LIFE-CHANGING "MOMENTS"
IT IS HARD TO IMAGINE HOW TEN YEARS HAS PASSED AS MY PATIENT HANDED ME A BOOK ENTITLED "MOMENTS", in which he describes his journey with Nasopharyngeal (Nose) Cancer. It is also harder to imagine how deeply such a diagnosis can impact a person's life. In my many years of practice, there are times when it seems that my care and surgery seem to meet the needs of patients, but there are also times when I feel helpless.
Nose cancer is one of those conditions in which I find myself helpless as my main contribution to the patient is making the diagnosis and staging the disease. The treatment for such condition is fundamentally radiation therapy, with or without chemotherapy. The majority of such patients do well, like the patient who wrote the book, or at least from the standpoint of the control of the disease. However, as this patient writes in his book, there are many areas relating to the management of the condition, the impact on the patient's overall health, the impact on his or her relationships with immediate family and friends that as a doctor I do not have the privilege of appreciating.
How could being Chinese and, in particular, Cantonese, be a risk factor? The data strongly indicates that nose cancer occurs in much higher proportions in Hong Kong and Guangzhou, China. Over the years, however, due to cross marriages and genetic drift, the other Chinese dialect groups are not spared. Of course, the Chinese are not the only race to suffer from nose cancer; I also have patients from other ASEAN countries, including Malays, Vietnamese, Indonesians, Filipinos, Myanmar, Cambodians, etc.
After cancer diagnosis, most patients will ask the question, "Doc, what are the foods I should avoid?" As it turns out, in large population nose cancer studies, researchers have linked it to some Cantonese favourites including preserved foods, like salted fish, preserved mustard and preserved sausages/meat. The underlying relationship between cancer and food has been postulated to be a chemical called nitrosamines which can be found in the foods. However, it is not proven that abstinence of these foods upon diagnosis would reduce the rate of recurrences after treatment. It may be that a reduction in intake of such preserved foods could reduce the risk of developing nose cancers.
My patient who wrote the book had a Neck Lump for several months. It is not always that a neck lump is linked to nose cancer. Like him, often the neck lumps would have been treated with several courses of antibiotics without resolution. Nose cancer usually begins growing at the back of the nose but this is hard to detect. In Singapore, the data reveals that the first presenting symptom in 60 per cent of all nose cancer patients is a neck lump. This implies that in 60 per cent of patients, the nose cancer has already spread at the time of diagnosis. However, today's technology allows us to place a simple soft fibre-optic scope into the nose to make a diagnosis, allowing for the early detection of nose cancer.
Finally, my patient reminded me of the period of times he suffered between the "OK" times that I saw him in the clinic. It is a great reminder that patients need more than just a single doctor to diagnose, treat and follow-up. Thus, the complexity of caring for patient with cancer involves the sensitivity to meet the needs of emotional challenges, fear, physical pain from treatment, advice for future plans etc. I would recommend this book called "Moments" by Steven Wong- it is a journey that should benefit other patients and also remind the doctors of our limitations in patient care.
A/PROF LUKE K S TAN
Ear Nose & Throat Surgeon

MBBS FRCS (England) MMEDS ci FAMS (ORL)
Head & Neck Surgery (Texas, USA)
Luke Tan ENT - Head & Neck Cancer and
Thyroid Surgery Centre
3 Mount Elizabeth #14-17 Mount Elizabeth Medical Centre. Tel: 6474 6116
www.thyroidsurgery.com.sg