Esophageal Cancer Diagnosis & Treatment in Singapore
What are Esophageal Cancer Treatments in Singapore?
Esophageal cancer is a type of cancer that originates in the esophagus, which is the muscular tube that connects the throat to the stomach. The esophagus is responsible for transporting food and liquids from the mouth to the stomach for digestion. In Singapore, there are various treatment options available for esophageal cancer.
The actual treatment plan for esophageal cancer will depend on various factors including the stage of the cancer, the patient’s overall health, and individual preferences.
Esophageal Cancer Treatment: Surgery
Surgery is the most common treatment option for localised esophageal cancer, ie for tumours that haven’t spread to distant parts of the body. The type of surgery performed depends on the location of the tumour, its size, and the stage of the cancer. Here are some surgical approaches used in the treatment of esophageal cancer:
- Esophagectomy: This is the most common surgical procedure for esophageal cancer. It involves removing a portion of the esophagus along with nearby lymph nodes. The remaining healthy portions of the esophagus are then reconnected to the stomach, or a portion of the stomach is brought up to the chest to replace the removed esophagus. This procedure can be done using open surgery or minimally invasive techniques such as laparoscopy or robotic-assisted surgery.
- Endoscopic Resection: In cases where the cancer is detected at a very early stage and is limited to the superficial layers of the esophagus, endoscopic resection might be an option. This involves removing the cancerous tissue using an endoscope inserted through the mouth.
- Palliative Procedures can be useful when curative surgery is not possible. A stent might be placed in the esophagus to keep it open and improve swallowing.
Surgery for esophageal cancer is a major procedure that requires careful evaluation of the patient’s overall health and the extent of the cancer. Often, pre-surgery treatment, also known as neoadjuvant treatment, can be utilized to down-stage the cancer, decrease the size, and improve the outcomes of surgery. Neoadjuvant treatment involves the use of radiotherapy and/or chemotherapy.
Esophageal Cancer Treatment: Radiation Therapy
Radiotherapy, also known as radiation therapy employs high doses of radiation to target and eliminate cancer cells. Here’s an overview of how radiation therapy is utilized in the treatment of esophageal cancer:
- External Beam Radiotherapy: This is the most common type of radiation therapy for esophageal cancer. It involves using a machine to deliver precise doses of radiation to the cancerous area from outside the body. The goal is to damage the DNA within the cancer cells, preventing them from dividing and growing.
- Neoadjuvant and Adjuvant Radiotherapy: Before or after surgery, neoadjuvant and adjuvant radiotherapy respectively might be employed to downstage or eradicate any remaining cancer cells in the treatment area, reducing the risk of recurrence.
- Proton Beam Radiotherapy: The most advanced type of radiotherapy available currently. Similar to external beam radiotherapy, but the dose of radiotherapy is more precise and damage to normal surrounding tissue is decreased.
- Palliative Radiotherapy: In advanced cases where a cure isn’t feasible, palliative radiotherapy can be used to alleviate symptoms such as difficulty swallowing, pain, and bleeding. This can improve the patient’s quality of life.
Radiation therapy for esophageal cancer is a highly targeted procedure, aiming to maximize the impact on cancer cells while minimizing harm to healthy surrounding tissue. The treatment plan is customized to the patient’s specific condition, including factors like the stage and location of the cancer, as well as the individual’s overall health.
Esophageal Cancer Treatment: Chemotherapy
Chemotherapy is a significant treatment approach for esophageal cancer, particularly in cases where the cancer has spread beyond its original site or when it’s part of a multimodal treatment plan. Chemotherapy involves using anti-cancer drugs to target and destroy cancer cells throughout the body. Here’s an overview of how chemotherapy is utilized in the treatment of esophageal cancer:
- Neoadjuvant Chemotherapy: This involves administering chemotherapy before surgery (neoadjuvant therapy). The goal is to shrink the tumour, making it more manageable to remove during the surgical procedure. Neoadjuvant chemotherapy is often used in combination with radiation therapy.
- Adjuvant Chemotherapy: After surgery, adjuvant chemotherapy might be employed to eradicate any remaining cancer cells and reduce the risk of cancer recurrence.
- Palliative Chemotherapy: In advanced or metastatic cases where a cure isn’t feasible, palliative chemotherapy is used to alleviate symptoms, slow the cancer’s growth, and enhance the patient’s quality of life.
- Combination Therapy: Chemotherapy can be combined with other treatments, such as surgery, radiation therapy, and targeted therapies, to create a comprehensive treatment plan tailored to the patient’s specific situation.
