AMA: Ask Me Anything with Dr Donald Poon
Have questions on elderly cancers, gastrointestinal/hepatobiliary/pancreatic cancers, neuroendocrine cancers, bone/tissue cancers or skin cancers?
Q. How often does breast cancer come back after the patient has a mastectomy? What is the best way to kill the residual cancer?
A. It depends on the stage of the disease, type of breast cancer – whether hormone receptors and Her-2 over expression are present. Mastectomy need not be done all the time, breast conservation surgery if possible is also an option. There are adjuvant treatment methods such as hormonal therapy, chemotherapy, targeted antibody such trastuzumab and pertuzumab, radiotherapy to the chest wall/axillae, to reduce risk of recurrence. Please discuss these options with the doctor in charge.
Q. Is it surgery or ablation that is effective in treating recurrent liver cancer? If a patient is suitable for either procedure, would drug therapy still be necessary?
A. It is effective and several studies have shown that if the tumour is small (<3 cam) and in a suitable location within the liver, the outcome is equivalent to surgery. Drug therapy will depend on whether there is cancer detected outside of the liver, in which case, surgery or ablation may be unnecessary as this will be advanced liver cancer and systemic drug therapy should be started first.
Q. My dad’s pancreatic cancer has spread to his liver. What do you think of folfirinox therapy? Is it ideal when balanced out to the potential side effects?
A. Folfirinox is a chemotherapy regimen that is associated with one of the highest response rates in pancreatic cancer. But do let us know the exact histology of the tumour. Some pancreatic tumours may respond better to other treatment options in the longer term. It is also worthwhile doing tumour molecular profiling, if it is in the uncommon minority – without KRAS mutation, there is a good chance that the tumour harbours an actionable mutation. This therapeutic option is useful when the tumour progresses or treatment which is a matter of time when resistance to chemotherapy develops, no matter how good the response is initially.
Q. I have stage IIA2 cervical cancer. I was advised to undergo a radical hysterectomy, but the thoughts of going for a surgery scares me. What are my alternatives? Chemoradiation or brachytherapy?
A. When it is stage IIA2 for cervical cancer, the tumour is more than 4 cm and has invaded adjacent soft tissue beyond the uterus but not to the lower third of the vagina or pelvic wall. The recommended treatment is concurrent chemoradiation only. In several studies, surgery plus radiotherapy in our context is associated with higher risk of complications. Do discuss with your oncologist as brachytherapy is frequently beneficial too.
