Thyroid Cancer: Specialists, Diagnosis And Treatment
What are the Thyroid Cancer Treatments available in Singapore?
Thyroid cancer is a common type of cancer that affects the thyroid gland, a small butterfly-shaped gland located at the base of the neck. The thyroid gland produces hormones that regulate metabolism, growth, and development. In Singapore, thyroid cancer is one of the most commonly diagnosed cancers in women.
There are several treatment options that may be recommended by a thyroid cancer specialist including surgery, radioactive iodine therapy, external beam radiation therapy, and chemotherapy. The choice of treatment depends on the type and stage of the cancer, as well as the patient’s overall health.
Surgery
Surgery is the primary treatment recommended by specialists in Singapore for thyroid cancer. The goal of surgery is to remove the cancerous thyroid gland and any nearby lymph nodes that may contain cancer cells.
The type of surgery performed depends on the size and location of the tumour. In some cases, a partial thyroidectomy may be performed, where only a portion of the thyroid gland is removed. In more advanced cases, a total thyroidectomy where the entire thyroid gland is removed may be necessary.
During surgery, the patient is placed under general anaesthesia, and an incision is made in the neck to access the thyroid gland. The surgeon carefully removes the cancerous tissue while trying to preserve as much surrounding healthy tissue as possible. If cancer has spread to nearby lymph nodes, those may also be removed during the surgery.
After surgery, the patient will need to take thyroid hormone replacement medication for the rest of their life. This medication replaces the hormones that were previously produced by the thyroid gland and helps regulate metabolism and other bodily functions.
Radiation Therapy
Radiation therapy is a type of cancer treatment that uses high-energy radiation beams to potentially kill cancer cells. There are two main types of radiation therapy used by specialists in the treatment of thyroid cancer in Singapore: external beam radiation therapy and radioactive iodine therapy.
- External beam radiation therapy involves the use of a machine that delivers high-energy radiation beams to the area where the cancer is located. This treatment is typically prescribed by specialists after surgery to potentially destroy any remaining cancer cells or to treat cancer that has spread to nearby lymph nodes or other areas of the body. During external beam radiation therapy, the patient lies on a table while the machine delivers the radiation beams to the affected area. The treatment is typically administered over several weeks, with the patient receiving treatment once a day or a few times a week.
- Radioactive iodine therapy is a type of targeted therapy that uses radioactive iodine to potentially destroy cancer cells. This treatment is typically given after surgery to destroy any remaining cancer cells. During radioactive iodine therapy, the specialist will prescribe a pill containing radioactive iodine. Radioactive iodine travels through the bloodstream to the thyroid gland, where it concentrates in the thyroid cells. The radioactive iodine then works to potentially destroy the cancerous thyroid cells while sparing the surrounding healthy tissue. After radioactive iodine therapy, the patient may need to stay in the hospital for a few days to allow the radioactive iodine to pass out of their body. The patient will need to avoid close contact with other people during this time, as they will be emitting radiation.
Radiation therapy is a common treatment option for thyroid cancer. However, the choice of radiation therapy will depend on the type and stage of the cancer and the patient’s overall health.
Chemotherapy
Chemotherapy is not typically used as a first-line treatment for thyroid cancer. This is because most types of thyroid cancer are not very responsive to chemotherapy.
However, in some cases where the cancer has spread to other parts of the body or is not responding to other treatments, chemotherapy may be prescribed by a specialist. Chemotherapy involves the use of drugs that target and aim to kill rapidly dividing cancer cells.
Chemotherapy is usually given as an infusion into a vein or as a pill that is taken orally. The treatment is typically administered in cycles, with a period of rest in between cycles to allow the body to recover.
Thyroid Cancer Treatment: Targeted Therapy
Targeted therapy is a type of cancer treatment that uses drugs to target specific proteins or genes that help cancer cells grow and divide. In Singapore, targeted therapy is becoming an increasingly important treatment option for certain types of advanced thyroid cancers.
One of the main targeted therapy drugs used in the treatment of thyroid cancer is tyrosine kinase inhibitors (TKIs). TKIs are drugs that target specific proteins on the surface of cancer cells, potentially inhibiting their growth and division.
TKIs are typically used to treat advanced or metastatic thyroid cancer that has spread to other parts of the body and is no longer responding to other treatments. TKIs are taken orally, usually once or twice a day, and are generally well-tolerated with fewer side effects compared to chemotherapy.