- Systemic Treatment: Chemotherapy works by targeting rapidly dividing cells, which includes cancer cells. However, it can also affect healthy cells that divide quickly, leading to potential side effects such as hair loss, nausea, fatigue, and lowered blood cell counts.
- Targeted Chemotherapy: In some cases, targeted therapies can be used alongside traditional chemotherapy. These therapies are designed to specifically target certain molecules involved in cancer growth, minimizing damage to healthy cells.
The specific chemotherapy drugs used and the treatment schedule depend on various factors, such as the cancer’s stage, the patient’s overall health, and any previous treatments received.
Esophageal Cancer Treatment: Targeted Therapy
Targeted therapy is a significant advancement in the treatment of esophageal cancer, particularly for cases that involve specific genetic mutations or molecular characteristics. This approach involves using drugs that specifically target certain molecules or pathways involved in the growth and spread of cancer cells. Here’s an overview of how targeted therapy is employed in the treatment of esophageal cancer:
- Personalised Treatment: Targeted therapy is guided by the unique genetic and molecular profile of the patient’s cancer cells. This allows for a more individualised treatment approach compared to traditional chemotherapy.
- Identification of Targets: Before starting targeted therapy, a patient’s tumour tissue is analysed to identify specific genetic mutations or protein over expressions that can be targeted with the therapy.
- Inhibiting Cancer Growth: Targeted therapy drugs work by blocking specific proteins or pathways that are crucial for the survival and growth of cancer cells. By disrupting these mechanisms, the therapy aims to halt or slow down cancer progression.
- Combination Treatment: Targeted therapy can be used in combination with other treatments, such as chemotherapy or radiation therapy, to enhance the overall effectiveness of the treatment plan.
- Reduced Side Effects: Because targeted therapy focuses on specific molecules associated with cancer cells, it may have fewer side effects on healthy cells compared to traditional chemotherapy.
- Regular Monitoring: Patients undergoing targeted therapy are closely monitored to assess the response to treatment and adjust the therapy as necessary.
It’s important to note that targeted therapy is not suitable for all esophageal cancer cases. The decision to use targeted therapy depends on the results of molecular testing and the presence of relevant targets in the cancer cells.
Esophageal Cancer Treatment: Immunotherapy
Immunotherapy is an approved treatment of esophageal cancer, claimable under the Ministry of Health Cancer Drug List. It is approved for use in the adjuvant setting, following completion of neoadjuvant chemotherapy and radiation and surgery, or for the use in advanced esophageal cancer, that has spread to other organs.. This approach harnesses the body’s own immune system to recognize and fight cancer cells. Here’s an overview of how immunotherapy is employed in the treatment of esophageal cancer:
- Enhancing Immune Response: Immunotherapy drugs, known as immune checkpoint inhibitors, target specific molecules on immune cells and cancer cells. By blocking these molecules, they release the brakes on the immune system, allowing it to mount a stronger attack against cancer cells.
- Personalised Treatment: Similar to targeted therapy, immunotherapy can be tailored to the patient’s specific cancer characteristics, which might include the presence of certain proteins on the cancer cells.
- Nivolumab (Opdivo) This is an approved immune checkpoint inhibitors used on its own, or in combination with chemotherapy.
- Clinical Trials: Ongoing research is exploring various immunotherapy approaches for esophageal cancer, including combination therapies and the identification of new targets for treatment. Patients may have the opportunity to participate in clinical trials to access innovative treatments.
- Response Monitoring: Regular monitoring and imaging scans help determine the effectiveness of immunotherapy. Some patients might experience significant responses, while others may not respond as well.
- Side Effects: Immunotherapy can have unique side effects known as immune-related adverse events. These can affect various organs and systems in the body and are related to the overactivity of the immune system. Prompt identification and management are crucial.
It’s important to note that not all patients with esophageal cancer will be candidates for immunotherapy, and its use often depends on factors such as the cancer’s molecular characteristics and the overall health of the patient.
Are there any Side Effects of Esophageal Cancer Treatment?
Side Effects of Esophageal Cancer Treatment: Surgery
Undergoing surgery for esophageal cancer can lead to several potential side effects. These side effects can vary depending on the extent of the surgery, the patient’s overall health, and individual factors. Here are some common side effects associated with esophageal cancer surgery:
- Pain: Pain at the surgical site is normal after surgery. The severity and duration of pain can vary, but it is typically managed with pain medications prescribed by the medical team.
- Difficulty Swallowing (Dysphagia): After surgery, especially in cases where a portion of the esophagus is removed, patients might experience difficulty swallowing. This can improve over time with proper healing and, if needed, with guidance from a speech therapist or dietitian.
