BETTER TREATMENT OPTIONS NOW FOR OVARIAN CANCER ...HELPING READERS TO ACHIEVE GOOD HEALTH. AN NCCS QUARTERLY PUBLICATION April June 2014

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1 Issue No. 29 MICA (P) 40/03/204 AN NCCS UARTERLY PUBLICATION April June HELPING READERS TO ACHIEVE GOOD HEALTH Salubris is a Latin word which means healthy, in good condition (body) and wholesome. BETTER TREATMENT OPTIONS NOW FOR OVARIAN CANCER

2 2 SALUBRIS APRIL JUNE 204 SALUBRIS APRIL JUNE CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY A VIABLE OPTION FOR ADVANCED OVARIAN CANCER BY DR CLARAMAE CHIA AND DR MELISSA TEO Division Of Surgical Oncology Ovarian cancer is the 5th commonest cancer amongst females in Singapore. There are 390 cases diagnosed yearly based on the Singapore Cancer Registry It is the second most common female genital tract cancer. Epithelial ovarian cancer usually affects older women although it can also happen to younger women. Most patients with ovarian cancer present with seemingly innocuous symptoms of abdominal distension and discomfort at the onset. Other common presentations may be the presence of a pelvic mass, urinary urgency or frequency, nausea, anorexia and early satiety. As the symptoms are not specific, patients may be treated or worked up for other conditions before and hence are often diagnosed at an advanced stage, with 60 70% presenting with disease that has spread from the ovaries. 75% have International Federation of Gynecology and Obstetrics (FIGO) stage III disease (within the peritoneal cavity or involving para-aortic, pelvic, or inguinal lymph nodes) and FIGO stage IV disease (beyond the peritoneal cavity, including lung and liver parenchyma) 2. Patients usually undergo blood tests that include the tumour marker CA25. Imaging involves an ultrasound or CT of the abdomen and pelvis to evaluate masses or distension as well as evaluate the liver for metastasis. A CT chest may be done to look for lung metastasis or pleural effusions. Surgery remains the cornerstone of management for ovarian cancers, as it is often required initially to obtain a diagnosis, to formally stage the patient, and is also the mainstay of treatment in the majority of diagnosed cases. In the advanced cases, it is followed by adjuvant chemotherapy with platinum-based and taxol-based chemotherapy. The definition of optimal cytoreduction has evolved with the initial definition of residual tumour less than 2cm being adjusted to tumour less than 5mm. Over the years, there has been a plethora of data concluding that complete cytoreduction, with no gross residual disease, yields the best results in terms of survival. Patients with no gross residual disease, 0. 2cm residual disease, and more than 2cm residual disease had 5-year survivals of 60, 35, and less than 20%, respectively 3,4. For patients who have not metastasized to the lung or liver, the disease remains confined to the peritoneal cavity and retroperitoneal lymph nodes for much of its natural history and hence, it is a good candidate for aggressive locoregional therapy. Ovarian cancer is prone to spreading to peritoneal lining and many patients may be found to have peritoneal disease on preoperative imaging or during surgical exploration. When the disease recurs, a large proportion of them also tend to be in the peritoneum. Complete cytoreduction is the treatment of choice. Recently, cytoreductive surgery (CRS) with peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly being performed. CRS aims to remove all the visible tumours in the abdomen. Intra-abdominal organs that are invaded by tumour and can be safely removed will be resected to ensure that no disease remains. Peritoneum that is commonly removed includes the peritoneum in the pelvis, under the diaphragm and the paracolic gutters (the right and left flanks of the abdominal cavity where the colon lies). HIPEC was first introduced in the early 980s for the treatment of peritoneal carcinomatosis. CRS and HIPEC for the management of peritoneal surface malignancies were popularised by Dr Sugarbaker in the 990s 5. The addition of hyperthermia to the intraperitoneal chemotherapy has been shown to increase penetration of the chemotherapy and improve its absorption into the tumour cells, increasing the intracellular accumulation of the drug. The cytotoxic effect appears to be similarly potentiated, secondary to an impairment of the cells ability to perform DNA repair, hence has a greater deleterious effect. HIPEC is performed intraoperatively under general anaesthesia after cytoreductive surgery, via a pump that maintains the temperature and circulation of the drug solution. This ensures that the entire peritoneal surface is bathed in the chemotherapeutic agent, prior to the formation of obstructing adhesions that may develop in the postoperative period. Cisplatin is the drug that is commonly used for ovarian cases. The most important prognostic factor remains the completeness of cytoreduction, with a 5.5% increase in the median overall survival for every 0% of patients undergoing optimal cytoreduction, leading to the inevitable conclusion that the changing surgical paradigm for ovarian cancer embracing radical CRS