Oncologist shares insight on nose cancer

Dr Zee Ying Kiat

MIRI: Those who love to eat salted fish as part of their daily food intake should start to worry as it is a possible cause of nasopharyngeal cancer (NPC), commonly known as ‘nose cancer’.

Senior consultant and medical oncologist Dr Zee Ying Kiat said though the causes of nose cancer are not widely known,  statistics from the nasopharyngeal cancer cases he had gathered appear to be leading to the cured food.

“Excessive consumption of salted fish at an early age and high consumption of preserved or fermented food are considered as the factors.

“Therefore, it is highly recommended for those who often consume these foods to frequently check with their doctors. It would be best if they could stop altogether for the benefit of their own health,” he said when met recently.

Epstein Barr Virus (EBV) infection, he said, is considered an important factor in the development of NPC.

Other risk-factors for NPC include having Chinese ancestry, gender and high consumption of alcohol.

“It is not known why, but Chinese from endemic regions like Hong Kong and southern Chinese have the highest risk (of getting NPC). In terms of gender, the percentage of men diagnosed with NPC appears to be higher than women.”

As the symptoms of nose cancer may be easily passed off as ordinary health condition, Dr Zee suggested that individuals who have any of the following symptoms consult their doctors for further check-up and diagnosis.

The symptoms of NPC include nose bleed, headache, neck swelling (due to enlarged lymph nodes), drooping eye lid, double vision and blood stained sputum (saliva).

“I had a case whereby a patient had a lump in the neck, which was thought to be related to area near the neck. However, after a detailed check-up, it appeared that the lump was actually caused by NPC,” he said, adding that it could also be a symptom of other sicknesses instead of NPC.

Dr Zee said the treatment for NPC based on the stages of the diagnosis.

For patients with non-metastatic NPC (from stage I to IV), the primary treatment is radiotherapy.

In the treatment of NPC, radiotherapy uses high-energy rays to kill the cancer cells, and the treatment affects cells only in the treated area.

“The treated areas include the posterior nasal space as well as both sides of the neck.”

For stage 1 to 5, the radiotherapy treatment uses as curative procedure will usually pair with chemotherapy.

For late stage diagnosis, whereby the cancer cell had spread to other parts of the body, radiotherapy and chemotherapy are used to ease the pain.

“People may question the possibility of cancer relapse after the treatment. For stage 1 and 2 patients, the surviving rate is higher at 90 per cent.

“For stage 3 NPC, patients are given a five-year window of monitoring period with 60 per cent surviving rate. Whether it is long or short period, one must adopt a change of lifestyle and frequently check with their doctor,” he said.

He added that blood test to assess EBV and endoscopy procedure are highly encouraged for those with high possibility of NPC.

“The earlier they are checked and found out (the condition), the higher is the surviving rate,” he added.

Colorectal cancer Dr Zee said that colorectal cancer is the second most common cancer among men and women.

“Therefore, for men and women who are 45 to 50 years old, it is highly suggested for them to undergo large intestine screening.”

Colorectal cancer originates from the tissues of the colon (the longest part of the large intestine) or rectum (the last several inches of the large intestine before the anus).

The factors that contribute to colorectal cancer include age, gender, lifestyle and dietary habit, obesity and lack of exercise.

Unhealthy habits like heavy alcohol drinking, smoking, love for red meat, low fibre diet and processed food are said to be the possible factors that lead to the cancer.

Dr Zee also stressed that a person who has had ulcerative colitis or Crohn’s disease; or personal history of cancer or family history of colorectal cancer should take extra precautionary measures by frequently checking with their doctor.

The symptoms are bloody faeces, sudden change of bowel habits, feeling that bowel does not empty completely, feeling very tired all the time, and having nausea or vomiting must not be ignored.

“The development of colorectal cancer starts from polyp and it usually takes about three to five years or most, 10 years to develop into either benign (not cancer) or adenomas (cancer tumour). Polyp is growth on the inner wall of the colon or rectum. Colonoscopy screening is a vital part in the diagnosis of colorectal cancer because the earlier the polyp is found, removal procedure can be done to eliminate the polyp and prevent it from becoming tumour.”

Screening tests are offered at different procedures according to one’s need – Fecal occult blood test (FOBT), sigmoidoscopy, colonoscopy, double-contrast barium enema and virtual colonoscopy.

“FOBT is more suitable for people aged 50 years and above and they have to undergo the procedure once a year. However, the result of FOBT may not be accurate because the blood in the faeces may be caused by other reasons and not the cancer or polyps.”

Dr Zee suggested that colonoscopy is the most appropriate procedure to diagnose colorectal cancer.

“In the colonoscopy examination, usually rectum and entire colon will be examined using a long, lighted tube called Colonoscope. Any precancerous and cancerous growths throughout the colon can be found more effectively before they are removed or biopsied,” he said.

The treatment for stage 1 and 2 colorectal cancer is to surgically remove the tumour, while for stage 3, a combination of surgery, chemotherapy and radiotherapy might be suggested.

“Meanwhile, for fourth stage colorectal cancer, sometimes immunotherapy will be suggested to control the condition. Of course, it all depends on the sample of the tumour obtained.”

Before concluding the interview, Dr Zee reminded the public to consult their doctor should they detect any abnormality and changes in their body.

“Yearly body check and screening, blood test always save lives. The earlier the diagnosis, the higher the survival rate.”

Dr Zee, who is a specialist in medical oncology at Parkway Cancer Centre, was recently in Miri for a community health awareness talk. He is a member of the American Society of Clinical Oncology and founding member of the Hepatocreatobiliary Association of Singapore.

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