- Gastroesophageal Reflux: Surgery that involves altering the anatomy of the esophagus and stomach can sometimes lead to an increased risk of gastroesophageal reflux disease (GERD), causing symptoms such as heartburn and regurgitation.
- Dumping Syndrome: In cases where part of the stomach is used for reconstruction, patients might experience dumping syndrome. This is a condition in which food moves too quickly from the stomach to the small intestine, causing symptoms like nausea, sweating, and diarrhea.
- Weight Loss and Nutritional Challenges: Surgery can affect the way the body absorbs nutrients, leading to weight loss and potential nutritional deficiencies. A dietitian might work with patients to develop a nutrition plan that supports healing and recovery.
- Digestive Changes: Surgery can result in changes to bowel habits and digestion. Patients might need to make dietary adjustments and take medications to manage these changes.
- Infection: As with any surgery, there is a risk of infection at the surgical site or in the incision area. Proper wound care and post-operative hygiene are important to prevent infection.
- Complications: Surgery for esophageal cancer is a major procedure and can involve potential complications such as bleeding, infection, blood clots, and damage to surrounding organs.
- Recovery Time: Recovery from esophageal cancer surgery can take time, and patients might need to stay in the hospital for an extended period. Physical activity and certain daily tasks might be limited during the initial recovery phase.
Side Effects of Esophageal Cancer Treatment: Radiation Therapy
Radiation therapy for esophageal cancer can lead to a range of side effects, as the treatment aims to target cancer cells while affecting some healthy tissue in the area. These side effects can vary in intensity and duration depending on factors such as the radiation dose, the treatment area, and the patient’s overall health. Here are some common side effects associated with radiation therapy for esophageal cancer:
- Difficulty Swallowing (Dysphagia): Irritation of the esophagus due to radiation can cause difficulty swallowing. This can lead to discomfort and sometimes require dietary modifications or temporary use of a feeding tube.
- Fatigue: Radiation therapy can cause fatigue, which might increase as treatment progresses. Adequate rest and managing daily activities can help alleviate this side effect.
- Skin Changes: Skin in the radiation treatment area might become red, dry, and sensitive, resembling a sunburn. Proper skincare and avoiding irritants can help manage these skin changes.
- Nausea and Vomiting: Radiation targeting the upper abdomen can sometimes lead to nausea and vomiting. Medications and dietary adjustments can help manage these symptoms.
- Heartburn and Indigestion: Irradiation of the upper abdomen can cause irritation to the stomach lining, leading to symptoms of heartburn and indigestion.
- Chest Discomfort: Radiation therapy targeting the chest area can lead to chest discomfort or pain, similar to heartburn. This is usually temporary and can be managed with medications.
- Shortness of Breath: In some cases, radiation can affect lung function, leading to shortness of breath. This side effect is more common when the treatment area includes the chest.
- Dry Mouth: Radiation therapy that involves the head and neck region can damage salivary glands, leading to dry mouth. This can affect speech, eating, and dental health.
- Changes in Taste: Radiation can affect taste buds, leading to altered taste perceptions and decreased appetite.
- Swelling (Edema): Some patients might experience mild swelling in the treatment area, particularly if lymph nodes are targeted.
Side Effects of Esophageal Cancer Treatment: Chemotherapy
Chemotherapy for esophageal cancer can lead to a variety of side effects, as the treatment involves using powerful drugs to target and destroy cancer cells. These side effects can vary in severity and duration depending on the specific chemotherapy drugs used, the treatment regimen, and the patient’s overall health. Here are some common side effects associated with chemotherapy for esophageal cancer:
- Nausea and Vomiting: Chemotherapy can trigger nausea and vomiting, which might occur shortly after treatment or last for a few days. Anti-nausea medications can help manage these symptoms.
- Fatigue: Chemotherapy can cause fatigue and decreased energy levels. Adequate rest and managing daily activities can help alleviate this side effect.
- Hair Loss: Some chemotherapy drugs can lead to hair loss. Hair loss might be partial or complete and can affect the scalp, eyebrows, eyelashes, and body hair.
- Weakened Immune System: Chemotherapy can lower the body’s immune response, making patients more susceptible to infections. This is why it’s important to take precautions to avoid exposure to illness.
- Decreased Blood Cell Counts: Chemotherapy can reduce the number of red blood cells (anemia), white blood cells (increasing infection risk), and platelets (increasing bleeding risk) in the body.
- Mouth Sores: Some chemotherapy drugs can cause sores and ulcers in the mouth and throat. Good oral hygiene and special mouthwashes can help manage these effects.