has resulted in significantly better survival results 6. The combination of CRS and HIPEC has shown promising results, with median overall and progression-free survivals of up to 64 and 57 months, respectively 7. Optimal cytoreduction yields 5-year survivals of 2 66% 8. The time points at which CRS and HIPEC have been used in the management of advanced ovarian cancer include the primary setting, after neoadjuvant chemotherapy, at the point of recurrence, and as a second-line treatment. In the Milan 2006 consensus statement, it was concluded that CRS and HIPEC could be feasible at all the abovementioned time points. REFERENCES: Coleman RL, Monk BJ, Sood AK, et al. Latest research and treatment of advanced-stage epithelial ovarian cancer. Nat Rev Clin Oncol 203; 0: Young RC, Decker DG, Wharton JT et al. Staging laparotomy in early ovarian cancer. JAMA. 983;250(22): Fotopoulou C, Savvatis K, Kosian P, et al. uaternary cytoreductive surgery in ovarian cancer: does surgical effort still matter? Br J Cancer 203; 08: doi: 0.038/bjc Chang SJ, Hodeib M, Chang J, Bristow RE. Survival impact of complete cytoreduction to no gross residual disease for advancedstage ovarian cancer: a meta-analysis. Gynecol Oncol 203; 30: Mohamed F, Cecil T, Moran B, Sugarbaker P. A new standard of care for the management of peritoneal surface malignancy. Curr Oncol 20; 8:e84 e96. 6 Kang S, Park SY. To predict or not to predict? The dilemma of predicting the risk of suboptimal cytoreduction in ovarian cancer. Ann Oncol 20; 22 (Suppl. 8):viii23 viii28. doi: 0.093/annonc/mdr Biliatis I, Haidopoulos D, Rodolakis A, et al. Survival after secondary cytoreduction for recurrent ovarian cancer: which are the prognostic factors? J Surg Oncol 200; 02: The morbidity and mortality for such a procedure range from 0 to 40 and 0 to 0%, respectively, and include nausea and vomiting, gastrointestinal disturbances and ileus, anastomotic leaks, perioperative bleeding, pleural effusions and pneumothoraces, intra-abdominal collections/ abscesses, and sepsis. The key is in patient selection, and it is imperative that patients with a good ECOG and an ability to tolerate such a radical procedure be chosen. The best candidates have long disease free intervals prior to surgery and low volume disease that can be confidently optimally debulked. NCCS has been performing CRS and HIPEC since 200. In 203, we published our data on our initial 00 patients 9. Between 2005 and 203, our unit has performed 55 cases of cytoreductive surgery and HIPEC for patients with recurrent ovarian cancer. The median age of the patients was 5 years old. The median SICU stay was day (range 0-5 days) and the median hospital stay was 6 days (range 8-88 days). The median disease free interval was 9.7 months. We had no 30-day mortalities and the morbidity rate was 57.4%. These rates are comparable to other major oncological surgeries such as hepatectomies and esophagectomies. The, 3 and 5 year overall survival rates are 9.6%, 56.5% and 56.5% respectively. The, 3 and 5 year disease-free survival rates are 69.9%, 6.8% and 8.4% respectively. Without HIPEC, the 5-year overall survival rate has been shown to be.5%. A higher PCI score and a CC score of or 2 were associated with a worse overall and disease free survival. In spite of the improved survival and acceptable morbidity and mortality of cytoreductive surgery and HIPEC, concerns about the quality of life for survivors remain. Multiple papers including our own unit s data, has shown that the quality of life drops initially after surgery but returns to baseline or higher after 2 years 0. While we compared our patients to a group of comparable advanced cancer patients who were undergoing chemotherapy, our patients generally had a better quality of life. In conclusion, ovarian cancer is a common gynaecological cancer and many patients present at a late stage as the symptoms are non-specific. Cytoreductive surgery and HIPEC with the aim of no residual disease is a procedure that has improved overall and disease free survival rates. It can be considered as a viable option for patients who present with peritoneal disease from ovarian cancer. 8 Chua TC, Robertson G, Liauw W, et al. Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in EOC peritoneal carcinomatosis: systematic review of current results. J Cancer Res Clin Oncol 2009; 35: Teo MC, Tan GH, Tham CK, Lim C, Soo KC. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in Asian patients: 00 consecutive patients in a single institution. Ann Surg Oncol. 203 Sep;20(9): Tan WJ, Wong JF, Chia CS, Tan GH, Soo KC, Teo MC. uality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: an Asian perspective. Ann Surg Oncol. 203 Dec;20(3):

