February • 2007

From From
your doctor your doctor
to you to you

Understanding Cancer Through Information

See back page for English

Treating Treating Prostate Cancer

Prostate Cancer Prostate cancer is the fourth most common type of cancer
in Hong Kong men, with 826 new cases and 209 deaths
from the disease reported in 2003.
A boy born today in Hong Kong has a 7% chance of
developing the disease and a 3% risk of dying from it.
Do I Need
he good news is that most types of prostate beam on the affected area for a few minutes at
a Second
Opinion? T cancer develop slowly, and many patients
live with it for years, even without
treatment. In addition, reliable diagnostic tests
a time; a course of radiotherapy usually takes
weeks. Intensity-modulated radiation therapy
provides a more precise and faster method to
and various treatment options are now available, deliver a higher radiation dose to tumor cells.
which have led to a decline in death rates from In interstitial brachytherapy (also called 'seed
the disease. therapy'), radioactive sources, usually in the
Unlike many other common cancers, there is form of needles, pellets or wires, are implanted
Diet Matters: no consensus among doctors about the best directly into the tumor to destroy it from within.
Eat Right treatment for prostate cancer or whether • Radical prostatectomy: This is an operation to
treatment is necessary at all. remove the prostate gland and some of the
for Cancer In general, treatment will depend on the tissue around it. The main goal of radical
Prevention clinical stage of the tumor, and the age and prostatectomy is to remove all the tumor and
health status of the patient. Furthermore, potentially malignant surrounding tissue. The
treatment selection is based on operation is performed under
risks versus benefits of each general anesthesia and may be
therapy, potential side effects, done by open or laparoscopic
Oral Drug cost and patient preference.
Aggressive treatment surgery. In open surgery, the
Improves Quality may prolong life,
surgeon uses a large incision to
Choosing your treatment reach the prostate, whereas in la-
of Life for but can compromise
There are currently four major paroscopic surgery several small
Cancer Patients treatment options for prostate the quality of life incisions are made in the belly
cancer: and special instruments are used
• Watchful waiting: Rather than un- to view, reach and remove the
dergoing immediate treatment, prostate. Newer surgical proce-
patients are regularly monitored dures allow doctors to preserve
for tumor progression. Monitoring includes patients' urinary control and the nerves that are
blood tests for prostate specific antigen (PSA, a essential for erection.
marker of prostate cancer), digital rectal exami- • Hormone therapy: Also known as androgen depri-
nations and periodic biopsies. Watchful waiting vation therapy, hormone therapy utilizes drugs
is generally applied to older patients and those to decrease the production of male hormones
with small tumors that pose no immediate (androgens) in order to stop or limit the growth
threat and have little potential for rapid pro- of prostate cancer, which is androgen-
gression. dependent. Hormone therapy is the primary
• Radiation therapy: Radioactive agents are used to treatment for advanced cancer that has spread
destroy cancer cells by targeting the genetic beyond the prostate to distant body sites.
material (DNA) within the cell. Traditional ra- Before deciding on any treatment,
diotherapy involves focusing an external X-ray always consult your doctor and other specialists!
Do I Need a Second Opinion?
Cancer is usually diagnosed by a pathologist – a doctor
who examines a small sample of the suspect tissue
(biopsy) under the microscope to determine whether the
cells are normal or malignant (cancerous).
However, opinions may differ among pathologists interpret- Here are some useful tips:
ing the same biopsy results; research has shown • Inform your primary treating physician/oncologist that you
differences of 5% to 24% between an initial
pathology diagnosis and a second opinion
from another pathologist, depending on
These are
cancer type. This problem must be consid- life-and-death input from another doctor who may have a
ered, as the diagnosis has major implications
matters.
for treatment selection and the chance
of cure. It's your life
and your
Where cancer is concerned, there is also
much misunderstanding, fear and uncertainty
peace of mind.
about selecting the best therapy. For a
disease as serious as cancer, a second
opinion is definitely a good idea. There may
be different approaches and, sometimes,
there is no definitive answer.
Ask the experts
While most patients feel they need to gather
information and consult with other special-
ists, they may be too shy to ask or reluctant
to offend their primary physician. Many
patients do not realize that getting a second
opinion is common practice.
• Seek a pathologist/oncologist specializing in your specific
cancer area. Large academic medical centers have more ex-
perience; they see more cases and can provide more
Myths & Facts oncology subspecialty services than small clinics or
