Rare Cancers in Singapore: How do you find the right diagnosis and treatment?

SPEAKER_1 (0:01)

Best of Live Well ft. Lance Alexander.

Lance Alexander (0:05)

Good morning Singapore. You know, my son who is in NUSS Cancer is when your cells go rogue. Cancer happens when normal cells stop following the rules that control growth, division and death. The cells change abnormally and grow out of control. Some of the more common ones are lung cancer, breast cancer, colorectal cancer, prostate cancer, skin cancer, and stomach cancer. But what about rare cancers? Cancers that occur in very small numbers, commonly defined as fewer than six new cases per 100,000 people each year.

One example is a sarcoma, a cancer that develops in bones or soft tissue such as muscle and fat.

For patients in Singapore, getting an accurate diagnosis can be difficult when symptoms resemble more common conditions. Next is finding a specialist experience in that particular cancer. These challenges have prompted Temerian Health, a healthcare group whose network includes OncoCare, to launch a rare cancer centre in Singapore. It brings together doctors' experience in rare and complex cancers to help patients find the specialist care they need. With us this morning is Dr. Kevin Tay, Senior Consultant, Medical Oncologist of OncoCare. Good morning, Doctor.

Kevin Tay (1:33)

Morning, Lance. Thank you for having me.

Lance Alexander (1:35)

My pleasure. Now, we've mentioned sarcoma as one example. What other rare cancers are we seeing in Singapore?

Kevin Tay (1:44)

In this, there are rare lymphomas. I mean, lymphoma as a group is not rare, but there are some subtypes that are very rare. And in this part of the world, skin cancers such as melanoma is not so common in our Asian context.

We also have gastrointestinal cancers such as neuroendocrine tumors. These are also rarer cancers that we're dealing with on a day-to-day basis.

Lance Alexander (2:08)

Why are these rare cancers difficult to diagnose?

Kevin Tay (2:12)

I think rare cancers, they don't have a particular symptom that is unique to rare cancers. And you must understand that it's a very heterogeneous population.

For example, sarcoma that you mentioned.

Sarcoma is a cancer involving the soft tissues, involving the muscle layer, involving down to the bones. So as you can see, the different anatomical sites comes with the different subtypes of sarcoma. And within soft tissue sarcomas, there are even over multiple subtypes. Altogether as a group, there are over 100 subtypes of sarcomas. So it is really not a homogenous disease. It is actually very heterogeneous, with different genomic aberrations, and therefore give rise to different clinical presentations at times.

Lance Alexander (2:56)

Okay. If someone has received treatment for maybe they think is one sort of cancer, but their symptoms persist or change, how soon should they be going back to their doctor to say, I need further checks? Because this is something not quite right still.

Kevin Tay (3:13)

So I think making, you actually, I mean, you actually point out the correct thing is that you really need to make an accurate diagnosis from the very beginning. And a lot of times with this complex rare cancers, the diagnosis can be very difficult to delineate and elucidate. So it comes because, like I said, under the microscope, a sarcoma may look alike. Two sarcomas may look the same under the microscope. But genetically, fundamentally, the underlying genomic landscape may be different. And therefore, the presentation or the clinical cause of the disease also may be different. And more importantly, the therapeutic targets will also be different if you isolate a different genetic marker.

So I think all in all, it is not a straightforward essay, breast cancer, for example.

I think we rely a lot on precision diagnostics in terms of the right imaging studies, the right pathologies readouts, and then the right genetic testings that we do to make an informed diagnosis, an accurate diagnosis.

Lance Alexander (4:17)

Has your work become even more difficult because there are new cancers or subtypes still being discovered today?

Kevin Tay (4:25)

Yeah, I think with all these new precision medicine, we are understanding the biology of cancer a lot better. With these new genomic aberrations we discover, it also gives rise to new therapeutic programs. New therapeutic treatments that we can then develop.

And therefore, we can then treat them appropriately. And patients do live longer as a result of this new treatments that we are seeing these days.

Lance Alexander (4:50)

So we know it is a rare cancer. It's caught early. Does it mean it's easier to treat because it's been caught early?

Kevin Tay (4:58)

Yeah, great question. So I think a lot of these rare cancers, if you diagnose actually in general, any cancer that is detected early and is localized to an area, it is still potentially curable. So I think the point I like to make to the audience is that rare cancer does not mean no treatment. Rare cancer does not mean the end of it all. I mean, I think you need to make a appropriate, accurate diagnosis and then stage it properly and then administer the right treatment. Patients can still do well.