- Digestive Disturbances: Chemotherapy can lead to digestive issues such as diarrhoea, constipation, and loss of appetite.
- Neuropathy: Some chemotherapy drugs can cause nerve damage, leading to symptoms such as numbness, tingling, and pain in the hands and feet.
- Changes in Taste and Smell: Chemotherapy can affect taste and smell perceptions, leading to altered food preferences.
- Emotional Impact: Coping with the physical side effects of chemotherapy can have emotional and psychological effects. Patients might experience anxiety, depression, or changes in mood.
- Difficulty Swallowing (Dysphagia): Irritation of the esophagus due to radiation can cause difficulty swallowing. This can lead to discomfort and sometimes require dietary modifications or temporary use of a feeding tube.
- Fatigue: Radiation therapy can cause fatigue, which might increase as treatment progresses. Adequate rest and managing daily activities can help alleviate this side effect.
- Skin Changes: Skin in the radiation treatment area might become red, dry, and sensitive, resembling a sunburn. Proper skincare and avoiding irritants can help manage these skin changes.
- Nausea and Vomiting: Radiation targeting the upper abdomen can sometimes lead to nausea and vomiting. Medications and dietary adjustments can help manage these symptoms.
- Heartburn and Indigestion: Irradiation of the upper abdomen can cause irritation to the stomach lining, leading to symptoms of heartburn and indigestion.
- Chest Discomfort: Radiation therapy targeting the chest area can lead to chest discomfort or pain, similar to heartburn. This is usually temporary and can be managed with medications.
- Shortness of Breath: In some cases, radiation can affect lung function, leading to shortness of breath. This side effect is more common when the treatment area includes the chest.
- Dry Mouth: Radiation therapy that involves the head and neck region can damage salivary glands, leading to dry mouth. This can affect speech, eating, and dental health.
- Changes in Taste: Radiation can affect taste buds, leading to altered taste perceptions and decreased appetite.
- Swelling (Edema): Some patients might experience mild swelling in the treatment area, particularly if lymph nodes are targeted.
Side Effects of Esophageal Cancer Treatment: Targeted Therapy
Targeted therapy for esophageal cancer can bring about specific side effects, as this treatment approach focuses on targeting particular molecules involved in cancer growth. The severity and occurrence of these side effects can vary based on the specific targeted therapy drug used, the patient’s individual response, and their overall health. Here are some common side effects associated with targeted therapy for esophageal cancer:
- Skin Rash: Some targeted therapy drugs can cause skin reactions, such as rash, redness, and dryness. These skin changes might resemble acne or sunburn.
- Diarrhoea or Constipation: Gastrointestinal disturbances like diarrhoea or constipation can occur as a result of targeted therapy. These side effects might require adjustments to the patient’s diet or medication regimen.
- Fatigue: Like other cancer treatments, targeted therapy can lead to fatigue and reduced energy levels. Managing daily activities and getting enough rest is important.
- Hypertension (High Blood Pressure): Certain targeted therapy drugs can cause an increase in blood pressure. Regular monitoring and medication adjustments might be necessary.
- Nausea and Vomiting: Targeted therapy drugs might cause nausea and vomiting, which can impact the patient’s comfort and overall well-being.
- Liver Enzyme Changes: Some targeted therapy drugs can affect liver function, leading to changes in liver enzyme levels. Regular monitoring of liver function is important.
- Blood Clotting Issues: In some cases, targeted therapy drugs can affect blood clotting, potentially increasing the risk of clot formation.
- Mood Changes: Targeted therapy can have emotional and psychological effects, leading to mood changes, anxiety, or depression.
- Hair and Nail Changes: Similar to chemotherapy, targeted therapy can cause changes in hair texture and nail appearance.
- Immune System Effects: Targeted therapy might affect the immune system, leading to increased susceptibility to infections.
Side Effects of Esophageal Cancer Treatment: Immunotherapy
Side Effects of Esophageal Cancer Treatment: Immunotherapy
Immunotherapy for esophageal cancer can lead to various side effects, as this treatment approach harnesses the immune system to target cancer cells. The occurrence and intensity of these side effects can differ based on the specific immunotherapy drug used, the patient’s individual response, and their overall health. Here are some common side effects associated with immunotherapy for esophageal cancer:
- Fatigue: Immunotherapy can lead to fatigue and decreased energy levels, similar to other cancer treatments. Adequate rest and managing daily activities can help alleviate this side effect.
- Skin Rash: Some patients might experience skin reactions such as rash, itching, or dryness due to immunotherapy.
- Flu-Like Symptoms: Immunotherapy can cause flu-like symptoms such as fever, chills, and muscle aches. These symptoms are usually temporary and can be managed with medications.