hospitals.
Myth Artificial sweeteners cause cancer.
Fact Since 1969, when cyclamate was first linked to tumors in
mice, tests on artificial sweeteners have occasionally
generated headlines. It was later disclosed that the mice
had been given an amount of cyclamate equivalent to
800 cans of diet soda daily, for several weeks. Currently,
there is no compelling evidence for a link between
artificial sweeteners and cancer in humans. Because
large amounts of saccharin have been shown to cause
tumors in lab rodents, people should be cautioned
against overusing it. Another common sweetener,
aspartame, shows no increased risk of causing cancer.
Myth Breastfeeding increases the risk of breast cancer.
Fact Women who breastfeed can get breast cancer, but no
studies indicate that breastfeeding causes breast cancer.
In fact, some studies indicate that breastfeeding can
reduce a woman's risk of developing the disease.
ii
Unless immediate treatment is required, it is worthwhile to
take time to obtain another expert opinion. This will help you
focus and consider the different options in an informed and
rational manner.
intend to seek a second opinion – it is your right.
You can explain that you are pleased with your
doctor's care but would like to get additional
different perspective.
• Involve a trusted family member/friend in the
process. You may be too worried or confused to
understand the larger picture. A relative or
friend can help you to better understand the
diagnosis, and gather information about
different treatment options and prognosis.
• Make sure to get all your medical records (labo-
ratory, X-ray and pathology reports) or ask your
primary treating doctor to forward them to the
second consultant.
• You may ask your primary treating physician to
refer you to another expert, but it is preferable
to seek the opinion of an independent unbiased
doctor.
• For a second pathology opinion, you don't need to travel to a
major medical institution. Biopsy samples can be sent to
the second expert (in Hong Kong or overseas), who will
review the case, then submit a written report to the referring
physician.
• Many medical insurance companies acknowledge the impor-
tance of second opinions and will pay for it. Even if your
insurer will not reimburse it, a second opinion may be a
wise investment.
Editorial development by CMPMedica. The opinions expressed in
this publication are not necessarily those of the editor, publisher or
sponsor. Any liability or obligation for loss or damage howsoever
arising is hereby disclaimed.
© 2007 CMPMedica. All rights reserved.
No part of this publication may be reproduced by any process in any
language without the written permission of the publisher.
Diet Matters:
Eat Right for Cancer Prevention
With many studies pointing
to the protective power of
certain foods, scientific
evidence is now
accumulating on the role of
nutrition in cancer prevention.
Experts estimate that at least
35% of all cancers have a
nutritional connection, suggesting
that many cancers may be prevented with
proper nutrition. When lifestyle factors such as
smoking and exercise are included, the
associated benefits become even stronger.
In daily life, we are exposed to a variety of oxidizing and
cancer-producing substances, but compounds found in
fruits and vegetables help limit the DNA damage and the
release of toxic free radicals caused by these carcinogens.
Depending on what we eat, our diets can either increase or
decrease our risk of getting cancer. When we choose foods
rich in reputed protective factors, such as fruits and veg-
etables, we are doing something positive for our health and
may be preventing the development of various types of
cancer. According to the American Institute for Cancer
Research, at least 20% of all cancers could be prevented
by adopting relatively simple eating habits.
Modifying our diet is one of the easiest steps to take towards
a healthier lifestyle and cancer prevention. Here are some
examples of cancer-preventive foods and supplements:
• Pigmented (colored) plant compounds are important
antioxidants and eating more of them may decrease
cancer risk. For example, green plants such as bok choy,
kale, mustard and blue-green algae are rich in chloro-
phyl, a detoxifier and anticancer agent. Orange and red
foods contain high amounts of carotenoids, which are
According to the American Institute for
Cancer Research, at least 20% of all
cancers could be prevented by adopting
relatively simple eating habits.
iii
important antioxidants. Carotenoids appear to offer pro-
tection against lung, colorectal, breast and prostate
cancers.
• Sulfur-containing compounds found in many spicy plants
are protective against cancer. Broccoli, cabbage and
cauliflower are rich in compounds that bind chemical
carcinogens in the gastrointestinal tract. Studies in
animals have shown that garlic and onion prevent cancer
and inhibit the progression of existing tumors, especially
stomach cancer. Pineapples contain bromelain, a sulfur-
rich enzyme that has documented effects against
metastatic cancers.
• Wholegrain foods, unlike those made from processed