Thyroid Cancer Treatment: Immunotherapy
Immunotherapy is a type of cancer treatment that helps the patient’s own immune system to identify and attack cancer cells. In Singapore, immunotherapy is not currently a standard treatment option recommended by specialists for thyroid cancer, but it is being studied in clinical trials for certain types of advanced thyroid cancers.
One type of immunotherapy being studied for thyroid cancer is immune checkpoint inhibitors. These drugs work by blocking proteins in cancer cells that prevent the immune system from attacking them. By blocking these proteins, immune checkpoint inhibitors can potentially help the immune system recognise and attack cancer cells.
Clinical trials of immune checkpoint inhibitors have shown promising results in some patients with advanced thyroid cancer. However, not all patients respond to these drugs, and some may experience serious side effects, such as inflammation of the lungs, liver, or colon.
Another type of immunotherapy being studied by specialists for thyroid cancer is adoptive cell transfer therapy. This involves removing T cells from the patient’s blood, genetically modifying them to potentially recognise and attack cancer cells, and then infusing the modified T cells back into the patient’s bloodstream. This approach is still in the early stages of development and is not widely available.
Are there any Side Effects of Thyroid Cancer Treatment?
Side Effects of Surgery
While surgery is generally safe and effective, there are still some potential side effects associated with the procedure. The specific side effects that a patient may experience depend on the extent of the surgery, and other factors such as their overall health and medical history.
Some common side effects of thyroid cancer surgery may include:
- Damage to the parathyroid glands, which can cause hypocalcaemia (low calcium levels) and symptoms such as numbness or tingling in the fingers, toes, or around the mouth, muscle cramps, and seizures.
- Damage to the recurrent laryngeal nerve, which can lead to hoarseness or loss of voice.
- Temporary or permanent difficulty swallowing, depending on the extent of the damage.
- Temporary or permanent changes in thyroid hormone levels, which may require lifelong hormone replacement medication.
- Risks associated with anaesthesia, such as bleeding, infection, or other complications.
Side Effects of Radiation Therapy
Radiation therapy is a common treatment option administered by thyroid cancer specialists in Singapore, but it can also have side effects. Here are some potential side effects of radiation therapy for thyroid cancer:
- Fatigue or tiredness: Radiation therapy can cause fatigue, which may persist for weeks or months after treatment.
- Skin changes: Radiation therapy can cause skin changes in the treated area, including redness, dryness, itching, or peeling. These changes usually resolve within a few weeks after treatment.
- Nausea or vomiting: Some patients may experience nausea or vomiting during or after radiation therapy, but this is less common with modern radiation techniques.
- Difficulty swallowing: Radiation therapy to the neck area can cause inflammation and swelling of the throat, which can make it difficult to swallow.
- Hoarseness or voice changes: Radiation therapy to the neck area can also damage the vocal cords, which can cause hoarseness or changes in the voice.
- Dry mouth or thickened saliva: Radiation therapy can damage the salivary glands, which can lead to dry mouth or thickened saliva.
- Taste changes or loss of taste: Radiation therapy can affect the taste buds, causing changes in taste or loss of taste.
- Hair loss: Radiation therapy to the head and neck area can cause hair loss in the treated area.
- Inflammation of the thyroid gland (thyroiditis): Radiation therapy can cause inflammation of the thyroid gland, which can lead to temporary or permanent changes in thyroid hormone levels.
- Long-term risks: In rare cases, radiation therapy for thyroid cancer can increase the risk of developing other cancers or thyroid problems later in life.
Side Effects of Chemotherapy
Chemotherapy is not a common treatment option for thyroid cancer, but specialists generally only prescribe it for certain cases.
Here are some potential side effects of chemotherapy for thyroid cancer:
- Nausea and vomiting: Chemotherapy drugs can cause nausea and vomiting. Your doctor may prescribe medication to help prevent or manage these symptoms.
- Hair loss: Chemotherapy drugs can cause hair loss, including hair on the scalp, eyebrows, eyelashes, and body hair.
- Fatigue: Chemotherapy can cause fatigue, which may persist for several weeks after treatment.
- Mouth sores: Some chemotherapy drugs can cause sores in the mouth, throat, and oesophagus.
- Decreased appetite: Chemotherapy can cause a decreased appetite and weight loss.
- Increased risk of infection: Chemotherapy can weaken the immune system, increasing the risk of infections.
- Bruising or bleeding: Chemotherapy can lower the number of blood cells, which can lead to an increased risk of bruising or bleeding.
- Peripheral neuropathy: Some chemotherapy drugs can cause damage to the nerves in the hands and feet, leading to numbness, tingling, or pain.