3 4 SALUBRIS APRIL JUNE 204 SALUBRIS APRIL JUNE SINGAPORE CTC CoRE PAVING THE WAY FOR BETTER CANCER MANAGEMENT BY EDWIN YONG Executive Corporate Communications For cancer patients, the road to recovery is a long, enduring journey. Not only do they have to bear the emotional stages of their first diagnosis, the agony of chemotherapies and operations are no less easy to pass. Mindful of the woes of our patients, NCCS looks to continuously refine our treatment processes through research and collaboration. The Circulating Tumour Cell Centre of Research Excellence or CTC CoRE in short, has begun works to develop such treatments since late last year. The end objective of the research is to facilitate the use of circulating tumour cells (CTCs) in clinical diagnostics, which will allow better healthcare for cancer patients. What if we tell you that in the near future, medical treatments will be personalised to ensure that they are effective, efficient and minimises discomfort during treatment? TRADITIONAL CANCER DIAGNOSIS CANCER DIAGNOSIS WITH CTCS DIAGNOSIS TUMOUR BIOPSY TUMOUR BIOPSY With the new technology, cancer cells can be harvested from a regular blood sample without the need for complicated procedures to obtain cells from tumours. To determine whether a treatment is viable, blood samples will be drawn from the patient pre- and post-treatment. Through separation of cancer cells from other blood components, the number of cancer cells are counted and documented. If there is no reduction in the number of cancer cells, the oncologist may decide to modify the treatment regime to best combat the cancer. These diagnoses will result in an increase in treatment effectiveness in cancer therapy management, and will also lead to reduced side effects and significant cost savings. TREATMENT DECISION LIUID BIOPSY REAL-TIME FEEDBACK TREATMENT DECISIONS BASED ON RESULTS Circulating Tumour Cells will potentially provide key information in determining treatment effectiveness through real time monitoring and post treatment diagnosis. The collaboration between National Cancer Centre Singapore (NCCS) and Clearbridge BioMedics, in partnership with the Pathology Department at Singapore General Hospital (SGH) is still in its initial phases and if successful, this will boost NCCS position as a centre for cancer management, as well as enhance Singapore s reputation as an oncology thought leader in Asia. Lee, G.Y. and C.T.Lim, trends Biotechnol, 2007 CTCs are cells that have detached from a primary tumour and are circulating in the blood stream. They are rare, with only a few CTCs mixed with billions of blood cells per milliliter of blood. This is the age of personalised medicine, and it s important to be able to tailor the treatment that we give to patients based on the profile of the tumours that they have, said Professor Soo Khee Chee, Director of NCCS during the CTC CoRE press conference. The CTC CoRE team (from left): Prof Lim Chwee Teck, co-founder of Clearbridge BioMedics and also newly appointed NUS Provost s Chair, NUS Faculty of Engineering; Mr Johnson Chen, CEO of Clearbridge Biomedics; Assoc Prof Tan Puay Hoon, Head & Sr Consultant, Department of Pathology, SGH; and Prof Soo Khee Chee, Director of NCCS. A technician at the CTC CoRE.

4 6 SALUBRIS APRIL JUNE 204 SALUBRIS APRIL JUNE PROTEIN ANP32E GENE REGULATOR: THE KEY TO GENETIC DISCOVERY BY EDWIN YONG Executive Corporate Communications Imagine a day when doctors are able to foresee potential diseases and provide the absolute treatment to every individual through the study of their DNA structure. This scenario may no longer be a fantasy. A team of scientist from the National Cancer Center Singapore (NCCS), the Institut de Génétique et de Biologie Moleculaire et Cellulaire (Strassbourg France), and the Institut Albert Bonniot (Grenoble, France) has made an important finding on how genes are regulated, a big step towards that vision. The study was released on January 30, 204 and was published in the notable peer-reviewed journal, Nature. The discovery was found using a genetically modified mouse that was developed by Dr Patrick Reilly, a Senior Scientist in the Laboratory of Inflammation Biology at NCCS, to demonstrate that DNA architecture in the living cell is maintained in part by a protein called ANP32E. The ANP32E or Acidic leucine-rich nuclear phosphoprotein 32 family member E is a protein in humans. While DNA is normally represented as a two strands forming a helix, the actual amount of DNA in the cell means that these strands must be compacted into complex structures, called chromatin, which restricts the DNA volume while still allowing access to encoded information, said Dr Reilly. The ANP32E protein has the ability to remove a specific component of the chromatin known as H2A.Z, which has been previously known as an important element in controlling specific regions of DNA expression. The removal of H2A.Z will alter the gene expression and provide more insights to the chromatin structure. Over the recent years, researchers have discovered that errors in chromatin structure are usually found in a wide array of developmental diseases as well as in all types of cancers. Through understanding the processes controlling chromatin structure, the research aims to improve our tools for timely regulation of specific genes, thus reversing the impact of many diseases and could reveal novel therapeutic strategies in the long run. While DNA is normally represented as a two strands forming a helix, the actual amount of DNA in the cell means that these strands must be compacted into complex structures, called chromatin, which restricts the DNA volume while still allowing access to encoded information.

