Hi Doc, how does a patient on oral chemo (imatinib) increase her WBC? The low WBC is a side effect of the drug. Thk you.

Thank you for your question.

Firstly it depends on whether the WBC is low enough to cause any concern. If it is a concern as deemed by your doctor, in generally the following can be considered:

1.Reducing the dose of the medication

2.Changing the dosing schedule of the medication

Regular exercise has been shown in small studies to maintain the WBC during chemotherapy but whether this is applicable to you or not is uncertain as imatinib is not a chemotherapy (it is a targeted treatment). 

There are no proven dietary measures that can effectively and meaningfully increase the WBC, and that includes diet, supplements, herbal remedies. If you choose to change your diet or take supplements or herbal remedies, please speak to your doctor first before doing so, as these may interact with the treatment and cause more side effects. 

I am a caregiver for my aunt who underwent mastectomy if her right breast in 21/5/20 @ KKH. Her breast cancer is Stage 2. I am still puzzled as to why she has to see chemotherapy doctor even though breast cancer doctor confirmed the localised cancer growth was totally removed & 5 of the lymp nodes from her right arm pit have tested negative.  Do all breast cancer patients have to undergo chemotherapy regardless of the cancer stage?

Thank you for your questions.

All early stage breast cancers (Stage 1 to 3) have the future possibility of relapse and spread to other parts of the body (Stage 4) even though the cancer appears to be localized within the breast or lymph nodes initially. This happens because of the spread of microscopic cancer cells from the breast or lymph nodes into the blood stream (termed micrometastases) which if not gotten rid of by additional treatments (e.g. combinations of either chemotherapy, hormonal and targeted therapy, or radiotherapy) may spread and settle into other parts of the body, making the disease incurable. Whether a patient needs additional treatments or not will depend on a combination of factors found regarding the cancer itself e.g. the stage (size of the cancer and lymph node involvement) and the behaviour i.e. how aggressive the cancer is (grade, type of breast cancer). Based on these factors the oncologist will discuss the benefits and risks of additional treatments to reduce the risk of cancer relapse and hence improve the chances of long-term cure. Sometimes the oncologist orders additional tests (depending on the type of breast cancer) to better understand the behaviour of the cancer and whether chemotherapy is needed. It is routine for someone with stage 2 breast cancer to be referred for a discussion regarding additional treatments to improve her chances of cure.

Dietary wise – encourage her to eat healthily with a balanced combination of healthy carbs, proteins, vegetables and fruits. A healthy balanced diet is best for your aunt rather than specific diets that have not been proven e.g. ketogenic, veganism, extreme fruit / vegetable juicing, herbal supplements. At the same time, we should also allow some flexibility in her diet as her taste buds may become less sensitive during chemotherapy. Extreme restrictions to diet during treatment can lead to weight loss and more side effects. If she undergoes chemotherapy, it is important for foods to be clean and well-cooked to prevent food poisoning. 

Physically – if she is up to it encourage her to do gentle exercises e.g. walking. If she is coping reasonably well, then the exercises can pick up pace to a moderate intensity level (doing an activity to the point where she is still able to talk but is unable to sing). If she is able to, to keep doing the activities she normally does e.g. house chores, climbing stairs. Patients who exercise in general feel better and may even tolerate treatment better

Emotionally – we have a lot of information on this that you can refer to on our website - https://www.nccs.com.sg/patient-care/Pages/for-caregivers.aspx

Hi, Dr. I would like to ask what is your recommendation of exercise for breast cancer survivors who has completed Chemo/RT treatment. And is there any available resources (e. g facility, guidelines, exercise program) in Singapore?

Thanks for your question. 

Exercise is highly recommended in most cancer survivors. If there are no serious medical problems that would affect the safety to exercise, the recommendations are: 

1 - 150 minutes of moderate aerobic intensity exercise per week with each session lasting at least

2 - 10 minutes (doing an activity e.g. brisk walking, cycling, Zumba, to the point where she is still able to talk but is unable to sing), and if possible, 

Resistance or strength training at least on two non-consecutive days per week. 