- Nausea and Vomiting: Some patients might experience nausea and vomiting as a result of immunotherapy. Anti-nausea medications can help manage these symptoms.
- Diarrhoea or Colitis: Inflammation of the colon (colitis) or diarrhoea can occur due to an immune response triggered by immunotherapy. These gastrointestinal side effects might require medical intervention.
- Endocrine Effects: Some immunotherapy drugs can affect the endocrine system, leading to thyroid dysfunction or other hormonal imbalances.
- Liver Enzyme Changes: Immunotherapy can sometimes lead to changes in liver enzyme levels. Regular monitoring of liver function is important.
- Lung Issues: In some cases, immunotherapy can lead to inflammation of the lungs, causing symptoms like cough, shortness of breath, or chest discomfort.
- Immune-Related Adverse Events: These can involve a range of effects on different organs and systems in the body due to the overactivation of the immune system. These include skin, gastrointestinal, and endocrine issues.
- Emotional Impact: Coping with the physical side effects of immunotherapy can have emotional and psychological effects. Patients might experience anxiety, depression, or changes in mood.
What do I need to do if I have Esophageal Cancer?
It is important to remember that esophageal cancer can be treated successfully if caught early. If you have any concerns about your esophagus health or notice any changes, do not hesitate to see a healthcare professional for evaluation.
If you suspect that you or your loved one have esophageal cancer, it is advisable to get the support you need. Early detection and diagnosis of esophageal cancer is key to treating the disease.
Regardless of what stage your esophageal cancer may be at, you should schedule an appointment to see an oncologist specialising in esophageal cancer as soon as possible. With the speed of developments in esophageal cancer diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.
Our cancer specialists at OncoCare specialise in treating late stage and advanced stages of esophageal cancer, as well as earlier stages of the disease.
Who are the Bladder Cancer
Specialists in Singapore?
Senior Consultant, Medical Oncologist
MBBS (Delhi) – American Board Certified (Int Med) – American Board Certified (Hematology) – American Board Certified (Med Oncology)
Before joining OncoCare Cancer Centre at Mount Elizabeth Hospital, Singapore, Dr Akhil Chopra was a Senior Consultant in Medical Oncology at Johns Hopkins Singapore, Tan Tock Seng Hospital and Adjunct Associate Professor at Lee Kong Chian School of Medicine.
Dr Chopra has experience treating multiple cancer types including breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers; as well as Sarcomas and chronic leukaemia’s/multiple myeloma. Besides his clinical and research work, he has been involved in teaching medical students from the Lee Kong Chian School of Medicine as well as medical residents and students from Johns Hopkins University, Baltimore in USA.
- Graduated from Delhi in 2001
- American Board Certified, Internal Medicine
- American Board Certified, Medical Oncology
- American Board Certified, Hematology
- Fellowship Training at Hahnemann University Hospital/Drexel University College of Medicine in Philadelphia, USA
Cancer Specialities: breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers
Senior Consultant, Medical Oncologist
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology)
Dr Tay Miah Hiang, Senior Consultant Medical Oncologist at OncoCare Cancer Centre, was previously consultant at the National Cancer Centre Singapore’s Department of Medical Oncology, and Chairperson of Patient Education & Patient Survivorship programmes. Dr Tay also served on the board of Singapore Children’s Cancer Foundation from 2006 till 2015, and was Chairperson of this foundation from 2011 to 2013, and now serving as advisor. He is an elected member of Singapore Medical Council (SMC) since 2017 till date.
Dr Tay is passionate in contributing to Continuous Medical Education in the region, giving lectures in cancer management to cancer specialists, general practitioners, medical students and patients. He has won numerous awards for his service excellence and humanity contribution to disaster inflicted regions as such as post-Afghanistan war and Sri Lanka after Tsunami.
He has been actively involved in clinical and translational research for many years, in genitourinary (testicular, kidney, bladder, prostate), lung and other cancers. His research work is well published in hormone-refractory prostate cancer involved chemotherapy agents such as docetaxel and carboplatin. Acknowledged as a senior cancer specialist and an authority in prostate cancer in Singapore, he had also published on the use of ketoconazole and as part of a multi-centre clinical trial, the use of abiraterone acetate in metastatic castration-resistant prostate cancer progressing after chemotherapy.
As a pioneer in kidney cancer oncology, he had used sunitinib (Sutent), refametinib in kidney cancer patients when the drugs were coming into clinical practice in Singapore. Recognised as an authority in prostate cancer in Singapore, he had helped developed guidelines for the treatment of prostate cancer in Singapore in 2013 and the management of kidney cancer in Asia at the Asian Oncology Summit 2012.