- Skin changes: Some chemotherapy drugs can cause skin changes, including rash, dryness, or sensitivity to sunlight.
Side Effects of Targeted Therapy
Targeted therapy is a type of cancer treatment prescribed by specialists which uses drugs to target specific molecules involved in the growth and spread of cancer cells. While targeted therapy drugs may have fewer side effects than traditional chemotherapy, they can still cause some side effects. Here are some potential side effects of targeted therapy for thyroid cancer:
- Fatigue or weakness: Targeted therapy can cause fatigue, which may persist for several weeks after treatment.
- Nausea or vomiting: Some targeted therapy drugs can cause nausea and vomiting.
- Diarrhoea or constipation: Targeted therapy drugs can cause changes in bowel habits.
- Skin changes: Some targeted therapy drugs can cause skin changes, including rash, dryness, or sensitivity to sunlight.
- High blood pressure: Some targeted therapy drugs can cause high blood pressure.
- Liver problems: Some targeted therapy drugs can cause liver problems, including abnormal liver function tests or liver damage.
- Decreased appetite: Targeted therapy can cause a decreased appetite and weight loss.
- Risk of bleeding: Some targeted therapy drugs can increase the risk of bleeding.
- Risk of blood clots: Some targeted therapy drugs can increase the risk of blood clots.
Side Effects of Immunotherapy
Immunotherapy is a type of cancer treatment that uses the body’s immune system to fight cancer cells. While immunotherapy can be a promising treatment for some patients with advanced thyroid cancer, it can also cause some side effects. Here are some potential side effects of immunotherapy for thyroid cancer:
- Fatigue or weakness: Immunotherapy can cause fatigue or weakness, which may persist for several weeks after treatment.
- Skin reactions: Some immunotherapy drugs can cause skin reactions, including rash, itching, or blistering.
- Diarrhoea, abdominal pain or colitis: Immunotherapy can cause inflammation of the digestive tract.
- Endocrine dysfunction: Immunotherapy can cause dysfunction of the endocrine glands, including the thyroid gland.
- Infusion reactions: Some patients may experience infusion reactions, including fever, chills, or shortness of breath.
- Liver problems: Immunotherapy can cause liver problems, including abnormal liver function tests or liver damage.
- Lung problems: Some immunotherapy drugs can cause lung problems, including coughing or shortness of breath.
- Kidney problems: Some immunotherapy drugs can cause kidney problems, including abnormal kidney function tests or kidney damage.
What do I need to do if I have Thyroid Cancer?
It is important to remember that thyroid cancer may be treated by a trained specialist if caught early. If you have any concerns about your thyroid or notice any changes, do not hesitate to see a healthcare professional for evaluation.
If you suspect that you or your loved one have thyroid cancer, it is advisable to get the support you need. Early detection and diagnosis of thyroid cancer is key to treating the disease.
Regardless of what stage your thyroid cancer may be at, you should schedule an appointment to see an oncologist specialising in thyroid cancer as soon as possible. With the speed of developments in thyroid cancer diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.
Who are the Thyroid Cancer Specialists in Singapore?
Dr Wong Nan Soon
Senior Consultant, Medical Oncologist
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology) – MHsc (Duke, USA)
Dr Wong Nan Soon has over 15 years of experience in diagnosing and managing a wide range of cancer. He specialises in breast cancer and gastrointestinal cancers, such as colon cancer, rectal cancer, anal cancer, biliary cancer, pancreatic cancer, liver cancer, GI stromal cancers (GIST), and neuroendocrine cancer. Dr Soon also has experience treating patients with lung cancer, kidney cancer, uterine cancer, cervical cancer, and ovarian cancer.
In 1994, he graduated from the Faculty of Medicine, National University of Singapore and earned his Master’s in Internal Medicine and Membership of the Royal College of Physicians in the United Kingdom. In 2003, he completed advanced specialty training in general medical oncology.
Following his graduation, he completed a 1 year clinical fellowship sub-specialising in breast medical oncology in Canada, where he trained under Professor Kathleen Pritchard, world renowned breast oncologist.
