatment also has a similar risk that is found in chemotherapy. Radiation causes cancer, and the risk of developing a second cancer after treatment is present.
PLUS POINT:
PHOTODYNAMIC THERAPY (PDT)
This relatively new treatment uses a photosensitising agent and a specific wavelength of light to obliterate the cancer cell. Basically, a form of oxygen is produced when the light hits the agent which then destroy the tumour. It is less invasive than surgery and carries little to no long-term side effects when used properly, according to the ACS. The only limitation is that the light cannot penetrate more than 1cm of tissue so it is only effective in treating nearthe- surface cancer. The agent used makes the skin and eyes sensitive to light so patients are advised to stay in the dark for at least six weeks after the treatment. However, the newest generation PDT — the 6th generation — claims to have eliminated some of the shortcomings of the previous generations PDT. Dr Lim Eng Huat, the CEO of Next Generation PDT says, “The new PDT is far ahead now. For example, instead of injecting the agent into the bloodstream, patient can simply drink the agent. The agent is very selective and only targets cancer cell and patients do not have to stay in the dark.” This treatment, however, is not yet available in Malaysia.
Mind Over Matter
Battling cancer is not just about medication and treatment, as shared by Steve Yap. Having seen many of his family members defeated by cancer, Yap believed that his family had a history of developing this disease easily. “When I was a teenager, every few years I would receive news that my cousins, typically in their 40s, had passed away due to one cancer or another.
“It seems like the cancer would only target the male side of my family,” Yap adds, with among latest victims in his family being Leong Pea, his elder brother who passed away about fi ve years ago.
“We learnt about his cancer only two years before that; he tried to keep it hidden,” says Yap. “(Mostly) he didn’t want our mother to get worried.” It was not a secret that could be kept hidden and eventually, his whole family found out. At that time, Leong Pea was suffering from stage-2 colon cancer.
He went for surgery to remove the growth but it recurred. Steve and his brother rarely got to see each other often besides the occasional visits to their parent’s place. After being diagnosed, Leong Pea seemed to lead a very normal life. “No signs of sickness. If he was in pain, he didn’t show it,” says Steve. It led most of those around him to assume that he was fine. Then all of a sudden, Leong Pea passed away.“When we received the call from his wife, we were all shocked.” Yap recalls. “We didn’t know that he was going to leave us so soon.” Looking back, “I can understand why he tried to keep it hidden. He probably didn’t want to burden us,” says Yap. “But learning from this experience, maybe it would be good to tell those you love if you are diagnosed with cancer.” It’s a form of therapy. Not the medical kind, but more for the moral support.
It seems that cancer knows no borders, as Yap says. According to him, Leong Pea lived a reasonably healthy lifestyle — he was the only one in the family tree who never touched a cigarette, opted for vegetarian meals and exercised regularly. “If you live a happy life, it may help with you fi ghting the cancer better,” says Steve, who also thinks having support means having the mental strength that can be as imperative as the medication itself. “In my opinion, the combination of medication and positive thinking could make a signifi cant difference.” Take control. “My sister-in-law was diagnosed with cancer more than 10 years ago, but she has a very normal life now. She’s managing it very well,” he says. To Yap, this doesn’t mean dealing with it only once you've been diagnosed with cancer but managing it now. “You live a healthy life not to escape death.
You live a healthy life so that you don’t get sick easily,” he adds. “Ultimately not falling sick so often means you get to enjoy more of life.” have cancer.” It’s a phrase to be feared but people are hearing it all the time. As common as this bad news is, however, there are many who are unaware of the mechanics behind this disease Fit for Fighting Allan Wu is convinced that taking care of your body could go a long way in preventing cancer. At 10, Allan Wu lost one of his biggest role models — his grandfather — to stage-3 lung cancer. He remembers, “When I found out about his passing, I was completely shocked. Because I was young, my parents didn’t want to disclose too much information to me because they knew how much I loved my grandfather and what he meant to me.” Able to vividly recall the day his mother flew back to Taiwan, he shares, “I remember after my mother left for the airport, I went outside to shoot basketballs all day just to vent and grapple with the loss.” “It was the fi rst time someone close to me had died, and I still didn’t understand what cancer truly was at the time.”
All he knew was he had lost a hero. An event as signifi cant as this left Wu a valuable life-long lesson. He learnt that knowledge and understanding is essential in dealing with anything in life, more so with something as detrimental as cancer. “I made an effort after my grandfather’s passing to learn more about cancer and how to live a healthy life to prevent it,” Wu says, adding that the experience was “one of the key driving forces that guided me to be as healthy as I am today.” If anything, Wu puts great emphasis on the importance of cancer awareness. “It’s true especially when I hear of patients who are extremely healthy and can still get it. I don’t know if Lance Armstrong is the most politically correct example at this stage, but we cannot deny the fact that he was extremely healthy when he was diagnosed with cancer.” He adds, “I am more aware of doing screenings for cancer myself because I know anyone can get it - no matter how healthy, fi t and well you think you are.”