5 8 SALUBRIS APRIL JUNE 204 SALUBRIS APRIL JUNE ENREACH RETREAT: HEALING THE BODY, MIND AND SOUL BY BRANDON GOH Manager Department of Psychosocial Oncology The signature event of NCCS Patient Support Programmes was the brainchild of A/Prof Koo Wen Hsin. The idea of providing patients and caregivers with a short respite from their routine lifestyles forms the foundation of the retreat. While at it, Dr Gilbert Fan, Head of Department of Psychosocial Oncology, and his team of medical social workers furthered his idea, tailoring the programmes to encompass a wide variety of knowledge sharing and educational activities. The three days, two nights retreat has been ongoing for more than 0 years. The retreat programmes range from talks to workshops that primarily focus on three areas; medical, psychosocial and physiological aspects of cancer. The Programmes include ) workshop on common & chronic physiological symptoms that patients with cancer may experience, 2) diet and nutrition workshop on positive psychology in cancer and 3) panel discussions between participants and oncologist, which were very well received by the attendees. Adding wholesomeness to the event were programmes for the children. While parents were attending talks and workshops, the kids were attended by social workers who are cross-trained in Art Therapy. Using art as a medium, the medical social workers would then be able to help these children process their feelings they have pertaining to their parents illness. The overall objective was really to provide an opportunity for children coping with parental cancer to bond and support one another through their sharing of common experiences. Art Therapy helps children to explore their inner and external self, promotes the expression and release of associated feelings, and strengthens and enhances the coping skills of each individual child. Besides the therapeutic component of the Children Programme, there were also fun games and activities incorporated into the three days programme. The aim was to bring in the elements of normalcy and fun in the children s lives despite having to cope with their parental illness. Such fun team building games also helped to promote the bonding and trust among the children; leading to greater support for one another. Participants were also treated to songs and dance during dinner on the second night by the band E Thrust who has been supporting this retreat all these years. Besides the knowledge acquired, participants shared how they continue to meet and support one another, including going on holidays together, accompanying each other for medical appointments and at times, babysitting their peer s children. This was indeed a touching testimonial of friendship forged during the three days that goes a long way. The EnReach Retreat is a golden opportunity for patients and their caregivers to experience personal growth and transformation as they interact with other persons affected by cancer and hear from doctors and allied health professionals about how they can better manage their medical condition. JOLENE GOH Medical Social Worker Supported by Dr Yap Yoon Sim, Dr Chay Wen Yee, Dr Gilbert Fan and Brandon Goh, the successful event saw an increasing number of participants with a total of 88 sign-ups this year. Special mentions were given to the team comprising of the Department of Psychosocial Oncology, doctors, health professionals and volunteers who have made this event possible. STEPPING INTO CLINICAL TRIALS WITH MR YOW A persistent cough that just wouldn t go away for months, Mr Yow froze to the ground when he was told to be suffering from stage 4 lung cancer with barely three months to live. Apart from the contrary, the 70 years old retired teacher doesn t smoke or drink. Thirteen months and counting, Mr Yow has been experiencing better health, good appetite and had also travelled to China during the recent period. EDWIN YONG catches up with Mr Yow after his sharing session at the EnReach Retreat. Mr Yow was diagnosed with lung cancer on 26 December 202 after undergoing a biopsy at Khoo Teck Phuat Hospital, draining 6.5 litres of liquid from his lungs. He was then referred to National Cancer Centre Singapore for further treatment. Administered with