- Novartis Oncology Young Canadian Investigator Award 2005
- Canadian Association of Medical Oncology Annual Meeting Best Poster Award 2005
- Chairperson, Medical Treatment Fund Committee, Singapore Cancer Society 2007
- Clinical teacher, Yong Loo Lin School of Medicine, National University of Singapore from 2006-2011
- Adjunct Associate Professor in the Department of Clinical Sciences, Duke-National University of Singapore, 2011-2013
- Visiting Senior Consultant, KK Women’s & Children’s Hospital, Singapore 2010-2011
- Senior Consultant, Dept of Medical Oncology, National CancerCentre Singapore 2009-2011
- Visiting Consultant, Dept of Medical Oncology, National Cancer Centre Singapore 2012-2014
- Committee member, Specialist Training Committee (Medical oncology), Ministry of Health from 2009 to 2012
- Invited lecturer at Nanyang Polytechnic School of Health Sciences
- Director of Public and Patient Education, National Cancer Centre Singapore 2008-2011
- Deputy Director in the Division of Community Outreach and Philanthropy, National Cancer Centre Singapore
- Vice President, Singapore Society of Oncology 2011-2012
- Board Member, Chapter of Medical Oncologists of Singapore 2009-2012
- Honorary Secretary, Chapter of Medical Oncologists, College of Physicians, Academy of Medicine, Singapore 2007-2008
- Member, Clinical Trials Steering Committee, National Cancer Centre Singapore, 2008-2011
- Member, Singapore Society of Oncology
- Member, American Society of Clinical Oncology
Dr Tan Sing Huang
Senior Consultant, Medical Oncologist
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology)
Dr. Tan Sing Huang is a Senior Consultant Medical Oncologist who has more than 16 years experience in managing a wide range of cancers. Prior to joining OncoCare Cancer Centre, she held the position of Senior Consultant in the Department of Hematology-Oncology National University Cancer Institute, Singapore (NCIS). She was also Assistant Professor, Yong Loo Lin School of Medicine, National University of Singapore.
During her work at NCIS, she had continued to take care of patients with a wide variety of cancers, including Breast cancers, Gynecological cancers, Lung cancers and Gastrointestinal cancers (colon, rectum, pancreas, liver, gastric) although her primary interest is in Women’s Cancers. As a result of her clinical efforts in NUH, she was awarded the Sunny Side-Up and Sunny Side-Up WOW Awards for exemplary patient feedback.
She led the Senior Residency Education division in NCIS as its Program Director since 2012 till 2016, served as Co-Chairman for the NCIS Clinical Competency Committee and also as panel member for national selection of Medical Oncology trainees. In addition, she participated as an examiner for undergraduate final medical exams. As a result of her contributions to education, she was awarded the NUH Teaching Excellence Award in 2014.
She held the post of Vice President of the Singapore Society of Oncology since 2013 till 2018.
She is also a long-standing current active Committee Member and more recently Deputy Chair of the National Healthcare Group Domain-Specific Ethics Review Board since 2020 which reviews Medical Oncology clinical trial protocols for the hospitals.
She was also principal investigator of several multi-center studies investigating new investigational drugs in HER2-positive breast cancers as well as being co-investigator of several multi-centre clinical trials in lung, colorectal and breast cancers.
Her interest in translational research led to spending time with the RUNX research group in Singapore under a National Medical Research-Singapore (NMRC) Totalisator Medical Research Fellowship Award. She then went to Johns Hopkins Sidney Kimmel Comprehensive Cancer Centre in Baltimore in 2006-2007 where she was involved in epigenetics research and also gained clinical experience from attachments with the Breast Cancer Division of Johns Hopkins Medical Institute.
She has been awarded the Research-Investigator-Scientist Enabler (RISE) Grant Scheme Award from 2008 to 2010, and the Junior Investigator Protected Time Award in 2011.She won a Merit Award for her Oral Presentation at the 10th International Conference of The Asian Clinical Oncology Society in Seoul on oncogenic mutation profiling changes pre- and post-chemotherapy in breast cancers. She was given the National Medical Research Council Clinician Investigator Salary Support Program (CISSP) Award from 2012 to 2014. She went on to obtain a number of independent grants since 2008 studying methylation patterns, high-throughput oncogenic mutation profiling and the effects of chemotherapy on cognition in cancer patients.
She has contributed chapters on chemotherapy treatment of metastatic breast cancer in international textbooks such as Diseases of the Breast. In addition, she has written and contributed to publications which have appeared in local and international journals including Clinical Cancer Research and Annals of Oncology.
She has also given many local and overseas talks as an invited speaker including in China, Vietnam and Brunei. She has also chaired conferences and been an invited speaker for both local and overseas conferences. She is fluent in English, Mandarin and Hokkien and is able to speak some Malay and Bahasa. She has taken care of patients from many regional and overseas regions including Indonesia, Vietnam, Myanmar, China, Bangladesh, Sri Lanka, India and Russia.