You can refer to NCCS’ website for more detailed information on exercise - https://www.nccs.com.sg/patient-care/Pages/Exercise-and-healthy-living.aspx

Resources or facilities wise – there are many exercise programs / activities in Singapore arranged through Healthhub and ActiveSg, but these have stopped during the COVID19 pandemic. You can refer to their websites for the latest updates

https://www.healthhub.sg/programmes

https://www.myactivesg.com/Programmes

ActiveSg have dedicated gyms across Singapore that people can also access at an affordable price 

https://www.myactivesg.com/Facilities/Gyms 

My 15 yrs old son was diagnosed with choledochal cyst type 4a in March 2020 and underwent cholecystectomy with hepaticojejunostomy with partial hepatectomy in Mumbai ,India in March ,2020.my question is that what are the chances of developing cholangiocarcinoma in the future and how can it be prevented ? What can be done to screen it or detect it at the earliest in the future and are there any dietary and lifestyle changes or medications that can prevent the same.

Could you please provide advices/share some tips in preventing cancer relapse? Thank you.

Thanks for your question.

Most cancers if treated early enough are curable. In general, the risk of relapse will depend on the cancer type and stage at diagnosis. Treatment given in addition to the primary treatment for cancer e.g. surgery has been shown to reduce the risk of relapse for many cancer types. 

Examples include chemotherapy, radiotherapy, targeted therapy and immunotherapy. These are termed "adjuvant" treatments. Which of these will be suitable will entirely depend on one’s cancer type and stage. 

In addition to these adjuvant treatments, certain lifestyle measures e.g. exercise, maintaining a healthy weight and diet can potentially prevent new cancers developing. Whether these lifestyle measures can actually prevent a cancer that has previously been diagnosed relapsing is still subject to further studies.

Nonetheless there are many benefits (and little risk) in practicing a healthy lifestyle – exercising regularly, maintaining a healthy body weight, and eating healthily. Exercise reduces cancer treatment side effects and improves quality of life of cancer patients. Maintaining a healthy body weight reduces the risk of heart problems, diabetes and some cancers. Eating a diet rich with vegetables, fruits, grains, healthy meats e.g. poultry and fish may also reduce the risk of developing cancer. 

Dear Dr,

Is it true that prostrate cancer will reduce its occurrence depending on the number of times a person engages in sexual intercourse per month?

Thanks for your question. 

There is evidence that men with more frequent ejaculations have a lower lifetime risk of prostate cancer but researchers do not fully understand the reason behind this. Whether this protective effect extends to a prostate cancer survivor in reducing the risk of relapse is unknown. Nonetheless a healthy sex life is still important for quality of life even after the diagnosis of cancer. If this is concerning to you, you can speak to your doctor, in particular a urologist. 

Dear Dr,

As a cancer survivor of 11 years, what exactly is medically correct term pertaining to the declaration on the employment application form? Is it fit, cancer-free or cure? Thank you.

Thanks for the question. 

These words are often used interchangeably in practice and often cause confusion. 

Remission means that the signs and symptoms have reduced or resolved, and this remission can be partial or complete. Partial meaning the cancer is still there but is currently under control, complete meaning there is no detectable cancer seen on tests. Nonetheless, remission still means that the cancer can come back. 

When is someone actually cured or cancer free it is hard to say – for some cancer types e.g. colorectal cancer, being in remission for more than 5 years is suggestive of long-term cure i.e. cancer free, but for other types of cancers e.g. hormone driven breast cancer, cancer relapse can still occur even 10 years after diagnosis, so remission is a better term to use. 

Hence, doctors tend to monitor patients for cancer relapse for many years – some for at least 5 years and some, a lifetime. I don’t know your cancer circumstances so it is hard to say what you should declare on your application form. You may have to just state the facts – diagnosed when, completed treatment, currently only on follow up, last clinic visit no evidence of cancer. If they want more information, they may request for a medical report from your doctor.

Hi, I'm new here, so i don't know where to post this question. Are meal replacements okay to have in the morning regularly? If yes, which ones are good? I'm thinking of a few options:

1. Nestle's optifast

2. amway/herbalife etc.

