​The father of three was counting down the days till he could have his stoma bag removed so he could cycle with his young children or take them travelling.

But those plans had to be put on hold after Mr Alvin Pang, 50, found out that his colon cancer had spread to his peritoneum in September 2019. Devastated by the diagnosis and confused by the anatomical word, the construction engineer told The Straits Times that it was worse than finding out about his cancer initially. "I didn't know how to move forward. But after some time thinking, I got a grip on myself and started moving forward," said Mr Pang. It was explained to him that the peritoneum is a thin membrane that lines the abdominal and pelvic cavities. It contains and supports most of the abdominal organs except for some organs, such as the kidneys and adrenal glands. Tumours on the peritoneal surface may arise from the lining itself or may have spread from other abdominal organs such as the spleen, intestines, stomach, liver, uterus, ovaries, rectum and bladder.

Mr Pang was referred to the Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT) at the National Cancer Centre Singapore and Singapore General Hospital. The department was set up in 2019 to offer a one-stop service for patients with sarcomas, peritoneal disease, gastrointestinal and advanced intra-abdominal malignancies, as well as skin cancers, among other rare tumours. It sees more than 700 new cases and performs about 400 operations a year. Previously regarded as fatal, these tumours can now be treated with treatments including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Head of SPRinT and senior consultant Claramae Chia said: "Diagnosis of sarcoma, peritoneal and rare tumour cases can be challenging as symptoms may be vague and non-specific, and this can lead to delays in treatment or even the wrong treatment."

Associate Professor Chia added: "For example, retro-peritoneal sarcomas may be completely asymptomatic until they grow to a significant size and, even then, the patient may just feel bloated or that he is putting on weight. Hence, getting the initial diagnosis is essential."

The diagnosis of a peritoneal tumour for Mrs Trisha Jeanne Pineda came as a shock. The 35-year-old went to the emergency department at Khoo Teck Puat Hospital when the pain from what she initially thought was menstrual cramps became unbearable. A scan found that her appendix had burst.


Mrs Pineda’s surgery was a success and her first child is due in May. PHOTO: COURTESY OF TRISHA JEANNE PINEDA

After she was treated and discharged, her biopsy results showed she had a rare disease, called pseudomyxoma peritonei, which generally refers to peritoneal tumours that are frequently associated with appendiceal tumours. It was a low-grade tumour and non-cancerous. Prof Chia, who was Mrs Pineda's doctor, explained to her that during treatment, doctors might have to remove her ovaries if the tumour had spread there. This was especially difficult for Mrs Pineda to accept as she and her husband, both from the Philippines, had been trying to have children for years. "When she told us that, I wanted to cry but I was trying to control (myself), because we had been trying to get pregnant and then suddenly we hear about this," said Mrs Pineda, a pharmacy technician.

She then underwent in-vitro fertilisation (IVF) to freeze her eggs before undergoing surgery to remove the tumour in March last year. Doctors were able to preserve her ovaries during her surgery. Mrs Pineda completed her IVF treatment and is expecting her first child next month. "I didn't have any knowledge of this kind of tumour. What we are familiar with are only the normal types of cancers," said Mrs Pineda, who hopes that sharing her story will give members of the public an idea of such rare tumours and encourage them to see a doctor if they experience pain.

Mr Pang recalled: "The most dramatic thing was learning that I had to go through another six months and another cycle of chemo - that really had a big impact on me."

During his second cycle of chemotherapy, which was intravenous, he suffered side effects such as cracking skin, sensitivity in his hands and hair loss. Following chemotherapy and surgery in October last year, doctors finally told Mr Pang there was no sign of cancer. "After hearing the words, the world seemed so beautiful," he said, adding that he cried when he was given the good news. He was finally able to go cycling with his children, who are aged between eight and 11. He said he now sleeps early and exercises regularly. "Cancer is really no joke, it's very tough. It doesn't just affect me - it affects the family also, because I couldn't do a lot of things with them. "I've started to see the world in a different light. Now everything makes me very happy.