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Cancer Treatment

 

Chemotherapy

Chemotherapy is a type of treatment that uses anti-cancer drugs to kill cancer cells. It stops cancer cells from growing and reproducing themselves. These drugs can be given orally (by mouth) or by injection, entering the blood stream to be distributed throughout the body to kill cancer cells. Chemotherapy can be given in different ways and will depend on the patient, and cancer type and stage. Chemotherapy is commonly given in cycles with each cycle consisting of a treatment period followed by a recovery period.

As cancer drugs also affect normal cells, the resting period is to allow the body to recover before the next treatment cycle starts. You will probably have a combination of drugs over a few days, followed by a rest period of two to three weeks. You may also have continuous treatment where the chemotherapy is given via an infusion pump.

什么是化疗?
Depending on the cancer type and stage, chemotherapy can be used either alone or more commonly as part of the overall treatment:

• To achieve remission or cure – examples include:

- Chemotherapy is commonly used to cure some cancers e.g. testicle cancers, lymphomas and leukaemias
- Chemotherapy is commonly used before or after surgery to eradicate microscopic cancer cells to improve the chances of cure e.g. breast, colon, ovarian cancers
- Chemotherapy is combined with radiotherapy to eradicate certain types of cancers e.g. head and neck cancers, anal cancers

• To improve the chances of curative and better cancer surgery – examples include:

- Chemotherapy given before breast cancer surgery can:
- Shrink inoperable breast cancers to allow curative surgery
- Shrink breast cancers to allow surgeons to conserve the breast (rather than removing the entire breast)
- Chemotherapy together with radiotherapy before rectal cancer surgery can:
- Shrink low rectal cancers to the extent that surgeons may be able to remove the cancer without needing to remove the anus (and ability to control bowel motion) of the patient

• To control and relieve symptoms – when cancer is not curable, chemotherapy is commonly used to:

- Slow or control the growth and spread of cancer cells with the aim of helping cancer patients to live longer.
- Shrink the cancer to relieve any symptoms it may be causing e.g. pain, shortness of breath, with the aim of improving the quality of life of patients.

化疗的用意
Chemotherapy is most frequently given intravenously (through a drip into the vein). Depending on the types and number of drugs prescribed, the length of intravenous (i/v) treatment may range from 30 minutes up to several hours. It will usually be given during day visits at a hospital or treatment centre. Sometimes, chemotherapy is given via a portable pump programmed to deliver a prescribed dosage and amount of chemotherapy continuously over a few days.


Intravenous (IV) chemotherapy
Chemotherapy is often given through a small fine plastic tube (IV cannula) that is inserted into a vein at the back of the hand or lower arm. The cannula is secured with tapes during treatment and removed after each treatment. IV chemotherapy may also be given through catheters or ports, sometimes attached to a pump.

Catheter – A catheter is a thin, soft hollow tube to be inserted in a large vein, usually at the chest area. The other end of the catheter stays outside the body and stay in place till chemotherapy is completed. The catheter can be used for other prescribed IV drugs and draw blood for test. Care to be taken to watch for signs of infection around the catheter.

Implanted Port- An implanted port is a small round disc placed underneath the skin through a minor surgical procedure. It is put in place by a doctor before chemotherapy treatment starts and remains until treatment is completed. A catheter from the port connects the port to a large vein. A needle is inserted through the port externally for chemotherapy infusion and blood draws for tests.

Pump- pumps are often attached to catheter or ports. It can be programmed with the prescribed dosage and duration of chemotherapy to be delivered via the catheter or the port.

Oral chemotherapy
The chemotherapy comes in pills or capsules to be swallowed. The pharmacist will tell you how and when to take them, and how to handle the drugs safely.

Injections
The chemotherapy is given by a shot in a muscle in the arm, thigh or buttocks or under the skin (subcutaneous) in the fatty part of the arm, leg or abdominal area.

Intrathecal injection
The chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord.

Intraperitoneal (IP)
The chemotherapy goes directly into the peritoneal cavity, the area in the body that contains organs such as intestines, stomach and liver.