- Senior Consultant at National University Cancer Institute (NCIS) prior to joining OncoCare Cancer Centre
- Assistant Professor, Yong Loo Lin School of Medicine, National University of Singapore prior to joining OncoCare Cancer Centre
- Program Director, Senior Residency Education Division, National University Cancer Institute 2012-2016
- Deputy Chair National Healthcare Group Domain Specific Research Board B1 since 2020 and Committee Member since 2011
- Vice President of the Singapore Society of Oncology 2013-2018
- Merit Award for Oral Presentation 10th International Conference of the Asian Clinical Oncology Society (Seoul, Korea); 2012
- Received the Research-Investigator-Scientist Enabler (RISE) Grant Scheme Award 2008
- Awarded the National Medical Research-Singapore Totalisator Medical Research Fellowship Award 2003-2004
- Awarded the Sunny Side-up and Sunny Side-up WOW Awards for clinical patient care, National University Hospital
- Committee member inaugural Breast Day Symposium 2016, Singapore
Chairman for Best of ASCO conference, Singapore 2015 - Awarded the NUH Teaching Excellence Award 2014
- Member of the Singapore Cancer Network (SCaN) Breast Cancer Guidelines Workgroup 2014 and Section Lead for guidelines pertaining to adjuvant bisphosphonate use
- Postgraduate training at Johns Hopkins Medical Institute, Baltimore 2006-2007
Member, Singapore Society of Oncology - Member of the American Society of Clinical Oncology (ASCO)
Dr Peter Ang
Senior Consultant, Medical Oncologist
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology)
Dr Peter Ang graduated from the National University of Singapore in 1991 and then earned his Master of Medicine in the United Kingdom in 1997. He was awarded the Ministry of Health Manpower Development Programme (HMDP) Scholarship to train at Dana Farber Cancer Institute, where he focused on general oncology with a focus on breast cancer and cancer genetics.
He is recognised for his leadership and expertise as a breast cancer specialist doctor, and was the leading cancer specialist of the Breast Cancer Workgroup (2002) for National Cancer Centre, Singapore and Singhealth cluster. He is involved in providing comprehensive oncology information and excellent care for patients with a wide range of cancers including lung cancer, stomach cancer, colorectal cancer, lymphoma, kidney cancer, breast cancer, ovary cancer, uterus cancer, and cervix cancer. He has also been actively involved in clinical and translational cancer research for many years, in breast, colon, lung and other cancers.
- Graduated from the National University of Singapore in 1991.
- Obtained Master of Medicine (Internal Medicine) and Membership of the Royal College of Physicians (United Kingdom) in 1997.
- 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 2000-2001.
- He was the leading breast cancer oncologist of the Breast Cancer Workgroup (2002) for National Cancer Centre and Singhealth cluster and was involved in the cluster Breast Cancer Health Management Plan (2003). He was program leader for the Public Cancer Education with Singhealth Cancer Service Development Line (2004).
Dr Tan Chee Seng
Senior Medical Oncologist
Dr Tan Chee Seng | OncoCare Cancer Centre
MBBS (Singapore) – MRCP (United Kingdom)
Dr Tan Chee Seng is a Senior Medical Oncologist at OncoCare Cancer Centre. Prior to this, he was a Consultant with the Haematology-Oncology Department of the National University Cancer Institute of Singapore (NCIS), National University Hospital (NUH) and a Visiting Consultant at Ng Teng Fong General Hospital (NTFGH).
He obtained his undergraduate medical degree from the School of Medicine, National University of Singapore and his post-graduate qualification from the Royal College of Physicians, United Kingdom. He completed his advanced specialist training in Medical Oncology from National University Hospital. He was later awarded the prestigious Academic Medicine Development Award (AMDA) fellowship to subspecialise in the personalisation of lung cancer therapies at Addenbrooke’s Hospital, Cambridge University, United Kingdom.
His main clinical interests are in lung/thoracic and head/neck cancers. He was the principal investigator and co-investigator for several international multi-centre cancer clinical trials including novel chemotherapy agents, targeted therapies, tyrosine kinase inhibitors, antibody-drug conjugates, immunotherapy agents etc. Dr Tan has also authored and co-authored publications in peer-reviewed international journals including Lancet Oncology, Clinical Cancer Research, Molecular Cancer, Lung Cancer, Oncotarget, Target Oncology, Journal of Cancer Research and Clinical Oncology, Journal of Translational Medicine, Journal of Oncology Practice and etc.
