For Internal Circulation Only
Official Newsletter 1 st Quarter 2018
08 01 12 04
01 CEOâ€™s Message 02-03 Cervical Cancer in Malaysia by Dato Dr Thangadorai Aloysius Raj
0 4-05 Prevention of Cervical Cancer by Dr Chew Ghee Kheng 06-07 Winning War against Cancer with SABR by Dr Tang Weng Heng
08-09 Head & Neck Cancer by Dr Venkata Murali Krishna Bhavaraju 10-11 Immunotherapy with Immune System to Treat Cancer by Dr Ang Soo Fan
Upcoming Events - Charity Giant Patchwork & Health Class Common Signs and Symptoms of Cancer Cancer Wellness Screening Package
A Message from the
CHIEF EXECUTIVE OFFICER W
elcome to the first edition of the INFORM Newsletter for year 2018!
This will be another exciting year for Penang Adventist Hospital as we work towards providing a more modern and functional healthcare facility that is able to meet best practice standards for patient care. Beginning this year, Penang Adventist Hospital will be embarking on a 2-year expansion project involving some of our key patient areas such as the Heart Centre, emergency room (ER), catheterisation laboratory, operating theatre, high dependency unit (HDU), and intensive care unit (ICU). Meanwhile, a temporary Heart Centre has been constructed to keep up with the evolving needs of our patients. The medical ward at our sister hospital, Adventist Medical Centre has also been newly refurbished to further enhance patient experiences. Penang Adventist Hospital is not just another hospital that treats the sick. We encourage the community to take charge of their health by educating and helping them to improve their lifestyle. In reinforcing our reputation as a people-centred teaching and learning healthcare system, we organised an event dubbed the "Fit-A-Thon" on 28 th January 2018. Held in conjunction with World Cancer Day which is observed annually in early February, the event themed ‘Stay Fit & Fight Cancer’ emphasised three main elements – fitness, fundraising and education. We believe that cancer survival rates can be improved by increasing public's awareness on the prevention, early detection and early treatment of the disease. The event also helped raise funds in support of our needy cancer patients. Cancer rates have been increasing. Therefore in taking things a step further, we are featuring some articles on cancer in this issue of the INFORM. The Ministry of Health Malaysia estimated one in four Malaysians will develop cancer by age 75. Women are at a higher risk of cancer, with a ratio of male to female at 1:1.2. Women are playing an increasingly important role in the development of a nation. Their well-being is not only important to themselves, but to the society. As the world celebrates International Women's Day in March, Penang Adventist Hospital would like to take this opportunity to pay tribute to the womenfolk through a month-long campaign. We will be highlighting women's contribution to the healthcare system via a video that will be shown hospital-wide and on our Facebook page. Our female staff representing all levels of the organisation will be featured as a mean to inspire, encourage and empower other females to take action towards improving their quality of life. Adding to that, articles specially written for the womenfolk is also featured in here. As we cruise ahead with the rest of the year, we look forward to continuing to help you make informed healthcare choices. Thank you for the support thus far and happy reading! Sincerely,
Mr Ronald Koh, MHA President / CEO
CERVICAL CANCER Dato Dr Thangadorai Aloysius Raj
Consultant Clinical Oncologist MBBS (Madras), MD (Madras), DMRT (Madras), MS (Gen), AM (Mâ€™sia)
alaysia has a population of 11.55 millions women age 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 2145 women are diagnosed with cervical cancer and 621 die from the disease. Cervical cancer ranks as the second most frequent cancer among women in Malaysia and the second most frequent cancer among women between 15 and 44 years of age. About 1.0% of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 88.7% of invasive cervical cancers are attributed to human papilloma virus (HPV) infection.
Malaysia was among the first countries in Asia to introduce a national HPV vaccination programme for 13-year-old school girls about five years ago. So far, the coverage has been more than 70%. Three injections need to be taken within a 6 month period with the vaccine before the onset of sexual relationship.
Cervical Cancer Normal (front view)
Early Stage IB
Uterus Cancer Tissue
Late Stage IB
Cancer Tissue Cancer Tissue
Early detection, screening and vaccination can reduce the risk of getting the cancer by 70%. Yet, the disease remains the second most common cancer among women in Malaysia. For cervical cancer, screening can identify abnormalities in cells before they become cancerous. PAP smear test will show abnormalities which could potentially lead to cancer. When abnormalities are detected, action can immediately be taken to remove those cells and prevent the cancer from developing. Proper screening in the developed countries has helped reduce the cervical cancer by 70%.