Intra-arterial (IA)
The chemotherapy is injected directly into the artery that leads to the cancer.

Topical
The chemotherapy comes in a cream to be rubbed onto the skin.

化疗是如何进行的?
Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly like the cells that line the mouth and intestines as well as the cells that cause the hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better after completion of chemotherapy regime.

化疗的副作用
1. Pack a bag for treatment
This bag could include warm clothing, healthy snacks, drinks, lip balm and something to keep you entertained like a book, magazine, music with earpiece, laptop or tablet.

2. Arrange for someone to accompany you
It will be ideal to arrange for someone to bring you home after chemotherapy as some medications can cause drowsiness.

3. Arrange for help at home
Make arrangements for childcare for your young children before and after your treatment session. Ask a friend or family member to help coordinate or help out.

4. Seek support from your employer
Make work arrangements with your employer and discuss about any time off or leave required especially on day of treatment and day after.

5. Look after yourself
Stay healthy before and during the treatment. Drinks lots of water, have adequate sleep, eat nutritious food, stay physically active and have enough rest. All these can help reduce some of the side effects of chemotherapy.

6. Seek support on your concerns
The diagnosis of cancer can affect people differently. Speak to a family member, a friend or your doctor or call the Cancer Helpline to speak with the Nurse Counsellors at (65) 6225 5655 for support.

7. Be aware and prepare for possible side effects
Find out about the side affects you are likely to have and ways to manage them. You may wish to cut your hair before treatment starts if one of the side effects is hair loss.

8. Inform about other medicines
Inform your doctor of any other medication you are taking as they may interfere with the chemotherapy.

准备接受化疗
The cost of chemotherapy depends on:
• The types and doses of chemotherapy used
• How long and how often chemotherapy is given
• Whether chemotherapy is administered at home, in clinic or during a hospital stay

化疗的费用

Surgery

Surgery is a medical specialty that uses operative tools and techniques to diagnose or treat patients with particular diseases. As it is invasive and may cause pain, surgery is often performed under anaesthesia – this can be general anaesthesia where a patient is completely asleep and does not feel or remember any events; or local anaesthesia in which a numbing agent is injected in the region of the intended surgery. Surgery may be performed for any organ in the human body ranging from the head and neck to the lungs and heart to organs within the abdomen – liver, stomach, small and large intestine, etc.

The purpose of surgery can be multifold:
(1) To investigate and confirm the presence of a disease
(2) To remove non-cancerous or cancerous growth
(3) In trauma or severe injuries
(4) Remove life-threatening infections
(5) For aesthetic purposes

什么是外科手术?
Cancer Surgery is performed for 2 main purposes:

(1) To cure cancer by complete removal of all cancer cells

(2) To relief symptoms that are caused by a cancerous growth

When cancer cells are confined within a region or organ and can be removed fully, surgery has the potential to cure cancer. It may be used in conjunction with chemotherapy or radiotherapy before or after surgery to ensure the best outcomes. Careful planning is required before surgery to ensure that the cancerous growth is removed with clear margins of normal tissue and the draining lymph nodes are removed as well.

When cancer is aggressive and cannot be fully removed from the body, curative surgery may not be possible. However, it can continue to grow and cause troublesome symptoms such as bleeding, pain, blockage or rupture. When these complications occur, surgery may be required to resolve the patient’s symptoms.

什么是癌症手术?
There are 2 main surgical approaches:

(1) Open Surgery: This is the traditional mode of surgery and involves a cut on the skin surface. The scar left behind may be small or large depending on the type of surgery required.

(2) Minimally invasive Surgery: This is also known as ‘key-hole’ or laparoscopic surgery where by only a small cut is needed to introduce a small instrument to perform surgery. The patient will have several small cuts on the skin surface as several working instruments are often required. The benefit of this approach is possibly less pain due to the smaller wounds. In the recent years, the ‘robot’ has also gained popularity and may be used to perform surgery. It produces wounds that are similar to the ‘key-hole’/laparoscopic approach.

