Dr Claramae Chia, Senior Consultant for Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery & Surgical Oncology, National Cancer Centre Singapore (NCCS) and Singapore General Hospital (SGH), answers questions on advanced and rare cancers.
Advanced and rare cancers are a spectrum of cancers
Those with the condition would benefit from the prompt referral to a specialist tertiary unit with a multidisciplinary team that has a rich experience and expertise in the treatment of rare conditions to provide the best patient outcomes.
Advanced and rare cancers include:
Sarcomas are a group of rare and heterogeneous malignant soft tissue tumours that can present in almost any part of the body. Symptoms include pain, unexplained weight loss or presence of a lump that may be painless and increases in size over time. Treatment is dependent on the location and type of sarcoma, cancer grade and whether it has spread to other body parts.
Peritoneal surface malignancies is often a late-stage development of cancers that arise from the spread from an intra-abdominal organ including stomach, colon and ovaries to the peritoneal cavity. It can also develop from the peritoneum such as primary peritoneal cancer. Symptoms often present late including bloating, abdominal pain, unexplained weight loss or gain and loss of appetite. In highly selected patients, cure can be achieved through cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Palliative options are also available to manage symptoms and preserve quality of life such as pressurized intraperitoneal aerosol chemotherapy.
Conditions such as melanoma, advanced squamous cell carcinoma,
gastrointestinal stromal tumours (GIST), EMPD and dermatofibrosarcoma protuberans are examples of
rare tumours. Due to their rarity, diagnosis is the critical first step for treatment. Treatment options are directed by tumour biology and discussion by a multidisciplinary team built upon the latest international guidelines and research advances.
If you have questions about advanced and rare cancers, take this chance to ask
Clinical Associate Professor Claramae Chia, Senior Consultant for the
Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT),
Division of Surgery & Surgical Oncology,
National Cancer Centre Singapore (NCCS) and
Singapore General Hospital (SGH). Both SGH and NCCS are members of the
SingHealth group.
This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.
1. Question posted by K*****
I have ovarian cancer. Just had my surgery last month. Removed the parts affected which originally through CT scan saw only the ovaries, uterus and fallopian tubes. But at surgery spleen and appendix were also removed. I am advised by my oncologist to take Avastin to address relapse. I can identify with the article on Peritoneal Surface Malignancies which mentions two forms of cure: cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. What is hyperthermic intraperitoneal chemotherapy? When is this method of cure used in a cancer patient? Please address the use of Avastin in my case. Should I wait or start on Avastin immediately or is there other options of treatment. Thank you.
Answer by Assoc Professor Chia :
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is used to treat cancers on the peritoneum, either arising from the peritoneum or have spread to the peritoneum from other primaries. The common cancers that this is used for are cancers from the colon, appendix and ovary amongst others. This method can be used in various ways and at different times, depending on the type of cancer. You can learn more about the types of cancers that the SPRinT team sees here.
Avastin is used in many ovarian cancer patients. The use of avastin can depend on many factors like the extent of the cancer, when the cancer came back amongst others. To decide if avastin is suitable in your case, we would need to review your case prior to making a decision.
2. Question posted by N****
Good Day A/Prof Dr Chia,
My late mum passed on in 2009 with Ewing’s sarcoma cervical cancer and myself have hysterectomy in Q4’ 2017.
Will sarcoma be inherited to myself and my other generations? I look forward to receiving your reply.
Answer by Assoc Professor Chia :
Ewing’s sarcoma is a rare type of sarcoma. 88% of the time, it arises from bones and usually affects children and young adults. Ewing’s sarcoma that occurs in the soft tissue is even more rare and can occur in the soft tissue of the arms, legs, head, neck, chest or abdomen. The genetic abnormality in Ewing’s sarcoma is not known to be inherited.
3. Question posted by A*******
Dear Dr,
What are the symptoms of stomach cancer?
Answer by Assoc Professor Chia :
Stomach cancer may present with some of the following symptoms.
Abdominal discomfort or pain
Poor appetite, early satiety(feeling full after eating a small amount of food)
Loss of weight
Difficulty in swallowing
Anaemia (low blood count) and it’s symptoms like feeling faint, dizzy, tired, short of breath amongst others
Nausea and vomiting
Black stools
4. Question posted by L***
Dear Dr Chia,
I noticed that my toenail (big toe) is getting a greyish dark colour. It started with a black streak and now almost whole toe nail is greyish in colour. Nail itself is fine … not flaky or soft. The "moon" area is clear pinkish white.
Must I be worried about this and what can I do about this? If testing is required… what test and where can I get tested?
My general health is good, no heart conditions, no diabetes, cholesterols ratio is fine, not overweight.
Will appreciate your advice. Thank you.
Answer by Assoc Professor Chia :
It depends on whether you have had any trauma/hits to your big toe, how long this discolouration has been there amongst other symptoms and signs. It would be prudent to have to have a doctor look at it and assess. You can first see a general practitioner who will look out for warning signs and send you to see a specialist if further investigations are needed.
About Clin Assoc Prof Claramae Chia
Dr Claramae Chia is the Head and Senior Consultant in the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore. She graduated from the National University of Singapore in 2005. She obtained her membership diploma for surgery in 2008 from the Royal College of Surgeons of Edinburgh. In May 2013, she completed her advanced surgical training and joined as a Fellow of the Royal College of Surgeons of Edinburgh. She continued on to her subspecialty training in surgical oncology with a focus on peritoneal surface malignancies.
In 2013, she was awarded the SingHealth Health Manpower Development Plan - Peritoneal Surface Malignancy Surgical Oncology Programme. She trained at the Centre Hospitalier Lyon Sud in Lyon, France with Professor Olivier Glehen. Under her leadership, the SPRinT department was formed in 2019 in recognition of the advanced oncological work that the team had been performing. Dr Chia and the SPRinT department continue to push clinical boundaries by introducing new services and initiatives. Examples of this include the introduction of Pressurised Intraperitoneal Aerolised Chemotherapy (PIPAC) and a focus of palliative surgical care.
On the research front, Dr Chia has been actively involved in clinical as well as basic science research since her basic surgical training. She has had publications in several peer reviewed journals. In 2008, she joined the Wee Kim Wee Laboratory of Surgical Oncology at the National Cancer Centre as a clinical research fellow and won the Singapore Millennium Foundation Grant for Associate Investigator for her translational work in nasopharyngeal carcinoma.
In SPRinT, Dr Chia continues to remain actively involved in research with the focus on peritoneal surface malignancies, retroperitoneal sarcoma and advanced/pelvic malignancies. She has published more than 70 manuscripts over the course of her research. The department also runs several clinical trials in peritoneal surface malignancies. Dr Chia is also a strong advocate of teaching the next generation of surgeons and doctors. She contributes to the General Surgical Residency Program and is actively involved in teaching medical students from all 3 local medical schools. She is also the first and only mentor in an Asian institute under the European School of Peritoneal Surface Oncology (ESPSO).
Ref: J22