IN MALAYSIA About 99% of all cervical cancers are caused by sexual contact with a person who has been infected with HPV, a common sexually transmitted virus. It is important to note that it is transmittable through any form of sexual contact – there doesn’t have to be intercourse for the virus to spread. You can get HPV infection through any contact with genitalia which is why using condom is not an effective preventive measure. It thrives in moist, warm and dark environments and so the cervix is the perfect place, other areas that are prone to infection are the mouth and the anal area.
Most HPV infections resolve themselves and go away within a couple of months without symptoms. Therefore, those infected are often unaware that they have the virus and are carriers. There are over 100 strains of HPV, 15 of which can cause cervical cancer. The two main strains are HPV 16 and HPV 18 – responsible for 70% cervical cancer cases. Cervical cancer is slow growing and can take a long time to develop into cancer, average around 10 years.
Carcinoma Only In Cervix
Healthy cervix (viewed Cancer from Tissue below)
Dr Chew Ghee Kheng
Consultant Gynaecologist (General/ Gynaecological Oncological Surgery) MBBS (Adelaide), FRCOG (London), MD (Aberdeen), FAMS (Singapore)
ervical cancer is the fourth leading cause of female cancer among female in the world and is the second most common cancer in women aged 15 to 44 years. In Malaysia, cervical cancer is in the top five most common female cancers; and second most common in women aged 15 to 44 years. A large majority (around 85%) of the global burden occurs in the less developed regions, where it accounts for almost 12% of all female cancers. Yet in many developed countries, cervical cancer is no longer in the top 10 most common cancers in women. The question we should ask is why there is a disparity? Cervical cancer is cancer that affects the neck of the womb (uterus). It usually presents with abnormal bleeding or discharge. In the later stages of cancer, it can present with pain, kidney failure or general failing of the body. However, the very early stage cervical cancer is usually microscopic and has no symptoms. This is detected on cervical screening and can be cured if treated early.
reatment of cervical cancer is dependent on the stage of the cancer at diagnosis. Once a cervical cancer is suspected on examination, a biopsy (small sample of tissue) is taken from the cervix to confirm the diagnosis. This is followed by MRI and CT or CT-PET scan to determine if the cancer has spread. Examination under anaesthetic is performed to examine the bladder and assess if the cervical cancer can be excised surgically. Early stage cervical cancer can be treated with surgery to either remove part of / entire cervix and the lymph nodes or to remove the uterus and lymph nodes. When surgery to completely remove the cancer is not possible, the patient is offered treatment of concurrent chemotherapy and radiotherapy.
Cervical cancer is a disease that affects young women. Treatment for cervical cancer can affect fertility. In todayâ€™s generation where women postpone child bearing in favour of establishing a career, delayed detection and treatment of cervical cancer often means loss of fertility, which is heart breaking. Screening and prevention of cervical cancer should be our priority to reduce the incidence of cervical cancer. Since the 1940â€™s, we have recognised that there is a pre-cancerous disease of the cervix, referred to as cervical intraepithelial neoplasia (CIN). Women with CIN have no symptoms. Detection and treatment of CIN will prevent the transformation to cancer. The Papanicolaou smear test, commonly known as the PAP smear, is a screening test where cells are collected from the cervix. The cells are examined, to look for changes typical of CIN.
In developed countries, organised cervical screening using the PAP smear has led to a steady decline in the incidence of cervical cancer. Organised screening is very expensive to sustain, so most countries in Asia have opportunistic screening, where women who attend for health checks are offered screening. This is a less effective screening programme. Cervical screening detects the pre-cancerous disease to allow treatment. To further reduce the incidence of cancer, we have to eradicate the cause of the cancer. In 1999, research concluded that infection with high risk human papillomavirus (HPV) is necessary for the development of cervical cancer. HPV infection is acquired through intimate genital contact. Although the infection is highly prevalent, it is transient as most people are able to clear the infection, so the number of women with cervical cancer is comparatively low. HPV research has extended to development of HPV vaccination and screening test. HPV vaccines are available to prevent infection against 2 to 7 high risk HPV subtypes that are responsible for 70 â€“ 90% cervical cancers worldwide. HPV vaccine is safe and global population studies have started to demonstrate a decline in the incidence of the precancerous disease CIN in the vaccinated population.