He has been invited to speak and to chair in local and regional oncology meetings. He also routinely held public talks with local GPs to inform them of the latest innovative treatments for cancers. Dr Tan was also the recipient of several grants including the National Medical Research Council (NMRC) Clinician Investigator Salary Support Programme and Investigational Medicine Unit (IMU) Bridging Funds.
He is a member of several professional bodies including the American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), International Association for the Study of Lung Cancer (IASLC) and was an executive committee member of the Singapore Society of Oncology.
He was actively involved in both undergraduate and postgraduate teachings at the Yong Loo Lin School of Medicine (YLLSOM) and the National University Hospital (NUH) respectively. He was previously appointed as the Assistant Professor for the Faculty of Medicine, YLLSOM and Undergraduate Education Director (Medical Oncology). He was also a core faculty member of the Medical Oncology Senior Residency of NUH. He was invited to be an examiner for YLLSOM final year MBBS examinations.
Dr Tan is fluent in English, Mandarin and Malay/Bahasa. He is able to speak some Cantonese and Hokkien. He has taken care of patients from many regional and overseas regions including Malaysia, Indonesia, Vietnam, Myanmar, China, Bangladesh, Sri Lanka and India.
Dr Tan has sub-specialty oncology interest in head/neck cancers (including thyroid cancer, nasopharyngeal carcinoma, NPC) and thoracic/lung (small cell and non-small cell lung cancers, mesothelioma).
MEDICAL PROFILE
- Graduated from the National University of Singapore in 2005.
- Obtained Membership of the Royal College of Physicians (United Kingdom) in 2007.
- Awarded ASEAN Scholarship (1998-2000) and KUOK Foundation Scholarship (2000-2005).
- Awarded the prestigious AMDA Academic Medicine Development Award (AMDA) (2014-2015) for fellowship training at Addenbrooke’s Hospital Cambridge University, United Kingdom on personalisation of treatment for lung cancers.
- Clinical lecturer, Yong Loo Lin School of Medicine, National University of Singapore from 2012-2018.
- Director of Undergraduate (Medical Oncology), Yong Loo Lin School of Medicine, National University of Singapore from 2012-2018.
- Assistant Professor Yong Loo Lin School of Medicine, National University of Singapore from 2016-2018.
- Invited as an examiner for Yong Loo Lin School of Medicine final year MBBS examinations.
- Authored or co-authored publications in peer-reviewed international journals including Lancet Oncology, Clinical Cancer Research, Molecular Cancer, Lung Cancer, Oncotarget, Target Oncology, Journal of Cancer Research and Clinical Oncology, Journal of Translational Medicine, Journal of Oncology Practice and etc.
- Recipient of several grants including the National Medical Research Council (NMRC) Clinician Investigator Salary Support Programme and Investigational Medicine Unit (IMU) Bridging Funds.
- Member of several professional bodies including the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO), International Association for the Study of Lung Cancer (IASLC) and was an executive committee member of the Singapore Society of Oncology.
- Sub-specialty oncology interest in thoracic/lung (small cell and non-small cell lung cancers, mesothelioma) and head/neck cancers (including nasopharyngeal carcinoma, NPC).
Dr Leong Swan Swan
Senior Consultant, Medical Oncologist
Cancer Specialist, Expert in Oncology, Singapore (oncocare.sg)
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology)
Dr Leong Swan Swan did her basic Medical studies at the National University of Singapore (NUS) and obtained her Master of Medicine (Internal Medicine), NUS and Membership of the Royal College of Physicians (United Kingdom) in 1995. She started her training in Medical Oncology in 1995 and was awarded HMDP for further training, with a special focus on Thoracic Oncology under Dr Mark Green at Holling’s Cancer Centre in 1997. In 2000, she obtained Specialist Accreditation in Medical Oncology as well as European Society of Oncology (ESMO) certification.
Dr Leong has been working in the Department of Medical Oncology, Singapore General Hospital / National Cancer Centre since 1995. She has provided outstanding cancer care for a wide spectrum of cancers including breast cancer, colorectal and stomach cancers, lung cancer, head & neck cancer, ovarian/uterine/cervical cancers, lymphomas and other solid tumours. Prior to leaving for private practice, Dr Leong was serving as a Senior Consultant, managing different tumour types and was involved in the multi-disciplinary care tumour boards, establishing her as a key opinion cancer specialist doctor in lung as well as head and neck cancers. She was also a Visiting Consultant at Changi General Hospital. She was the Director of the Ambulatory Treatment Unit at the National Cancer Centre and was the Chairperson of the Code Blue Team.