chemotherapy as a first line of treatment, he immediately felt relieved from the persistent coughing he had earlier. He was offered a place in a phase 3 clinical trial programme when the doctors found his tumour grew in size after the initial treatment. The second line of treatment adopts immunotherapy drugs on top of his standard chemotherapy treatments. We spoke to Mr Yow on his thoughts on participating in clinical trials. What were your considerations when the doctor broached to you the idea of being in a clinical trial programme? YOW: A glimmer of hope was all I see. A chance towards recovery and that pushes me to participate without hesitation. Back of my mind tells me that this is a trial, there are risks involved but I am willing to try. A leap of faith for success is indeed a good motivating factor. So how did you physically and mentally prepare yourself for the trials? YOW: Be positive and have a good attitude and mindset. Support from my family is crucial and I do have great faith in my doctors. I also do simple exercises where permitted to help to build up my strength. A short research on my doctor also assures me that of his credentials and capability. Well, a little research does help in confidence building. What were your expectations during the trial; did the doctors pass you any special instructions to follow? YOW: Strictly no Traditional Chinese Medicine as this might obstruct or cause complications with the results. Other than that, the nutritionist also reminded me to refrain from eating raw and uncooked food. I will also feedback to my doctor of any arising side effects during the weekly consultations. Were there any instances that made you feel like withdrawing from the programme? YOW: Withdrawal was not the top list on my mind. Though there were some discouraging news when my tumour grew slightly in size during the late stage of the trial. The side effects of coughing and numbness on my legs came along too. The doctor then suggested proceeding to the third line of treatment since it was not working well for me. Even through all these, I know I am not going down without a fight and am willing to push further towards recovery. Congratulations as we know that your tumour has shrunk in the last diagnosis since commencing the third line of treatment, could you share with us your overall experience of being in clinical trial? YOW: I am fortunate to be offered a place in this clinical trial programme. The medical care team has also showered me with care and concern, answering whatever queries I have. I would truly encourage fellow patients to enroll if given an option, as the doctors know your condition and will provide the best line of treatment for your disease. What are three pieces of advice you would give to patients who are considering or are already in clinical trials? YOW: Be positive, exercise when possible and eat normally. Cancer is not a death sentence, giving up is.

6 0 SALUBRIS APRIL JUNE 204 SALUBRIS APRIL JUNE 204 NATIONAL CANCER SURVIVOR S DAY BY GILLIAN TAN Executive Marketing Communications National Cancer Survivor s Day is observed worldwide in June annually as a celebration of life and an inspiration to cancer patients. It serves as an important outreach to the community in raising awareness on cancer and survivorship. Many cancers can now be prevented and treated. With early detection and the advances in treatment, life after cancer can continue to be meaningful and productive. Take a look at the truth about cancer:

7 2 SALUBRIS APRIL JUNE 204 SALUBRIS APRIL JUNE 204 Poster Exhibit Upcoming Events booth uiz Trivia The Butt Stops Here The Great Smoke Free Sale Photo Puzzle Blocks Interactive educational games such as Photo Puzzle Blocks, uiz Trivia, The Butt Stops Here and The Great Smoke Free Sale were popular among children and youths. Information on signs of cancer as well as cancer screening were shared with parents while the children and youths were engaged in these games. CREATING CANCER AWARENESS IN THE COMMUNITY BY ALICIA PANG Executive Cancer Education And Information Service Stubbing out cigarette butts with Velcro balls; using giant metal chopsticks to maneuver a golf ball while managing the arduous task of dropping it into specific cylindrical