HPV vaccination does not preclude the need for cervical screening. Cervical screening tests which detect high risk HPV subtypes have been validated as a more sensitive and standardised screening tool. In many countries, HPV testing is beginning to replace the PAP smear in the cervical screening programme. The Malaysian government has implemented National HPV Immunisation Programme in schools since 2010, with catch up programmes in the LPPKN clinics. We hope to see a decline in cervical cancer in the next few decades. However, awareness and attendance for cervical screening is poor. We should be looking to move towards using HPV test as our cervical screening tool as it has a high negative predictive factor, allowing screening to be extended to every 3 to 5 years. There are also feasibility studies to assess the self-collection kits for HPV test to promote compliance with screening. With the advances in our understanding of the natural history and the development of vaccination to prevent cervical cancer, it is a crime for a woman to die from cervical cancer. We should encourage women to attend for cervical screening and vaccination against cervical cancer in order to eradicate this deadly disease.
WINNING WAR against Dr Tang Weng Heng
Consultant Clinical Oncologist & Radiotherapist MBBS (Malaya), M. Clin. Onco (Malaya)
r A is an active 75-year-old retired veterinarian who enjoys travelling and hiking. Even though he has already retired from his veterinary practice, he does not mind attending to sick animals that were brought to him occasionally by his friends and relatives. When he discovered that his serum tumour marker CEA was on the high side, during a routine check-up, he was perplexed. He could eat and sleep well. He could jog and hike as well as someone half his age. Brushing it aside as probably a laboratory error, he decided to sit on it and repeat the test again some time later. It remained elevated. Serum CEA (carcinoembryonic antigen) is a blood test, usually done for surveillance and to assess treatment response in colorectal cancer. However, it may also be elevated in a number of other conditions.
Mr A eventually underwent OGDS (oesophageal gastroduodenoscopy), an endoscopic examination of food pipe (oesophagus), stomach and upper part of small bowel (duodenum) as well as colonoscopy (endoscopic examination of colon and rectum). The results were normal, yet his CEA continues to rise.
His children were concerned when they get to know about it. They persuaded their father to undergo further investigations. They certainly hope their fit, loving father would remain so for many years to come.
For further investigation, Mr A did a PET-CT scan. Positron emission tomography-computed tomography (PET-CT) combines the functional information from PET with the structural localisation of CT. He was found to have a metabolically active lung nodule at his left upper lobe on the PET-CT. Fortunately, the disease has not spread to the lymph nodes, his right lung as well as other organs such as the liver, adrenal, bone and brain. A subsequent CT-guided lung biopsy confirmed the lung nodule to be malignant (precisely a type of lung cancer known as adenocarcinoma, EGFR mutation positive, exon 21 L858R).
CANCER with SABR SABR, also known as stereotactic body radiotherapy (SBRT), refers to the precise delivery of radiation in several sessions (usually 3-5), instead of the conventional 20 to 30 sessions, with the aim of ablating the tumour. It combines the advantage of radiotherapy precision, as in Gamma Knife radiosurgery, with the radiobiological advantage of fractionated radiotherapy. Mr A is an ex-smoker, with a mild degree of smoking-related chronic lung disease (COPD). He had also undergone balloon angioplasty and stenting for multiple heart vessel blockage three years earlier. Mr A takes blood thinning medication, clopidogrel, for the prevention of heart attack. Until a few years ago, surgery, in the form of lobectomy (removal of an entire lobe of lung) was the â€˜gold standardâ€™ for stage I lung cancer. However with the advancement in radiotherapy technique and delivery, there is a new treatment option, in the form of stereotactic ablative body radiotherapy (SABR) that gives much hope for patients with stage I disease like Mr A. Mr A and I had a very thorough discussion on stage I lung cancer, the available treatment options, possible outcome and potential side effects. Considering his age and heart condition, surgery would pose a higher risk with prolonged recovery period. Mr A thus made an informed decision to be treated using a non-surgical approach. Prior to the treatment, Mr A underwent a 4D CT simulation, during which images of his lung tumour were taken over all phases of breathing. During the radiotherapy treatment planning process, an internal target volume (ITV) of the lung tumour was delineated based on the maximal intensity projection (MIP) from the 4D CT.
