Breakthroughs: Update for the docs

Annual scientific meeting sees doctors from Singapore and beyond gather to share and discuss new ways to treat cancer.

Doctors from Singapore and the region updated themselves on the latest in cancer treatment when they attended the oncology track of the annual scientific meeting organised by Parkway Cancer Centre and Mount Elizabeth Hospital last November.

Entitled ‘Enhancing Lives with Breakthrough Medicine’, the event consisted of five sessions which covered the latest in minimally invasive surgery for thoracic malignancies; what is new in the management of liver cancer; the latest advances in the management of lymphoma; updates in the prevention and management of colorectal cancer and the current status and future prospects of immunotherapy as a treatment for cancer.

It was attended by 70 regional and local doctors.

Dr Lim Chong Hee, a thoracic surgeon, kicked off the session by showing how minimally invasive surgery is now more common in thoracic surgery.

Traditionally, getting into the chest involves a huge chest incision called posterolateral thoracotomy. “Patients usually need an epidural because of the pain involved,” he noted.

However, with advances in minimally invasive surgery, extremely small incisions are now used to insert the necessary instruments. Video thoracic instruments have now become as small as 2 mm in width, he noted. In thoracic surgery, there have also been some efforts to move to single-port procedures, where all the instruments as well as the camera enter via a single, relatively small, incision.

Small incisions are superior to large ones because patients feel less pain, hospital stays are shorter and people can get back to work sooner, he noted.

He did warn though, that not all surgeries can be done using minimally invasive procedures. This is especially so, if the tumours are large.

Dr Lim was followed by Dr Stephen Chang, a liver, pancreas and gallbladder surgeon, who spoke about new developments in the operative management of liver cancer.

Dr Chang noted that one recent discovery was that transplantation could be a cure for certain forms of hepatitis, including hepatitis C. Some 70 per cent of patients who have hepatitis C and who undergo a liver transplant are cured, he said. “This means that these people will not have cirrhosis for the rest of their lives. This is wonderful,” he added.

He also pointed to the increasing use of laparoscopic surgery in liver surgeries as well. “In terms of survival, there is no difference between laparoscopic surgery and open resection.”

Dr Lim ZiYi, a haematologist, then took the stage to discuss advances in lymphoma treatment. Lymphoma is one of the most common forms of blood cancer in adults. One in 50 people will develop lymphoma in their lifetime and it is the most common cause of blood cancer death.

Thanks to targeted therapy and immunotherapy though, as treatment outcomes are improving for lymphoma, said Dr Lim. Drugs such as rituximab, brentuximab vedotin (CD20) and imbruvica (ibrutinib) have all helped to reduce mortality rates. Dr Lim also pointed to how different types of immunotherapy such as monoclonal antibodies, checkpoint inhibitors and cellular therapy are also showing promise in the treatment of lymphoma.

The prevention and management of colorectal cancer was the topic of Dr Ho Kok Sun, a colorectal surgeon, who presented next. Dr Ho noted that there have been advances in terms of the screening and surgical treatment of colorectal cancer.

Previously, doctors relied on the faecal occult blood test (FOBT) to detect blood in stools as a symptom of colon cancer. However, this is not a sophisticated test as even eating meat beforehand could result in a positive result. These days, doctors use the faecal immunochemical test (FIT) which is able to detect haemoglobin specifically.

Dr Ho also spoke about advances in colorectal surgery such as the use of single-port surgeries, a procedure called colonic stenting to deal with colonic obstruction, the advantages of robotic surgery, and discussed other surgical options such as trans-anal surgery, where you cut through the rectum, and natural orifice transluminal endoscopic surgery (NOTES), where no incisions are made on the skin because entry is made through organs such as the stomach, colon and vagina.

The session closed with a presentation by Dr Zee Ying Kiat who focused on cancer immunotherapy, which is a form of treatment that harnesses the innate powers of the immune system to fight cancer.

An oncologist, Dr Zee focused in particular, on immune checkpoint inhibitors which act by lifting the brakes on the immune system. He reviewed the current role of immune checkpoint inhibitors and offered some insight into what the future might hold for this class of drugs.

Immunotherapy is now used to treat melanoma, lung cancer, some types of colorectal cancers, squamous cell cancers for the head and neck, kidney cancers, Hodgkin’s lymphoma, bladder cancer and non-small cell lung cancer, he noted.

“Immunotherapy stands alongside targeted therapy, chemotherapy, radiation therapy and surgery as one of the important modalities of anti-cancer treatment,” he said.

According to Dr Zee, there are now hundreds of trials to see if immunotherapy can be used for other types of cancer.

Written by Jimmy Yap



Tags: blood cancer, cancer laparoscopic (minimally invasive) surgery, cancer latest breakthrough, dr stephen chang, FOBT (faecal occult blood test), hepatitis cancer, immunotherapy, new ways to treat cancer, robotic surgery, targeted therapy, thoracotomy