Dr Leong was also actively involved in teaching. She was a Clinical Lecturer for medical students, involved in undergraduate teaching as well as teaching for junior staff and nurses. She has also given many public lectures.
She has published widely in both local and International journals including the Journal of Clinical Oncology, Chest, Cancer and has written book chapters for the staging and treatment of lung cancer. Recognised for her expertise in lung and other cancers, she has been a reviewer for several journals including the Journal of Clinical Oncology, Respirology and Singapore Medical Journal.
Dr Leong’s subspecialty interest is in lung cancer, thyroid cancer and head & neck cancer. (Head and neck cancer is a cancer that starts in the lip, oral cavity (mouth), nasal cavity (inside the nose), paranasal sinuses, pharynx, and larynx.) She is fluent in English and Mandarin as well as Cantonese dialect.
MEDICAL PROFILE
- Graduated from the National University of Singapore.
- Obtained Master of Medicine (Internal Medicine) and Membership of the Royal College of Physicians (United Kingdom) in 1995.
- Awarded the Ministry of Health Manpower Development Programme (HMDP) Scholarship HMDP for further training, with a special focus on Thoracic Oncology under Dr Mark Green at Holling’s Cancer Centre in 1997. In 2000, she obtained Specialist Accreditation in Medical Oncology as well as European Society of Oncology (ESMO) certification.
- She was the Director of the Ambulatory Treatment Unit at the National Cancer Centre and was the Chairperson of the Code Blue Team.
- She has been actively involved in clinical and translational research for many years, in lung cancer and head and neck cancer. These have involved international trials of chemotherapy drugs currently in active use and newer targeted therapy drugs. She was the principal investigator for more than 10 clinical trials for cancer drug development.
- Research work by Dr Leong has been published in both local and international reputable journals including the Journal of Clinical Oncology, Chest, Cancer and has written book chapters for the staging and treatment of lung cancer. She has been a reviewer for several journals including the Journal of Clinical Oncology, Respirology and Singapore Medical Journal.
- With respect to public service, Dr Leong was also actively involved in teaching. She was a Clinical Lecturer for medical students, involved in undergraduate teaching as well as teaching for junior staff and nurses. She has also given many public lectures.
- Accredited for Palliative Medicine.
Types of Thyroid Cancer
There are different types of thyroid cancer, including:
Papillary thyroid cancer
This is the most common type of thyroid cancer, accounting for about 80% of all cases. It develops from follicular cells and tends to grow slowly.
Follicular thyroid cancer
This type of thyroid cancer also develops from follicular cells and accounts for about 10% of all cases. It tends to spread to other parts of the body more quickly than papillary thyroid cancer.
Medullary thyroid cancer
This type of thyroid cancer develops from C cells, which produce a hormone called calcitonin. Medullary thyroid cancer accounts for about 5% of all thyroid cancer cases.
Anaplastic thyroid cancer
This is a rare and aggressive form of thyroid cancer that tends to spread quickly and is difficult to treat.
Thyroid lymphoma
This is a rare type of thyroid cancer that develops in the lymphatic tissue of the thyroid gland. Treatment may involve surgery, radiation therapy, chemotherapy, and targeted therapy.
According to the International Agency for Research on Cancer (IARC), in 2020, there were an estimated 586,000 new cases of thyroid cancer worldwide and 42,000 deaths from the disease.
In Singapore, thyroid cancer is the 7th most common cancer among women, with an incidence rate of 8.1 per 100,000 individuals in 2018, according to the Singapore Cancer Registry. The incidence of thyroid cancer in Singapore has been increasing over the past few decades, with an average annual increase of 5.2% in women between 1973 and 2017, and 3.8% in men between 1993 and 2017. The mortality rate for thyroid cancer in Singapore is relatively low, with 1.1 deaths per 100,000 population in 2018.
It is worth noting that the incidence of thyroid cancer has been increasing globally over the past few decades, which is partly attributed to the increased use of diagnostic imaging tests such as ultrasound and CT scans, which can detect small thyroid nodules that may not have been detected in the past. However, the majority of thyroid cancers are still highly treatable, and the prognosis for most patients is excellent, with a 5-year survival rate of around 98%.
What are the Signs and Symptoms of Thyroid Cancer?
Some people with thyroid cancer may not have any symptoms, and the cancer may only be detected during a routine physical exam by a specialist or through imaging tests. The symptoms can also vary depending on the type and stage of the cancer. An individual with thyroid cancer may experience the following symptoms:
A lump or swelling in the neck
This is the most common symptom of thyroid cancer. The lump may be painless or tender to the touch and may increase in size over time.