During cell cycle, tumour cells are more vulnerable during DNA synthesis phase. Meanwhile, oxygen-deprived tumour cells during the resting phase are relatively resistant. By delivering the radiotherapy over several fractions (or sessions), thereby irradiating the tumour in various phases of cell cycle, oncologists are able to exploit the relative vulnerability of tumour cells. For patients like Mr A, who travelled from his home country for treatment, treatment over several fractions is logistically more convenient and reduces the overall treatment time. More importantly, SABR has been proven to be more effective than conventional radiotherapy. Various publications have confirmed the safety and efficacy of SABR, in comparison to other forms of treatments. Mr A has been able to continue with his life saving blood-thinning medication throughout the SABR process. Prior to every session, verification process with on-board kilovoltage cone-beam CT (CBCT) was done to ensure accuracy. Online registration of CBCT and 4D CT simulation images was done to identify set-up variation, with real time correction being made accordingly. Mr A completed five sessions of SABR, done alternate day on out-patient basis over a week and a half. He was able to fly home in the same evening following the last session of his treatment and tend to the animals that required his attention.
Dr Venkata Murali Krishna Bhavaraju
Consultant Clinical Oncologist MBBS (India), MD ( Radiotherapy), PGIMER (India)
Fig. 1- Anatomy of Head And Neck Region
ead and neck cancer (HNC) is the sixth most common cancer globally. In Malaysia HNC is the The main advantage of the CRT is to increase the tumour control, leading to second most common cancer, breast cancer increase in the rates with minimal acute and late reactions and being the first. HNC is asurvival heterogeneous disease Paranasal sinuses involving thepreservation. different parts ofThe the head and organ common radiation reactions noted during the neckradiotherapy (HN) region and or its chemo-radiotherapy clinical and are Skin Reactions, Mucosal Reactions The main advantage of the CRT is to increase the tumour control, leading to pathological presentation. Squamous cell Nasal cavity during the radiation and late reactions inisthe form ofthe Xerostomia (Dryness of to The main advantage of the CRT to increase control, leading carcinoma is increase the most common pathological in the survival rates with minimal acuteNasopharynx and tumour late reactions and increase in the survival rates with minimal acute and late reactions and mouth due to decrease in the saliva), dental caries, very rarely Osteo radio variant noted in thisadvantage region. In theofyear 2008, preservation. The common radiation reactions noted during The organ main the CRT is to increase the tumour control, leading tothe organ preservation. The common radiation reactions noted during the Coral cavity more thanincrease 600,000 patients diagnosed necrosis of Mandible. with theacute availability ofreactions the advanced Oropharynx in the survival rateswith withHNC minimal and and Tongue radiotherapy or However, chemo-radiotherapy arePharynx Skin late Reactions, Mucosal Reactions or Skin late Reactions, Mucosal Reactions globally. Treatment ofradiotherapy HNC depends onchemo-radiotherapy the the incidence are radiation techniques like VMAT of the radiation organ preservation. The common radiation reactions noted during the reactions Salivary glands during the radiation and late reactions in the form of Xerostomia (Dryness during the radiation and late reactions in the form of Xerostomia (Drynessof of region of origin.
radiotherapy or to chemo-radiotherapy are Skin Reactions, Mucosal Reactions are decreased and there is improvement in the Quality of very Life (QoL) of the mouthmouth due decrease in theinsaliva), dental caries, very rarely Osteo due to decrease the saliva), dental caries, rarely Osteo- radio - radio
the radiation and late reactionswith in the form of Xerostomia (Dryness of HN HNC regionduring is necrosis divided into pharynx Hypopharynx patients. of oropharynx, Mandible. However, the availability of the advanced necrosis of Mandible. However, with the availability of the advanced Larynx and hypopharynx (Fig.to 1).decrease Common presentation mouth due in the saliva), dental caries, very rarely Osteo radio radiation techniques like VMAT the incidence of the late radiation reactions radiation techniques like VMAT the incidence of the late radiation reactions of the patients of the HNC also differs necrosis of Mandible. However, with the availability of the advanced are decreased and there is improvement in the Quality of Life (QoL) ofofthe are decreased and there is improvement in the Quality of Life (QoL) the depending on the region of cancer radiation techniques like(Table VMAT1).the incidence of the late radiation reactions HNC patients. HNC patients. Wheneverare a person noticed the above decreased and there is improvement in the Quality of Life (QoL) of the complaints or having the suspicious lesion HNC patients. (Table 2) should consult the family physician or a ear, nose & throat (ENT) specialist. The treatment of oropharynx is mainly surgery followed by radiotherapy depending on the necessity. For pharynx and hypopharynx, radiotherapy along with chemotherapy is the main stay of treatment. Multi-disciplinary treatment planning (surgery, radiotherapy (XRT), chemotherapy and biological therapy) either alone or in combination is the main stay for the management of HNC. Radiotherapy plays a major role in the management of the HNC, about 75% patients of HNC will receive radiotherapy with either curative or palliative intent.