tubes; or solving cancer informationrelated photo puzzle blocks these are some of the interactive educational activities that one can partake at cancer awareness roadshows organised by the Cancer Education and Information Service (CEIS) of the National Cancer Centre Singapore (NCCS). With the rising incidence of cancer worldwide, cancer education plays an indispensable role in reducing the frequency of late stage cancer. T he inaugural roadshow for the year of Horse was held at Woodlands Civic Centre from 22 to 23 February. Fusing fun with learning, the roadshow provided knowledge on common cancers and emphasised the importance of adopting a healthier lifestyle. The two day event saw an estimated crowd of,000 indulging in family-friendly activities. The public was also encouraged to sign up for upcoming Public Forums and CancerWise workshops, and subscribe to NCCS newsletter, Salubris for more insights about cancer and related matters. Nurses explaining to the public about FIT and BSE Cancer screening was one of the key objectives of the road show. With support from the Singapore Cancer Society, colorectal Fecal Immunochemical Test (FIT) kits were distributed at the roadshow. Breast Self-Examination (BSE) was taught to ladies using the silicone breast models while BSE decals were given as reminders to perform BSE regularly. National Cancer Centre Singapore believes in being pro-active when it comes to cancer awareness. Empowering the public with knowledge is the key to a cancer free tomorrow. After all, prevention is better than cure, and early detection saves lives. We are looking forward to holding more roadshows and public forums at community centres, workplaces, schools, institutions and faith-based organisations. If you or your organisation is keen to share our cause, please do contact us. All requests for health talks, roadshows and education booths at events, institutions, or at your workplace can be forwarded to hope@nccs.com.sg, or call us at With your support in the fight against cancer, we believe we can lower the cases of untreatable cancers in Singapore. Health Talk Cancer Awareness Roadshow 3

8 4 SALUBRIS APRIL JUNE 204 SALUBRIS APRIL JUNE 204 海报展览 健康讲座 问答游戏 把烟熄了 照片拼图 照片拼图 问答游戏 把烟熄了 和 无烟大热卖 等互动式教育游戏深受儿童和青少年欢迎 孩子沉浸于有趣 的游戏当儿 父母也有机会多了解有关癌症症状和检测的资讯 培养社区居民 的癌症意识 彭薇洳 执行人员 癌症教育与资讯服务 随着癌症病患在世界各地的人数不断 增加 癌症教育在减少晚期癌症发生 率方面有不可或缺的作用 不少公众 在新加坡国立癌症中心癌症教育与资 讯服务主办的癌症意识路演上用魔 术帖球将 烟蒂 熄灭 以一双巨大 的筷子夹高尔夫球并小心翼翼将它们 放入个别的圆形管 或完成传递癌症 资讯的照片拼图 通过互动式教育游 戏 获取癌症知识 无烟大热卖 马年的第一个路演于2 月22 日至 23 日在兀兰民事中心举 行 此次路演通过寓教于乐的方式 提供了许多有关常 见癌症的资讯 并强调健康生活的重要性 为期两天的 路演共吸引约000名公众前来参与适合全家大小一同 进行的活动 公众可报名参加接下来将举办的公共论坛 以及CancerWise癌症预防工作坊 并订阅新加坡国立 癌症中心出版的 Salubris癌症资讯简报 加强对癌症和 相关课题的了解 护士向公众解释进行粪便免疫化学检测和乳房自检的方法和作用 举办路演的一个主要目标 是向公众传达 癌症检测的重要性 新加坡防癌协会在路 演上分发粪便免疫化学检测器 并利用硅 胶乳房模型教导女士们如何自行检查乳 房 主办当局也在现场分发了乳房自检贴 纸 提醒女性朋友定期自行检查乳房 新加坡国立癌症中心认为有必要积极进行提高癌症意 识的工作 因为让公众多了解癌症 是预防更多人日后 患病的关键 毕竟 预防胜于治疗 而尽早发现患病将 能挽救生命 我们希望未来能在民众俱乐部 工作场所 和学校以及为机构和宗教组织举办更多类似的路演和 公共论坛 如果您或您的机构有意加入我们的防癌行 列 请与我们联系 若您想在自己的活动上 机构或工作场所举办 健康讲座和路演或设置癌症教育亭 请电邮 5655咨询 有了您的支持 我们更有信心与病魔对抗 减 少新加坡无法治愈的癌症病例 健康讲座 癌症意识路演 5

9 6 SALUBRIS APRIL JUNE 204 SALUBRIS APRIL JUNE OUTREACH PUBLIC FORUMS & CANCERWISE WORKSHOPS OUTREACH PUBLIC FORUMS & CANCERWISE WORKSHOPS Event Date, Time, Venue Registration Event Date, Time, Venue Registration CancerWise Workshop Nose Cancer What You Need to Know TOPICS: What is Nose Cancer? What are the risks, signs & symptoms? What diagnostic tests to detect Nose Cancer? Preventing Nose Cancer What are the treatments available? New development in Nose Cancer 5 April 204, Saturday Session will be conducted in English. Registration :.00pm Workshop :.30pm to 4.00pm Level 4 Function Room National Cancer Centre Singapore Hospital Drive Singapore 6960 Free Admission Strictly No Admission for children below 2 years old. Registration is a MUST as seats are limited. REGISTRATION IS BY PHONE ONLY Please call: / / Monday to Friday: 8.30am to 5.30pm Bilingual Public Forum Common Cancers in Female Reproductive System TOPICS: The Female Reproductive System Anatomy & Functions Common Gynecological Problems Contraceptive Pills & Hormone Replacements Therapy - Are there health risks? Other Myths & Misconceptions Cancers of the Female Reproductive System: Cervix, Ovary and Uterus