Ask an Oncologist: Dr Donald Poon from Mount Elizabeth Novena Hospital Singapore

dr. Donald Poon replied 2 years ago

It depends on what tumour it is that you underwent surgery for. Immunotherapy is indicated for stage 3 non-small cell lung cancer after the primary treatment. The lung tumour will need to be PD-L1 positive for immunotherapy to be effective in this context. PD-L1 is a protein on the cancer cell that the lab can test to see if the cells are susceptible to immunotherapy. If immunotherapy is given for lung cancer, it is for 1 year. The infusions are done once every 3 weeks, lasting half hour each. In some forms of breast cancer especially the triple negative type, immunotherapy is also indicated in the post-surgery setting. You will need to discuss this with your oncologist.

dr. Donald Poon replied 2 years ago

Yes total cure is always possible if surgery and adjuvant chemotherapy has been done. Smoking cessation is key to prevent new lung cancers from developing if your father-in-law is a smoker.

Lung cancer is not inheritable as a condition. Your husband’s chances of lung cancer compared to the average population is not increased if he does not smoke.

dr. Donald Poon replied 2 years ago

Liver cancer is usually due to an underlying chronic hepatitis B or C viral infection. She should be screened for it. The family should also be screened for carrier status by doing a blood test as these viruses are frequently transmitted from mother to child during childbirth with exposure to maternal blood. If positive, effective antiviral drug such as entecavir may be taken to treat it. A carrier of hepatitis B virus has about 200 times increased risk of liver cancer compared to the non-carrier.

Liver cancer can be cured by surgery. If surgery is not possible, liver transplant should be explored as she is young.

Other methods to treat if advanced include Y90 SIRT, radio-frequency ablation therapy, TACE, sorafenib, levantinib, regirafenib, immunotherapy atezolizumab and bevacizumab combination, pembrolizumab depending on the situation. Do discuss options with the oncologist.

dr. Donald Poon replied 2 years ago

Bone cancer (osteosarcoma) is not associated with any mutated gene that can be inherited in the majority of cases. So do not worry unnecessarily.

If it is an inheritable form, there are mainly 2 types.

The first type is Li Fraumeni syndrome, a mutation in the p53 tumour suppressor gene in germline cells. There will be a strong family history of cancers not limited to bone cancers, may include breast cancer, soft tissue sarcoma and solid tumours of any type. The inheritance is autosomal dominant – one out of two chance of the affected?s children having this mutation. Is there a strong family history of cancers in your husband's family?

The second type is called retinoblastoma Rb1 gene mutation. Does your husband have a childhood eye problem causing blindness in one or both eyes? If so, he may harbour an Rb1 gene mutation with osteosarcoma developing in adulthood. The chance of your child inheriting the Rb1 gene mutation in this case will be also 1 in 2.

These gene mutations may be tested through a blood test but you must seek a genetic counsellor?s help before taking these genetic tests.

If your husband’s family history is devoid of high cancer incidence and he did not have eye problems leading to blindness when young, then you do not need to consider germline genetic testing for your child.

dr. Donald Poon replied 2 years ago

This is most likely coughing due to the thickened dry mucosal lining of the throat and airways. Research has found that COVID-19 infections are more severe in smokers due to the damaged airway lining that makes infection by the virus easier and impaired lung function making infection more severe.

For lung cancer, you should do a baseline chest x-ray. A CT scan of the lungs will be needed depending on the chest x-ray findings to rule out lung cancer.

Do see a doctor.

dr. Donald Poon replied 2 years ago

For adjuvant breast cancer hormonal therapy, there are 2 main different types of hormonal therapy. Aromatase inhibitors such as letrozole, anastrozole, and exemestane are used for post-menopausal women. Selective estrogen receptor modulators like tamoxifen are used for pre-menopausal women. Some women are rendered menopausal by monthly to 3 monthly injections before use of aromatase inhibitors.

The common side effects of aromatase inhibitors include joint aches, bone loss giving rise to osteoporosis, fatigue, mild hair loss, and slightly higher risk of Long term heart problems.

The common side effects of tamoxifen include weight gain, disruption of menstrual cycle with womb lining thickening resulting in heavier bleeding, potential complications include deep vein thrombosis, early stage womb uterine cancer, liver adenoma and triglyceride elevation.

Do discuss with your oncologist on strategies to prevent these side effects and surveillance for the potential longer term complications.

dr. Donald Poon replied 2 years ago

It depends on the size and profile of the tumour. If it is estrogen and progesterone receptor positive (ER/PR) and Her-2 negative breast cancer, you may ask your oncologist about Oncotype-DX or Mammaprint genetic profiling of the tumour, these are FDA approved tests that will depend if chemotherapy is useful in reducing risk of recurrence. If these tests show that chemotherapy is not beneficial, then hormonal therapy will do.

If it is Her-2 positive breast cancer, the answer is yes, combined antibody trastuzumab and pertuzumab therapy may be needed in addition to chemotherapy.

If it is triple negative breast cancer – ER/PR/Her-2 negative, adjuvant chemotherapy is usually advised as this is an aggressive breast cancer with high risk of systemic spread.

dr. Donald Poon replied 2 years ago

Unfortunately the details given are not sufficient for me to reply satisfactorily. The questions to ask the oncologist include the following –
1) Stage of cancer
2) Has the cervical tumour invaded the rectum causing rectal obstruction?
3) Has a PET or CT scan been done?
4) Has radiotherapy been given to the cervix tumour before?
5) What are the names of the chemotherapy drugs given for 6 cycles?
6) Has tumour profiling been done for presence of driver mutations?

Thank you

dr. Donald Poon replied 2 years ago

Please see a doctor for the breast lump. A mammogram / ultrasound examination will be in order. A biopsy may be needed to ascertain the nature of the lump. It may not be cancer but even if it is, early surgery and treatment usually results in a cure. Herbal medications will only delay proper treatment and lower chances of cure with the delay.

dr. Donald Poon replied 2 years ago

There may be more conservative surgery done called wide excision / lumpectomy without mastectomy. Even if a mastectomy needs to be done – there are other options of breast reconstruction post mastectomy. Surgery is still the mainstay for cure in breast cancer treatment.