Upper part of the spinal column Bone under the tongue (hyroid bone) Cartilage around the thyroid and trachea
Lymph nodes in the neck Esophagus
Thyroid Trachea Hypopharynx Larynx Esophagus Trachea
Fig. 3 & 4 - 3D CRT/ IMRT/ IGRT/ VMAT Mechanism
The goal of radiotherapy is to deliver a high dose of radiation to the tumour and less dose to the surrounding normal tissue i.e. organs at risk (OAR). Radiotherapy treatment is revolutionised in the last decade and half in reaching its goal. With the development in the field of imaging CT scan machine for planning, linear accelerators and computer technology, reaching the goal become a reality (Fig. 2). Abbreviations: 3D CRT - 3 Dimensional Radiotherapy
- Intensity Modulated Radiotherapy
IGRT â€“ Image Guided Radiotherapy
VMAT â€“ Volume Modulated Radiotherapy
Fig. 2 Radiotherapy Machines & CT Scan Machine For Planning
Table 1- Presentation Of HNC Patients The radiotherapy delivered to the HNC is becoming more and more conformal radiation (CRT). Conformal radiation is the method to deliver the high dose of radiation to the tumour volume by shaping the radiation beams and minimizing the dose to the OAR. To achieve the conformal radiation to the target, oncologist use 3D CRT/ IMRT/ IGRT/ VMAT mechanism (Fig. 3 & 4). With the availability of state-of-art technology of the linear accelerators, it is now possible to check the area of treatment daily for the reproducibility of the area of radiation. The main advantage of the CRT is to increase the tumour control, leading to increase in the survival rate with minimal acute and late reactions and organ preservation. The common radiation reactions noted during the radiotherapy or chemo-radiotherapy are skin reactions, mucosal reactions during the radiation and late reactions in the form of xerostomia (dryness of mouth due to decrease in the saliva), dental caries, and very rarely osteo - radio necrosis of mandible. However, with the availability of the advanced radiation techniques like volumetric modulated arc radiotherapy (VMAT), the incidence of the late radiation reactions are decreased and there is improvement in the quality of life (QoL) of the HNC patients.
Tongue Buccal Mucosa Palate Gums Lips
Non Healing Ulcer Growth over Palate/ Lips Excessive Salivation Halitosis (Bad Breath) Slurring of Speech
Smoking Betel Nut Chewing Chewing Tobacco Sharp Tooth HPV Infection
Nasal Bleeding Neck Nodes Hearing Defects Nasal Block Double Vision Facial Pain (Rare) Head Ache (Rare)
Smoking Alcohol Consumption Excessive Consumption of Smoked / Salted Fish Infection with Epstein Bar Virus
Change of Voice Difficulty in Breathing Stridor Pain
Smoking Consumption of Alcohol
Difficulty in Swallowing Neck Nodes Painful swallowing
Smoking Consumption of Alcohol
Table 2 -When To Suspect Cancer In HN Region Hoarseness or change of voice persisting for > 6 weeks. Non healing ulcers for > 3 weeks on tongue, cheeks, lips or palate. Oral swellings persisting for > 3 weeks. Suspicious white or red patches on the palate or cheeks. Difficulty in swallowing persisting for > 3 weeks. Nasal obstruction, particularly when associated with purulent or blood discharge. Unexplained tooth mobility not associated with periodontal disease. Newly detected painless neck masses for > 3 weeks. Double vision sudden onset.