Changes in the voice
Thyroid cancer can affect the nerves that control the voice box, leading to hoarseness or other changes in the voice.
Difficulty swallowing
A large thyroid tumour can press on the oesophagus or trachea, causing difficulty swallowing or breathing.
Neck pain
Some people with thyroid cancer may experience pain in the neck, ears, or jaw.
Enlarged lymph nodes
Cancer cells can spread to the lymph nodes in the neck, causing them to become enlarged and tender.
Fatigue
Thyroid cancer can cause fatigue or weakness, especially if the cancer has spread to other parts of the body.
Screening for Thyroid Cancer
There is currently no universally accepted screening test for thyroid cancer. In individuals without symptoms or risk factors, routine screening for thyroid cancer is not usually recommended. However, in some cases, a specialist may recommend a thyroid ultrasound or other imaging tests if a person has symptoms or risk factors, such as a family history of thyroid cancer or exposure to radiation.
In Singapore, the Health Promotion Board recommends that individuals aged 50 years and above should undergo a screening for thyroid disorders, including thyroid cancer, during their routine health check-ups. The screening may include a physical examination of the neck to check for any lumps or nodules, as well as a blood test to measure thyroid hormone levels.
It is important to note that thyroid nodules are common, and most of them are benign. Only a small percentage of thyroid nodules are cancerous, and not all cases of thyroid cancer can be detected through screening.
How Thyroid Cancer is Diagnosed
Thyroid cancer is typically diagnosed through a combination of physical examination, imaging tests, and biopsy conducted by a specialist. The diagnostic process may include the following steps:
A doctor will perform a physical examination of the neck to check for any lumps or nodules in the thyroid gland.
Imaging tests such as ultrasound, CT scan, or MRI may be used to visualise the thyroid gland and surrounding tissues and to determine the size, location, and characteristics of any nodules or masses.
If a nodule or mass is detected, a biopsy may be performed to determine if it is cancerous. The biopsy may be done using a fine needle aspiration (FNA) technique, in which a thin needle is inserted into the nodule to collect a sample of cells for examination under a microscope.
Blood tests may be done to measure levels of thyroid hormones and other substances in the blood, which can help diagnose thyroid cancer and monitor its progression.
Once a diagnosis of thyroid cancer has been made, your specialist may administer additional tests to determine the stage of the cancer and whether it has spread to other parts of the body. These tests may include chest X-ray, bone scan, or PET scan.
What are the Causes and Risk Factors of Thyroid Cancer?
The exact cause of thyroid cancer is not known. However, certain risk factors may increase the likelihood of developing thyroid cancer. These include:
Thyroid cancer is more common in women than in men.
The risk of developing thyroid cancer increases with age, with most cases occurring between the ages of 25 and 65.
Exposure to high levels of radiation, especially during childhood, increases the risk of developing thyroid cancer.
Having a close relative, such as a parent or sibling, who has had thyroid cancer increases the risk of developing the disease.
Inherited genetic mutations, such as those associated with familial medullary thyroid cancer, can increase the risk of developing thyroid cancer.
Prolonged iodine deficiency or excess can increase the risk of developing certain types of thyroid cancer.
Having a history of goitre or benign thyroid nodules may increase the risk of developing thyroid cancer.
Some hormonal factors, such as having a history of hyperthyroidism or radiation therapy to the head and neck, may increase the risk of developing thyroid cancer.
It is important to note that having one or more of these risk factors does not necessarily mean that a person will develop thyroid cancer, and many people with thyroid cancer have no identifiable risk factors.
What are the Stages of Thyroid Cancer?
The staging of thyroid cancer refers to the extent to which the cancer has spread beyond the thyroid gland. The most commonly used staging system used by specialists is the TNM system, which stands for Tumour, Nodes, and Metastasis.
Here are the stages of thyroid cancer:
The cancer is confined to the thyroid gland and has not spread to nearby lymph nodes or other parts of the body.
The cancer is still confined to the thyroid gland but has grown larger and may have invaded nearby tissues.
The cancer has spread to nearby lymph nodes but has not spread to other parts of the body.
The cancer has spread beyond the thyroid gland to nearby tissues or organs, or to distant sites in the body such as the lungs or bones.
Each stage is further divided into subcategories based on the size and extent of the cancer, as well as the number and location of affected lymph nodes. The stage of cancer helps guide treatment decisions and can also provide information about the likely outcome of the disease.