3. Sustenance meal replacements (https://sustenance.com.sg/)

Are they safe to take? Do they cause cancer? Please advice. thanks

Thanks for your question. Meal replacements/medical nutrition products are generally not known to cause cancer, although there are going to be countless products on the market from varying sources and ingredients. Whether something is carcinogenic or not will depend on what ingredients are within. Compounds that are carcinogenic are generally shown to cause cancer in animals and/or humans and usually officially recognized as so by international agencies e.g. International Agency for Research in Cancer (IARC). 

My recommendation is to not rely on meal replacements if possible, especially for patients who can eat a normal diet. We do not recommend complementary nutritional supplements as these have not been shown to meaningfully improve outcomes in cancer patients. It is preferable to eat a natural, balanced, nutrient rich diet rather than rely on meal replacement products.

Can I check: if a person has gone for mammogram at least 3 to 5 times and been given the clear between their 40//50s, would this mean that she will stay in the clear? 

For how Long and how many times does a woman  need to keep going for this rather uncomfortable and always stressful test?

Answer is no. The risk of cancer and in particular to your question, breast cancer increases with age. Hence screening mammograms will need to continue (2 yearly for >50yo, yearly for 40-50yo). A caveat is screening is mainly useful if the person is going to live long enough to benefit from early detection of cancer. As an example, someone with a life expectancy of 1-2 years due to having multiple medical problems is not going to benefit from screening mammograms (which picks up very early stage cancers e.g. stage 0, stage 1 mainly) as they would have probably died even before the cancer would have surfaced and treated in the future. 

We usually use a cut off 10 life expectancy years. In Singapore , the life expectancy of women (and men) have progressively risen – now reaching the mid-80s. Assuming a regular Singaporean woman will live to 85yo – then we usually stop mammograms about 75yo but this is subject to a case to case discussion. 

Beyond the statistics, it is understandable that the test is uncomfortable and stressful for many women. I want to assure however that screening can potentially be life-saving for many women. Earlier detection of breast cancer (the commonest cancer in women) in general leads to less aggressive treatment and much better chances of survival. Take heart that you are doing your part in keeping yourself healthy for yourself and your family. 

Hi Doc,

What are the chances of survival for my wife who was diagnoised with Ovarian cancer Stage 3C, two years ago? 

Operation was done in 2018 to remove the big tumor along with her Uterus and Ovaries. First round Chemo of 6 cycles was done soon after the operation. CA 125 marker came down from initial 790 to 30.

In 6 months, the Marker went up again to 690. So, 2nd round of Chemo was done in 2019 and was stopped when it came down to 40.

In 4 months, the Marker went up again to 330. So, 3rd round of Chemo is in progress now in 2020. Just after the first cycle, it has come down to 200 now.

Based on the CT Scan reports, it seems cancer has spread to many areas in abdomen, causing her severe pain every hour, every day, even with all the chemos that are being carried out. She is also under Palliative care Consultant for her pain management.

Even though she is under the care of an Oncologist care now, we just want to have a 2nd opinion from another consultant, like yourself:

1.What is her survival probability?

2.What can we do to keep her pain free?

3.How many more sessions of chemo can be continued and for how long?

4.What else can we do to reduce her pain and prolong her life?

Thanks.

It sounds like her ovarian cancer is in the advance stages now. Regarding her anti-cancer treatments, you will need to consult the oncologist, in particular one that specialises in gynaecological cancers as this is outside my field of expertise (breast cancer, supportive care and survivorship). 

Taking advice and treatment from the palliative care team is important to keep her pain under control. It is understandably heart wrenching to see your wife in the current condition and like all loved ones, would want her to have a longer life. Whether this can be meaningfully extended or not is uncertain and will depend on the available cancer treatment options, of which you will discuss with her oncologist. 

Do check on this to give yourself and her an idea on whether further anti-cancer treatment is going to be helpful or not and whether the risks are worth the potential benefit. During this time however, do not lose focus on her comfort, quality of life, and doing what is meaningful to her. What is meaningful to someone will vary from person to person, and only you will know what is meaningful to your wife, and how to achieve it. Most patients treasure time with their loved ones – and is often a good thing for their families to work on.