癌症治疗的手术种类
Cancer can occur in any organ system. In Singapore, colon cancer is the most common cancer in man while breast cancer is the most common cancer in women. Surgery treatment differs according to the organ system involved. This table shows common cancers and their type of cancer surgery:
Cancer Type Surgery Involved
Colon Removal of portion of colon with good margins of normal tissue and draining lymph nodes. The remaining portions of the colon are then joined back together.
Sometimes, a stoma (a portion of the small or large intestine) may be required and is considered on a case by case basis. This can be temporary or permanent.
Breast Removal of part of or the entire breast with or without removal of lymph nodes that are at the underarm region.
This can be followed by reconstruction of the breast by the plastic surgeons.
Head and Neck  This can sometimes be treated by radiation therapy.

Surgery is performed but only for specific cancer types e.g. thyroid, tongue cancers or when the cancer recurs or does not respond well to radiation.

Stomach  Removal of part of or the whole stomach. To allow for future normal food intake, a portion of the small intestine is used to connect the remaining stomach or food pipe to the remaining small intestine.
Liver  Removal of a portion of the liver.
Liver transplant surgery may also be performed – this involves removing the diseased liver and replacing it with a new liver from a deceased organ donor or a living donor.
Pancreas Removal of a portion or the whole pancreas.
Kidney Removal of a portion or the entire kidney. As there are 2 functioning kidneys, removal of one kidney is possible and the patient does not usually require dialysis.
Gynaecological Organs

(Uterus, Cervix, Ovaries)

Cervical Cancer is treated with radiotherapy and surgery only reserved for patients whose cancer comes back despite radiation.
In ovarian and uterine cancer, a common surgical approach is to remove both ovaries and the uterus. In patients that are still keen to have children, preservation of some gynaecological organs is possible and considered on a case by case basis.


常见癌症与手术
Complications may arise from anaesthesia given prior to surgery or from the surgery itself.

Complications of Anaesthesia include:
• Heart attack
• Stroke
• Allergic reactions
• Respiratory infections

Complications of Surgery include:
• Bleeding
• Wound infection
• Anastomotic leak: This refers to leakage of intestinal material due to a gap in between the joining that was created after removal of a portion of the intestine
• Injury to surrounding structures or organs
• There are also specific complications related to surgery performed for different organ systems. This should be explained by your performing surgeon.

手术后可能面对的并发症
After diagnosis of cancer is made, a clinical consult with a specialist surgeon is required to determine if a surgery is suitable for you.

Prior to surgery, blood tests and a chest X-ray are routinely performed to ensure that a patient is fit and ready for the surgery and anaesthesia.

Depending on the type of surgery performed, the patient will have to either be admitted to the hospital a day before surgery to ensure necessary preparations are made or on the morning of the surgery.

准备接受癌症手术
The cost of surgery depends on:
• Type of surgery performed
• Length of hospitalisation

手术费用
Immediately after Surgery

After surgery, the length of your hospitalisation depends on how big the surgery was and if there was any complications that occurred. You should expect to stay between 5 to 14 days.

Upon discharge, your surgeon should advise you when to resume your normal activities. As there will be wound from surgery, you should avoid heavy and strenuous activity or swimming to prevent wound infection and breakdown. Should you feel unwell, please do not hesitate to call the NCCS hotline to inform your primary surgeon.

A few weeks after

The cancerous growth would have been sent for testing and the stage of your cancer can be determined by 2 to 3 weeks after the surgery. Depending on the stage, you may require chemotherapy or radiotherapy after the surgery. This can be commenced when your surgical wounds are completely healed and there are no complications from the surgery.

A few months after

All cancer patients need to be followed up regularly for at least 5 years after curative surgery. This involves 3 to 6 monthly clinic visits, blood tests as well as regular surveillance computed topography (CT) or Magnetic resolution imaging (MRI) Scans.

Special tests and closer follow up may also be required depending on the patient’s cancer type.
The above measures help ensure the early detection of new cancer cells should the cancer relapses.

手术过后