Risk Factors, Signs & Symptoms Early Detection & Prevention What is PAP smear? Screening & Treatment Procedures 0 May 204, Saturday MANDARIN SESSION Time: 9.5am to 0.30am (Registration: 9.00am to 9.5am) ENGLISH SESSION Time:.5am to 2.30pm (Registration:.00am to.5am) Peter & Mary Fu Auditorium National Cancer Centre Singapore Hospital Drive Singapore 6960 Free Admission Strictly No Admission for children below 2 years old. Registration is a MUST as seats are limited. REGISTRATION IS BY PHONE ONLY Please call: / / Monday to Friday: 8.30am to 5.30pm CancerWise Workshop Nutritional Concerns for Cancer Patients TOPICS: Benefits of good nutrition Goals of nutrition for cancer patients Special nutrition needs of cancer patients Dietary supplementation Managing treatment side effects through diet Nutrition after treatment ends 2 April 204, Saturday Session will be conducted in English. Registration :.00pm Workshop :.30pm to 4.00pm Level 4 Function Room National Cancer Centre Singapore Hospital Drive Singapore 6960 Free Admission Strictly No Admission for children below 2 years old. Registration is a MUST as seats are limited. REGISTRATION IS BY PHONE ONLY Please call: / / Monday to Friday: 8.30am to 5.30pm CancerWise Workshop Beat Cancer Blues with Exercise and Relaxation TOPICS: The relationship between exercise and cancer Make fitness work for you Choose the Right Exercise Getting fit after cancer Cancer treatments options Maintaining a healthy weight 4 June 204, Saturday Session will be conducted in English. Registration :.00pm Workshop :.30pm to 4.00pm Peter & Mary Fu Auditorium National Cancer Centre Singapore Hospital Drive Singapore 6960 Free Admission Strictly No Admission for children below 2 years old. Registration is a MUST as seats are limited. REGISTRATION IS BY PHONE ONLY Please call: / / Monday to Friday: 8.30am to 5.30pm The information is correct at press time. NCCS reserves the right to change programmes or speaker without prior notice. The information is correct at press time. NCCS reserves the right to change programmes or speaker without prior notice.

10 8 SALUBRIS APRIL JUNE 204 SALUBRIS APRIL JUNE SEMINARS / FORUMS / TUMOUR BOARDS / SMC-CME ACTIVITIES SEMINARS / FORUMS / TUMOUR BOARDS / SMC-CME ACTIVITIES APRIL 204 Date Time Event Information CME Pt Registration Contact MAY 204 Date Time Event Information CME Pt Registration Contact 2, 9, 6, 23, 30 2, 9, 6, 23, 30 7, 4, 2, pm NCCS Tumour Board Meetings: Sarcoma Tumour Board Meeting General Surgery Tumour Board Meeting Head & Neck Tumour Board Meeting 2, 9, 6, 23, pm Hepatobiliary NCCS Level 4, Lecture Hall 3, 0, 7, am Lung Tumour Board Combine SGH-NCCS SGH Blk 2 Level, Radiology Conference Room 3, 7 NCC-SGH Joint Lymphoma Workgroup Meeting PH Journal Club Topic: To be NCCS level, Mammo Suite Discussion Room am Endocrine and Rare Tumour Meeting 24 NCC Neuro Onco Tumour Board Meeting pm Teaching Session Topic: To be NCCS level, Mammo Suite Discussion Room Lim Shufen / V. Kalai / dsolsf@nccs.com.sg / nsokal@nccs.com.sg Daphne pakiam.marie.daphne@nccs.com.sg V. Kalai / Lim Shufen / nsokal@nccs.com.sg / dsolsf@nccs.com.sg Christina Lee Siok Cheng christina.lee.s.c@nhc.com.sg Tan Si Xuan / Rachel Tan / Phua Chay Sin ddipcs@nccs.com.sg Tan Si Xuan / Rachel Tan / Low Peak Wah / Ang Hui Lan / nmolpw@nccs.com.sg / dmoahl@nccs.com.sg Phua Chay Sin ddipcs@nccs.com.sg 7, 4, 2, pm Hepatobiliary NCCS Level 4, Peter & Mary Fu Auditorium 22 NCC Neuro Onco Tumour Board Meeting am Endocrine and Rare Tumour Meeting 6.00 pm Journal Club Topic: To be NCCS level, Mammo Suite Discussion Room pm Teaching Session Topic: To be NCCS level, Mammo Suite Discussion Room JUNE 204 Lim Shufen / V. Kalai / dsolsf@nccs.com.sg / nsokal@nccs.com.sg Low Peak Wah / Ang Hui Lan / nmolpw@nccs.com.sg / dmoahl@nccs.com.sg Tan Si Xuan / Rachel Tan / Phua Chay Sin ddipcs@nccs.com.sg Phua Chay Sin ddipcs@nccs.com.sg Date Time Event Information CME Pt Registration Contact 4,, 8, pm Hepatobiliary NCCS Level 4, Peter & Mary Fu Auditorium 4,, 8, 25 4,, 8, 25 2, 9, 6, 23, pm NCCS Tumour Board Meetings: Sarcoma Tumour Board Meeting General Surgery Tumour Board Meeting Head & Neck Tumour Board Meeting Lim Shufen / V Kalai / dsolsf@nccs.com.sg / nsokal@nccs.com.sg Lim Shufen / V. Kalai / dsolsf@nccs.com.sg / nsokal@nccs.com.sg Daphne pakiam.marie.daphne@nccs.com.sg MAY 204 Date Time Event Information CME Pt Registration Contact 5, 2, 9, am Lung Tumour Board Combine SGH-NCCS SGH Blk 2 Level, Radiology Conference Room Christina Lee Siok Cheng christina.lee.s.c@nhc.com.sg 8, 5, 22, am Lung Tumour Board Combine SGH-NCCS SGH Blk 2 Level, Radiology Conference Room Christina Lee Siok Cheng christina.lee.s.c@nhc.com.sg 5, 9 NCCS SGH Joint Lymphoma Workgroup Meeting Tan Si Xuan / Rachel Tan / , 5 NCC-SGH Joint Lymphoma Workgroup Meeting Tan Si Xuan / Rachel Tan / am Endocrine and Rare Tumour Meeting Tan Si Xuan / Rachel Tan / , 4, 2, 28 7, 4, 2, 28 5, 2, 9, pm NCCS Tumour Board Meetings: Sarcoma Tumour Board Meeting General Surgery Tumour Board Meeting Head & Neck Tumour Board Meeting Lim Shufen / V. Kalai / dsolsf@nccs.com.sg / nsokal@nccs.com.sg Daphne pakiam.marie.daphne@nccs.com.sg 26 NCC Neuro Onco Tumour Board Meeting Low Peak Wah / Ang Hui Lan / nmolpw@nccs.com.sg / dmoahl@nccs.com.sg

11 20 SALUBRIS APRIL JUNE 204 A G.R.E.A.T. DAY AT NCCS BY SHAWN SOH Senior Executive Community Partnership Staff at the National Cancer Centre Singapore (NCCS) don t just talk when they seek public support in their fund raising drive for cancer research. They also donate to the effort by signing up for monthly GIRO deductions from their salary. Employee Giving was introduced in NCCS in 20. Since then, more than 690 NCCS employees have pledged to make monthly contributions via salary deduction to support cancer research and patient care initiatives at NCCS. Not only did our staff answer their call of duty with passion and excellence, they also went the extra mile to give back to their organisation through the G.R.E.A.T. Employee Giving Programme, which aims to create and cultivate a culture of philanthropy within the organisation. NCCS held its annual Staff Appreciation Day on 25 February 204 to acknowledge the contributions of all employees for their hard work and dedication. A sumptuous buffet spread consisting of local and Peranakan cuisines were served by Departmental Heads and Supervisors while employees enjoyed the carnival themed games specially organised for the day. It was a simple yet significant gesture by the management to appreciate their staff. Friendship and camaraderie took centre stage amidst a fun-filled atmosphere. Friends and colleagues alike made a beeline for the photo booth where memorable moments were captured as co-workers from various departments got together to pose in front of the camera complete with outlandish props. Their megawatt smiles were priceless and were caught on prints to be cherished forever. Staff Philanthropy was also celebrated on that day. Each staff donor received a cookie to symbolise the sweetness of giving and also to thank them for their continuous support. Their act of kindness was reciprocated with a mouth-watering, freshly baked raspberry macadamia cookie. It is the cohesiveness and generous spirit that makes NCCS and its people so special! While there is still much to be done in the area of research and in patient care, it is hoped that this simple gesture can motivate and inspire other non-staff donors to sign up as a G.R.E.A.T. employee. With each contribution, it enables our researchers to take closer steps to finding a cancer cure and our healthcare team to provide better care and facilities to our patients. It is the gift from your heart that touches the life of a patient. No gift is too small when it is given with a big hope of making a difference to our patients and towards a cancer-free tomorrow. Editorial Advisors Prof Kon Oi Lian Prof Soo Khee Chee Dr Tan Hiang Khoon Editorial Consultant Mr Sunny Wee Medical Editor Dr Richard Yeo Executive Editors Ms Rachel Tan Ms Siti Zawiyah Mr Edwin Yong Members, Editorial Board Ms Lita Chew Dr Mohd Farid Ms Sharon Leow Ms Jenna Teo Dr Melissa Teo Dr Teo Tze Hern Dr Deborah Watkinson is produced with you in mind. If there are SALUBRIS other topics related to cancer that you would like to read about or if you would like to provide some feedback on the articles covered, please to salubris@nccs.com.sg. NATIONAL CANCER CENTRE SINGAPORE Reg No Z Hospital Drive Singapore 6960 Tel: (65) Fax: (65)