Beating an ‘impossible’ cancer

Abdominal cancer with peritoneal metastases used to amount to a death sentence for many patients, according to Dr Tan Yu Meng, chief surgeon at Mount Elizabeth Hospital, Singapore. “Patients often live a few months after being diagnosed with it,” says Dr Tan.

The treatment for such advanced cancers, however, has undergone a paradigm shift in the last decade. With advances in the combined use of surgery, chemotherapy and targeted therapy, even late-stage cancer patients can now live much longer and enjoy an improved quality of life.

Improvements in the treatment of peritoneal cancer

Abdominal cancer from the gastrointestinal tract, including the colon, stomach and appendix, or from the ovaries, can grow and spread to the peritoneum, the membrane lining of the organs in the abdomen. This ‘inner skin’ covers organs like the stomach, colon and rectum, small intestines, liver, spleen, and pancreas.

This form of cancer, known as peritoneal cancer, affects up to 25 percent of patients with advanced gastrointestinal and gynaecological cancers, and was once deemed notoriously difficult or downright impossible to treat. Patients often complained of pain, bloatedness, abdominal swelling and difficulty eating and passing motion.

“It can now be combatted with a new, two-step treatment called Peritonectomy and Hyperthermic Intra-Operative Peritoneal Chemotherapy (HIPEC),” explains Dr Tan.

In this treatment, the patient first undergoes a peritonectomy with complete cytoreductive surgery, where all the cancerous tumours in the abdomen are removed together with the parts of the peritoneal lining that are affected by the cancer. This is a meticulous and carefully done surgery, which can take between six to eight hours.

The peritonectomy is followed by a hyperthermic intra-operative peritoneal chemotherapy (HIPEC) procedure, in which heated chemotherapy drugs are delivered into the patient's abdominal cavity and circulated at 42°C for 30 to 90 minutes. Unlike conventional chemotherapy, this method targets and removes all microscopic cancer cells in the abdominal cavity. In fact, it works very well because cancer cells are more easily killed at 41-43°C whereas normal body cells can survive this temperature without being affected.

“This new technique has gained worldwide acceptance and has an extremely low mortality rate of less than three percent,” shares Dr Tan. “In our local experience, we have had no mortality and a very low complication rate comparable to other top cancer centres.”

“At Mount Elizabeth Hospital, we adopt a holistic team approach. We help our patients prepare for surgery and tailor peri-operative care to each individual. This way, we do our utmost to ensure a smooth recovery for each patient,” he says.

Treatment renews hope for cancer patients

Dr Tan shares his recent experience in treating an Indonesian patient who was misdiagnosed with a hernia problem and was told he had an advanced cancer that cannot be treated,” he explains.

When the patient learnt of this, his life collapsed around him as he was effectively given what amounted to a death sentence. “To top it off, he was offered palliative chemotherapy, which would not cure him but ease his passing instead," says Dr Tan.

This patient sought out Dr Tan at Mount Elizabeth Hospital for a second opinion. He was diagnosed with appendiceal cancer with metastasis to the entire peritoneal cavity, and was started on the two-step peritonectomy and HIPEC course of treatment, explains Dr Tan.

The treatment process took about nine months, but it literally saved the patient’s life. "It is now nearly five years since his last surgery,” says Dr Tan. “He is disease-free and back to a normal life, working and going about his daily activities. He stands an 80 percent chance of beating his cancer - that's quite an amazing result for someone who was given no hope.”

Dr Tan Yu Meng is a specialist in pancreatic surgery and received extensive training in chemotherapy for peritoneal cancer. He graduated from the Charing Cross & Westiminster Medical School (now the Imperial College of Medicine) at the University of London with First Class Honors and Distinction in his Bachelor of Medicine and Surgery in 1994. He went on to train in general surgery at Singapore General Hospital under his mentor Professor Soo Khee Chee and became a Fellow of the Royal College of Surgeons Edinburgh in 1999. Dr Tan is one of the few surgeons in Asia who perform specialised surgery for peritoneal malignancies. In 2012, he has embarked on an exciting new venture as founder and chief surgeon of a new surgical group practice called ‘FeM Surgery’ at Parkway Hospitals. This is a multidisciplinary practice that adopts his philosophy of team based approach comprising medical and allied health professionals for the best patient care.

Mount Elizabeth Hospital
3 Mount Elizabeth, Singapore 228510
Tel: (+65) 6735 5000
www.mountelizabeth.com.sg

FeM Surgery
3 Mount Elizabeth #05-02
Mount Elizabeth Medical Centre
Singapore 228510
Tel: (65) 6733 3383
www.femsurgery.com