His significant research work has been published in both local and international journals including Urology, Cancer, and Annals of Oncology. He also wrote chapters in several internationally recognised cancer specialty books such as Comprehensive Textbook of Genitourinary Oncology (3rd Edition), American Cancer Society’s Complete Guide to Prostate Cancer 2006, and Textbook on Urologic Oncology 2004.
Dr Tay is lauded for his experience in treating prostate, kidney, testicular and the bladder, gynaecological cancers such as ovarian cancer and uterine/cervical cancers, gastrointestinal & hepatobiliary cancers, lung cancer, brain tumour. He does not see patients with lymphoma, leukemia and breast cancer.
- Graduated from the National University of Singapore in 1992.
- Obtained Master of Medicine (Internal Medicine) and Membership of the Royal College of Physicians (United Kingdom) in 1999.
- Awarded the Ministry of Health Manpower Development Programme (HMDP) Scholarship to train at Dana Farber Cancer Institute, (Teaching Affiliates of Harvard Medical School), Boston USA 2003.
- Completed the Cancer Medicine and Hematology course at Harvard Medical School, Boston, MA, USA 2003.
- He was the Chairperson of Cancer Education for National Cancer Centre and Dr Tay was also previously the Chairperson and management committee member of Children’s Cancer Foundation. He is an elected member of Singapore Medical Council since 2017.
- In clinical patient care, he was awarded for his professional and genuine care with National Excellent Service Gold Award (EXSA*) in 2006 and Star Award in 2007.
- He has been actively involved in clinical and translational research for many years, in prostate, kidney, lung and other cancers. These have involved international trials of chemotherapy drugs currently in active use and newer targeted therapy. He was principal investigator for more than 10 clinical trials for cancer drug development.
- Research work by Dr Tay has been published in both local and international journals including Urology, Cancer, Annals of Oncology. He also wrote chapters in several international books such as Comprehensive Textbook of Genitourinary Oncology (3rd Edition), American Cancer Society’s Complete Guide to Prostate Cancer 2006, and Textbook on Urologic Oncology 2004.
- With respect to public service, Dr Tay has given talks both locally and overseas. These include the 13th and 15th Malaysian Urological Symposium on management of prostate cancer and renal cell cancer and Urological Conferences held in Singapore in 2004-2007
- With teaching appointments as Clinical Teacher, Faculty of Medicine, National University of Singapore and had been one of the lecturer for the First Singapore Medical Oncology Review Course (2007) involving surgeons, medical oncologists, radiation oncologists and physicians.
- Accredited for Palliative Medicine.
- Clinical interest in lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and the bladder, gynaecological cancers such as ovarian and uterine/cervical cancers, and brain tumour.
- (*) National Excellent Service Award (EXSA) is a national award managed by SPRING Singapore and nine industry lead associations in Singapore. This award recognises the best of the best individuals who have delivered outstanding service in their respective industries. It seeks to develop models for service staff to emulate, create service champions and enhance professionalism in service delivery.
What is Bladder Cancer?
Definition of Bladder Cancer
Bladder cancer is a type of cancer that begins in the cells of the bladder, which is a hollow organ in the lower abdomen that stores urine. The most common type of bladder cancer is urothelial carcinoma, also known as transitional cell carcinoma, which starts in the urothelial cells that line the inside of the bladder.
There are several types of bladder cancer, including:
- Urothelial Carcinoma: This is the most common type, accounting for most bladder cancer cases. It begins in the urothelial cells that line the bladder and can also affect other parts of the urinary tract, such as the ureters or urethra.
- Squamous Cell Carcinoma: This type of bladder cancer starts in the squamous cells, which are flat cells that may form in response to long-term irritation or inflammation of the bladder, such as from chronic urinary tract infections or long-term use of a urinary catheter.
- Adenocarcinoma: Adenocarcinoma of the bladder is a rare form of bladder cancer that develops in the glandular cells of the bladder. It can be linked to conditions such as chronic bladder inflammation or certain congenital abnormalities.
Less common types of bladder cancer include small cell carcinoma, sarcoma, and lymphoma. These types are relatively rare and account for a small percentage of bladder cancer cases.
Bladder cancer is a significant global health concern. It ranks as the 10th most common cancer worldwide, accounting for around 3.2% of all new cancer cases. The disease primarily affects older individuals, with most cases occurring in people over the age of 55. The global mortality rate for bladder cancer is estimated to be approximately 2.8%.