with IMMUNE SYSTEM to treat CANCER
Dr Ang Soo Fan
Consultant Medical Oncologist MBBS (UM), MRCP (UK), FAMS Medical Oncology (S'pore)
r Jim is a 49 years old successful businessman. He is happily married with 2 lovely children. He likes to exercise, plays tennis every week, and goes for a jog regularly. He used to smoke for 15 years, but quit 5 years ago. What happened a year ago changed his life. It is something that may end his life too. He was diagnosed with stage 4 lung cancer. He felt tightness on his chest that lasted for a week, and getting more breathless while exercising about a year ago. He had been coughing for two months, seen a few GP and taken a few rounds of medications. Finally he consulted a physician. A chest X ray was done and it showed fluid accumulation in his left chest. A chest tube was inserted to drain the fluid. Subsequently a PETCT scan was performed. To his surprise, there were masses in his lungs, and a few bright spots could be seen in the lymph nodes at the center of his chest. These findings were consistent with an advanced stage of lung cancer. A biopsy was performed on the lung mass and the histo-pathological examination confirmed diagnosis for adenocarcinoma, the most common type of non-small cell lung cancer. This was the most devastating time in his life. As with all other patients, many negative thoughts popped into his head: what would happen then? How long could he live? Is he going to suffer the side effects of chemotherapy?
The lung biopsy was sent for further testing, including epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations test. The presence of one mutation can predict response to targeted therapy, using oral medicines such as Iressa, Tarceva, Geotrif, to treat lung cancer. Unfortunately, all these mutations were negative. This mean the oral medicine will not work for him. Negative mutations test is common among patients who were smokers. He was also offered another test to see if he was suitable to use a newly approved novel drug. The test is called PD-L1 (programmed death-ligand 1). The result of the test showed that he had high expression of PD-L1.
So What Does This Mean? What Is PD-1 Or PD-L1? PD-1 is a checkpoint protein on immune cells called T cells. It normally acts as a type of â€œoff switchâ€? that helps keep the T cells from attacking other cells in the body. It does this when it attaches to PD-L1, a protein on some normal (and cancer) cells. When PD-1 binds to PD-L1, it basically tells the T cell to leave the other cells alone. Our Immune System Our immune system has the natural capacity to detect and destroy abnormal cells which may lead to preventing the development of many cancers. However, cancer cells are sometimes able to avoid detection and destruction by the immune system. How does cancer cells do this?
Cancer Cells Are Smart!
Does Immunotherapy Has Any Side Effects?
Many people with healthy immune system still develop cancer. This is because our immune system doesn’t see the cancer cells as something foreign as there aren't any difference between them and the normal cells. One of the important mechanism cancer cells may avoid detection by the immune system is to express a large amounts of PD-L1 proteins on their cell surface that induce immune cell inactivation. PD-L1 acts like a protective shield to the cancer cells, masks the cancer cells from immune cells surveillance and destruction.
Immunotherapy enables the immune system to recognize and target cancer cells. Immunotherapy has been an effective treatment for patients with certain types of cancer that have been resistant to chemotherapy and radiation treatment.
Immunotherapy side effects can be different from those seen with chemotherapy or radiation. They are usually related to stimulation of the immune system and can range from minor symptoms like rash, itching, and fever, to major conditions similar to autoimmune disorders such as pneumonitis, diarrhoea, and hypothyroidism. Fortunately, severe side effects are rare.
Deeper understanding of the pathobiology of non-small cell lung cancer (NSCLC) has led to the development of novel molecules that target specific pathway known to play critical roles in the development of cancer.
The first immunotherapy approved in Malaysia is Pembrolizumab (Keytruda). This is an antibody that targets and block PD-1, and boost the immune response against cancer cells.
CAR T-cell Therapy
Cancer Vaccines A patient’s own immune cells are removed and exposed to these substances in the lab to create the vaccine. Once the vaccine is ready, it’s injected into the body to increase the immune response against cancer cells. Cancer vaccines induce the immune system to attack cells with one or more specific antigens. Sipuleucel-T (Provenge®) is the only vaccine approved in the US to treat advanced prostate cancer that is no longer responding to hormone therapy.
It is important to notify your doctor of any side effects when receiving immunotherapy treatment, as many of these can be treated to prevent worsening.
A type of treatment in which a patient's T cells are taken from his blood. Then the gene for a special receptor that binds to a certain protein on the patient’s cancer cells is added in the laboratory. The special receptor is called a chimeric antigen receptor (CAR). Large numbers of the CAR T cells are grown in the laboratory and given to the patient by infusion.