grains, contain essential fatty acids and lignans – weak
estrogens that may protect against estrogen-related
tumors, such as breast and colon cancer. The high fiber
content in these foods is also believed to reduce cancer
risk by binding carcinogens in the intestine.
• Legumes, especially soybeans, are an important source
of fiber, phytoestrogens and lignans. Soy also contains
isoflavones, which have been found to protect against
estrogen-related cancers in numerous studies.
• The spice rack may provide a good source of healthy
food ingredients. Cayenne pepper, curcumin, ginger,
rosemary, sage, turmeric and other spices have anti-
cancer, antioxidant and anti-inflammatory properties.
• Some types of mushrooms, as well as kelp and seaweed,
are rich in anticancer agents and fiber that absorb liquid
toxins and heavy metals in the intestine.
Your food choices
EAT MORE TRY TO AVOID
Cabbage-family vegetables Animal products: meat, fat, dairy
Wholegrain foods Artificial preservatives
Garlic and onion Synthetic foodstuffs
Nuts Food coloring
Soybeans and other legumes Foods rich in saturated fat
Leafy green vegetables Sugary foods
Oranges and tomatoes
Curry and ginger
Fish and fish oil
Oral Drug Improves Quality of Life
for Cancer Patients
Cancer patients normally need some
form of chemotherapy – either as
first-line treatment or as adjuvant
therapy after surgical removal
of the tumor.
However, chemotherapy causes
unwanted side ef fects, such as
diarrhea, hair loss, nausea and skin
reactions. Moreover, it is usually admin-
istered by slow intravenous infusion,
over several treatment cycles.
According to Dr. Wai Man Sze, a
Specialist in Clinical Oncology, home
infusion is an option, but most patients
in Hong Kong are too worried about
accidents and prefer to receive
chemotherapy in the hospital.
"Such frequent hospitalization – for
3 days every 2 weeks – disrupts the
normal routine and seriously compro-
mises patients’ quality of life," he says.
Capecitabine: A convenient option
For tuna tely, pa tients who need
chemotherapy can now use
capecitabine therapy. Capecitabine is
an oral chemotherapy agent tha t
is taken twice daily for 2 weeks on,
1 week off.
Capecitabine is an oral for m of
5-fluorouracil (5-FU), a chemotherapy
agent used in many common
chemotherapy regimens, such as
FOLFOX and FOLFIRI.
"When taken by mouth, capecitabine is
absorbed in the digestive system and
then converted in the tumor cells to the
active form, 5-FU. The active drug is
Cancer fighter hotline: 2733 4676 Web site: www.2eCancer.com
much more concentrated in the cancer
cells than in the surrounding tissue and
provides treatment efficacy that is
equivalent to 5-FU," explains Dr. Sze.
For example, clinical trials that
compared conventional FOLFOX
chemotherapy with an oral capecitabine
regimen in patients with colorectal
cancer that had spread (metastasized)
to other par ts of the body showed
the capecitabine-based therapy
(XELOX) was as effective as FOLFOX.
"Capecitabine is a good alternative to
infusion chemotherapy," says Dr. Sze.
"New cancer guidelines from the USA
Na tional Comprehensive Cancer
Network (NCCN) now recommend
capecitabine for all patients who can-
not tolerate intensive chemotherapy."
Capecitabine is currently approved for
the treatment of metastatic colorectal
cancer, breast cancer, stomach cancer
and nasopharyngeal cancer. "It is also
being evaluated in pancreatic and
biliary cancers, in combination with
other agents," pointed out Dr. Sze.
Capecitabine can be used as a single
therapy or in combination with other
chemotherapies or targeted cancer
drugs.
Favorable clinical results
Dr. Sze has used capecitabine to treat
more than 100 patients with different
types of cancer. "In my clinical experi-
ence, capecitabine therapy is as effica-
cious as 5-FU chemotherapy regimens,
sometimes even better," he notes.
One of his most successful cases was
a patient with metastatic colorectal
iv
cancer that had spread to the lung.
"The patient didn’t want to undergo
another surgery to remove the lung
tumor, so I prescribed a capecitabine-
based chemotherapy," says Dr. Sze.
"The patient had a complete remission
of the lung tumor after four treatment
cycles – a very favorable outcome."
Although complete cure is quite unusu-
al, patients can expect good results,
with capecitabine effectively slowing
tumor progression.
”Every patient who needs
5-FU chemotherapy
should consider using
capecitabine”
"Most importantly, patients are very sat-
isfied with capecitabine, as they don’t
need to spend time in the hospital to
receive the chemotherapy. The oral
treatment is so much more convenient,
significantly improving patient quality
of life," says Dr. Sze. "Every patient Dr. Wai-Man Sze,
who needs 5-FU chemotherapy should Clinical Oncology Specialist
consider using capecitabine."
He notes tha t side ef fects of
capecitabine therapy are quite similar
to conventional chemotherapy, although
somewhat milder.
"The most common is hand-foot syn-
drome, where the skin of palms and
soles becomes red and dry, and starts
peeling of f," he explains. "I advise
patients to use plenty of moisturizer;
sometimes we may need to adjust the
drug dose."
4
 •

•
•
•

3 2