In Singapore, bladder cancer is particularly prominent among males, ranking as the 5th most common cancer. However, it is less prevalent among females. In 2020, there were 1,004 new cases of bladder cancer reported in Singapore. The incidence rate stands at around 4.7 cases per 100,000 population, with a mortality rate of approximately 2.3 per 100,000 population.
These statistics provide a general overview of bladder cancer’s prevalence and impact both worldwide and in Singapore, emphasising the need for continued research, early detection, and effective treatment strategies to combat this disease.
What are the Signs and Symptoms of Bladder Cancer?
Signs and symptoms of bladder cancer can vary, and some individuals may not experience any symptoms in the early stages.
The most common symptoms of Bladder Cancer include:
- Hematuria (Blood in Urine): The most common and noticeable symptom of bladder cancer is blood in the urine, also known as hematuria. Blood may appear either grossly (visible to the naked eye) or microscopically (detected only during urine testing). Hematuria is typically painless.
- Frequent Urination: Bladder cancer can cause an increased urge to urinate frequently. This can be accompanied by a sense of urgency or discomfort during urination.
- Pain or Burning Sensation: Some individuals with bladder cancer may experience pain or a burning sensation during urination. This can be a result of irritation or inflammation caused by the tumour.
- Lower Back or Pelvic Pain: Advanced bladder cancer may cause pain in the lower back or pelvis. This pain can be persistent and may worsen over time.
- Changes in Urinary Habits: Bladder cancer can lead to changes in urinary habits, such as increased frequency, urgency, or difficulty emptying the bladder completely.
- Fatigue and Weight Loss: In some cases, bladder cancer may cause fatigue and unexplained weight loss. These symptoms are more commonly associated with advanced stages of the disease.
It’s important to note that these symptoms can also be caused by other non-cancerous conditions, such as urinary tract infections or bladder stones. However, if any of these symptoms persist or cause concern, it is crucial to consult a healthcare professional for a proper evaluation and diagnosis.
Screening for Bladder Cancer
Unlike some other cancers, there are no standard screening tests recommended for the general population to detect bladder cancer in its early stages. This is because there is currently insufficient evidence to support the effectiveness of routine screening for bladder cancer in individuals without any specific risk factors or symptoms.
However, in certain high-risk individuals, such as those with a history of bladder cancer or exposure to certain occupational hazards, regular screening or surveillance may be recommended. The specific screening or surveillance strategies may vary based on individual risk factors and medical history.
In general, if you have any symptoms suggestive of bladder cancer, such as blood in the urine (hematuria), frequent urination, or persistent urinary tract infections, it is important to consult a healthcare professional for a proper evaluation. They may perform tests such as urine analysis, imaging studies (like ultrasound or CT scan), or cystoscopy (a procedure to examine the bladder using a thin tube with a camera) to help diagnose or rule out bladder cancer.
Additionally, it’s worth noting that reducing exposure to known risk factors for bladder cancer, such as quitting smoking and minimising occupational exposure to certain chemicals, can help lower the risk of developing the disease.
How Bladder Cancer is Diagnosed
Bladder cancer is typically diagnosed through a combination of medical history evaluation, physical examination, and diagnostic tests. The diagnostic process for bladder cancer may involve the following steps:
- Medical History and Physical Examination: The doctor will begin by taking a detailed medical history, including any symptoms you may be experiencing and any risk factors you may have. They will also perform a physical examination to assess your overall health and look for any signs or abnormalities.
- Urine Analysis: A urine sample will be collected and analyzed for the presence of blood, cancer cells, or other abnormalities. This test, known as urine cytology, can help detect cancerous cells in the urine.
- Imaging Tests: Imaging tests such as ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be performed to visualize the bladder and surrounding structures. These tests can help identify the presence, size, and location of any tumours or abnormalities.
- Cystoscopy: Cystoscopy is a procedure in which a thin, flexible tube with a camera on the end, called a cystoscope, is inserted through the urethra and into the bladder. This allows the doctor to directly visualise the bladder and examine its lining for any abnormalities, such as tumours. During cystoscopy, a biopsy may be taken, where small tissue samples are collected for further examination under a microscope.
- Biopsy: If suspicious areas or tumours are detected during cystoscopy, a biopsy may be performed to confirm the presence of cancer cells. The collected tissue samples are sent to a laboratory where a pathologist examines them under a microscope to determine if they are cancerous and to determine the specific type and grade of bladder cancer.
Once a diagnosis of bladder cancer is confirmed, further tests may be conducted to determine the stage of the cancer and whether it has spread to other parts of the body. This information is crucial for developing an appropriate treatment plan.
What are the Causes and Risk Factors of Bladder Cancer?