In 2017, two CAR T-cell therapies were approved by the Food and Drug Administration (FDA), one for the treatment of children with acute lymphoblastic leukemia (ALL) and the other for adults with advanced lymphomas. Now we understand what immunotherapy is all about. Mr Jim had advanced lung cancer, which expressed high levels of PD-L1. This means there is a high possibility that immunotherapy is able to detect and destroy cancer cells in Mr Jim’s body.
Instead of the usual chemotherapy, he was started on Pembroliumab. This medicine is administered as an intravenous infusion over 30 minutes every 3 weeks. After 3 cycles, his cough completely resolved. A repeat scan showed the fluid in his lung had completely disappeared. After 6 cycles, a repeat scan amazingly showed all the cancer masses in his lung and lymph nodes have completely resolved. He has experienced no side effects with the treatment. Mr Jim has since return to his normal life.
International Women’s Day
Anti-aging For Women 4 th March 2018, 10am (Sunday) Auditorium
"Anti-Oxidant, Why is it important" by Loy Huey May , Nutritionist
"Embracing Menopause" by Kok Su Lynn , Senior Physiotherapist
HEALTH CLASS 肺癌 Lung Cancer by Dr Ang Soo Fan, Consultant Oncologist
18 th March 2018, 3pm (Sunday) Auditorium
流感疫苗 Flu Vaccine by Dr Edward Nathan, Public Health Doctor
25 th April 2018, 3pm (Wednesday) Auditorium
巴氏涂片检查 Papsmear by Dr Diong Seng Kwok , Consultant ObGyn
6 th May 2018, 3pm (Sunday) Auditorium * Subject to change.
A giant teddy will make its rounds around Penang to greet generous donors who believed in making needy patients’ life better through medical charities! Generous donors will be given an opportunity to meet our giant teddy, Snuggles, where one can write their names, sign encouraging messages or dedicate their donations in honour of a courageous family member of friend who overcome all odds to lead a healthy and normal life. Together with Snuggles, one can seized the opportunity for fun photos opportunities with Snuggles, learn more about hospital through simulation play, teddy making workshop and many more exciting activities. Another notable highlight for this project will be silent auction for teddies around the world. This project aims to raise funds for the Hospital’s Dr. J. Earl Gardner Fund, and to promote the Medical Social Services which constantly disburse funds to help the needy. All proceeds will be chanelled to Dr. J. Earl Gardner Fund, a fund that assist needy patients who undergo major surgeries suffering from major illnesses in the area of cleft palate repair, limb amputation, scoliosis, stroke, etc. We invite you to partner us by donating to help patients in need. Come and visit Snuggles and pledge to patch!
For further information, kindly contact:
(+604) 222 7606 / 7644 Adventist Hospital Charity 12
* Adapted from the National Cancer Society Malaysia.
TAKE CONTROL OF YOUR HEALTH Register Yourself and Get Screened Today!
“ SCREENING CAN SAVE LIVES ” FEMALE Physical exam and consultation by wellness doctor Lab tests for blood and urine Female cancer marker tests – colon, breasts, and ovaries Ultrasound of breast and upper abdomen, and chest X-ray Stress ECG Stool for occult blood
Promotion valid from
28 January - 31 March 2018 * Terms and conditions apply
Physical exam and consultation by wellness doctor Lab tests for blood and urine Male cancer marker tests – prostate, colon, pancreas Ultrasound of upper abdomen and pelvis, and chest X-ray Stress ECG Stool for occult blood
For registration, please contact Adventist Lifestyle Centre
(+604) 222 7779 / 7732 email@example.com 13
OUR SERVICES • Multidisplinary Treatment • Surgical Oncology • Advanced Imaging Facilities - Linac : Linac with VMAT & IMRT system ensures high precision and accuracy in radiation treatment - CT Simulator : CT Simulator with Sentinel Tracking system comes with the industry widest bore for faster, safer and more comfortable imaging
• • • • • • • •
Radiotherapy Chemotherapy Clinical Trials & Research Inpatient Services Cancer Information & Support Pre-Chemotheraphy / Pre-Radiation Counselling Nutrition, Wellness, Psychological Counselling Chaplaincy & Palliative Care / Patient Support Group
Published on Feb 22, 2018