The exact causes of bladder cancer are not fully understood, but it is believed to develop due to a combination of genetic and environmental factors. Several risk factors have been identified that can increase the likelihood of developing bladder cancer.
These include:
Smoking: Smoking tobacco is the most significant risk factor for bladder cancer. Chemicals in tobacco smoke are absorbed into the bloodstream and excreted in the urine, directly exposing the bladder lining to carcinogens.
Occupational Exposure: Certain occupations involving exposure to chemicals such as aromatic amines, benzidine, and certain dyes, rubber, paint, and metalworking industries have been linked to an increased risk of bladder cancer.
Age and Gender: Bladder cancer occurs more frequently in older adults, with the risk increasing with age. Men are more likely to develop bladder cancer compared to women.
Previous Cancer Treatment: Individuals who have received certain cancer treatments, such as radiation therapy or certain chemotherapy drugs, particularly cyclophosphamide, have an increased risk of developing bladder cancer.
Chronic Bladder Inflammation: Chronic urinary tract infections, bladder stones, and long-term use of urinary catheters can cause chronic irritation and inflammation of the bladder, which may increase the risk of developing bladder cancer.
Family History: Bladder cancer has been observed to occur more frequently in some families, suggesting a genetic predisposition.
Diet and Lifestyle Factors: A diet low in fruits and vegetables and high in processed meats, as well as obesity, have been suggested as potential risk factors for bladder cancer.
It’s important to note that having one or more of these risk factors does not necessarily mean that an individual will develop bladder cancer. Conversely, some individuals with bladder cancer may not have any known risk factors. Understanding the risk factors can help individuals make informed lifestyle choices and undergo appropriate screening or preventive measures when necessary.
What are the Types of Bladder Cancer?
Bladder cancer can be classified into different types based on the specific cells that are affected. The main types of bladder cancer include:
- Transitional Cell Carcinoma (Urothelial Carcinoma): This is the most common type of bladder cancer, accounting for most cases. It develops in the urothelial cells that line the inside of the bladder. Transitional cell carcinoma can also occur in the lining of the ureters and urethra.
- Squamous Cell Carcinoma: This type of bladder cancer arises from the squamous cells that form in response to chronic irritation or inflammation of the bladder, such as long-term urinary tract infections or bladder stones. Squamous cell carcinoma is less common than transitional cell carcinoma and is often associated with advanced disease.
- Adenocarcinoma: Adenocarcinoma of the bladder is a rare type of bladder cancer that develops in the glandular cells of the bladder. It is more like cancers found in other organs like the colon or prostate rather than typical bladder cells.
Less common types of bladder cancer include small cell carcinoma, sarcoma, and lymphoma. These types account for a small percentage of bladder cancer cases.
The type of bladder cancer and its stage play a crucial role in determining the treatment approach and prognosis. A proper diagnosis is essential to guide appropriate treatment decisions, and healthcare professionals use various diagnostic tests, including biopsies and imaging, to determine the specific type and stage of bladder cancer in each individual case.
What are the Stages of Bladder Cancer?
Bladder cancer staging refers to the process of determining the extent and spread of the cancer within the bladder and to nearby organs or lymph nodes. The stages of bladder cancer are typically classified using the TNM system, which stands for Tumour, Nodes, and Metastasis. The stages range from non-invasive (limited to the inner lining of the bladder) to invasive (spreading into deeper layers of the bladder or beyond). Here is a general overview of the stages of bladder cancer:
- Stage 0 (Carcinoma in Situ, CIS): The cancer is confined to the innermost layer of the bladder lining and has not invaded the bladder muscle or spread to nearby lymph nodes or distant sites.
- Stage I: The cancer has grown into the connective tissue layer beneath the bladder lining but has not reached the muscle layer or beyond. It has not spread to lymph nodes or distant sites.
- Stage II: The cancer has invaded the muscle layer of the bladder but has not spread beyond the bladder walls. It has not reached lymph nodes or distant sites.
- Stage III: The cancer has grown through the bladder muscle and may have spread to the fatty tissue surrounding the bladder. It may involve nearby organs or lymph nodes, but it has not spread to distant sites.
- Stage IV: This is the most advanced stage of bladder cancer. It indicates that the cancer has spread beyond the bladder to nearby organs, lymph nodes, or distant sites, such as the bones, liver, or lungs.
Staging plays a crucial role in determining the appropriate treatment options and predicting the prognosis for bladder cancer patients. Various diagnostic tests, such as imaging, biopsies, and sometimes surgical exploration, are done to accurately determine the stage of bladder cancer in each individual case.
