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Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore

Advancements in technology and cancer treatments have improved childhood cancer survival rates, with up to 85% surviving 5 years or more.1 The Malaysia-Singapore Leukaemia Study Group reported an improvement in overall 5-year survival for the past 20 years in Singapore, from 69% to 91% for acute lymphoblastic leukaemia, which...

Association between alcohol flushing syndrome and cancer: A systematic review and meta-analysis

Alcohol flushing syndrome (AFS) is characterised by intense facial flushing, often accompanied by palpitations, headache and nausea shortly after the consumption of alcohol. This phenomenon occurs in up to 46% of East Asians and to a much lesser extent Caucasians, due to the accumulation of acetaldehyde, a metabolic byproduct...

Challenges in genetic screening for inherited endocrinopathy affecting the thyroid, parathyroid and adrenal glands in Singapore

In the current landscape of medicine, it is well known that most diseases incorporate a genetic component to some degree. Genetic testing of human diseases originated in the 1950s, and screening for genetic disorders followed a decade after.1 It is worthwhile noting that the Human Genome Project (1990–2003), which...

Defining breast cancer-related lymphedema (BCRL) prevalence and risk factors: A pragmatic approach to lymphedema surveillance

Breast cancer-related lymphedema (BCRL) is a chronic progressive pathological condition of the lymphatic system that can lead to significant impact on the quality of life after breast cancer treatment.1 It is characterised by swelling and accumulation of protein-rich fluid in body tissues, leading to pain, tightness, skin changes such...

Breast cancer-related lymphedema (BCRL): Should we be doing more or less for the axilla?

Breast cancer mortality has declined steadily over the years with breast cancer screening, and improvement in diagnostic and therapeutic regimens. Despite cancer survivors living longer, breast cancer-related lymphedema (BCRL) is a significant complication after major breast surgery that can impact quality of life adversely. The incidence of BCRL reported...

Clinical utility of PET/MRI in multiple myeloma

Multiple myeloma (MM) is a haematological malignancy characterised by abnormal accumulation of malignant plasma cells and is associated with anaemia, renal impairment, hypercalcemia and bone lesions. A sensitive method to detect bone lesions is crucial as it could determine the decision to start treatment. In this era, the International...

Breast conservation treatment and frozen section analysis of margins

Dear Editor, Re. Surgical margins assessment reduces re-excision rates in breast-conserving surgery I read with interest the article by Woon et al. published in a recent issue of the Annals on the reduction of re-excision rates with the use of intraoperative frozen section (FS) analysis.1 This certainly has the potential...

Molecular testing in non-small cell lung cancer: A consensus recommendation

Lung cancer is a leading cause of cancer mortality worldwide, with an estimated 2.21 million new cases and 1.80 million deaths in 2020.1 In Singapore, lung cancer is the third most frequent cancer in men and women, and accounts for the highest and third highest number of cancer deaths...

Restaging of rectal cancer with hybrid positron emission tomography magnetic resonance imaging after preoperative chemoradiotherapy

Neoadjuvant chemoradiotherapy (CRT) followed by surgery is the current standard of care for locally advanced rectal cancers. Randomised trials have shown that a neoadjuvant approach results in improved tumour downstaging, improved R0 resections, improved local control and increased sphincter preservation rates.1 Reliable response assessment and restaging post-CRT add invaluable...

Poor survival rate of pregnancy-associated breast cancer in Asian countries

Dear Editor, Asia has a lower incidence of breast cancer than North America, Oceania, and Western Europe. However, breast cancer rates have been rising fast in recent decades.1 Breast cancer cases in Asian countries now constitute 40% of all cases diagnosed globally, and mortality due to breast cancer has similarly...

An approach to genetic testing in patients with metastatic castration-resistant prostate cancer in Singapore

Prostate cancer is the fifth most common cancer in Asian men, and with its rising incidence, is emerging as a health priority in Asia.1 Across Asian countries, age-standardised incidence rates (ASIRs) of prostate cancer range from 0.9 to 56.1 per 100,000 population, with the second highest ASIR reported in...

Challenges with mainstreaming genetic testing for metastatic prostate cancer treatment in Singapore

Compared with other solid tumours, patients with metastatic prostate cancer typically have better survival in the range of years.1 The long survival translates to a high prevalence, and thus, a large number of men living with prostate cancer. Singapore has one of the highest age-standardised incidence rates of prostate...

Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients

The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with solid and haematological malignancies to SARS-CoV-2 infections.1,2 Global efforts to combat SARS-CoV-2 led to the unprecedented rapid development of multiple vaccines, with reported efficacies of...

Early COVID-19 booster is beneficial in cancer patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in Wuhan, China, on 31 December 20191 and led to an unprecedented pandemic in modern times. It quickly overwhelmed healthcare systems around the world, and rendered...

Diagnostic accuracy of multiparametric MRI in endometrial cancer and its adjunctive value in identifying high-risk women requiring surgical staging

Dear Editor, Endometrial cancer is the most common gynaecological cancer in developed countries, with a five-year survival rate of 81%.1,2 Prognostic factors include the International Federation of Gynecology and Obstetrics (FIGO) stage, depth of myometrial invasion (MI), lymph node involvement, cervical stromal involvement, and histological grade. Total hysterectomy with bilateral...

Multidisciplinary lung cancer clinic: An emerging model of care

Dear Editor, Lung cancer management is progressively complex and multidisciplinary input is often needed. The recent publication of CheckMate 816 heralds a paradigm shift in the treatment of resectable non-small cell lung cancer (NSCLC),1 with many other perioperative trials soon to follow.2 Oligometastasis and oligoprogression in stage IV NSCLC...

Characteristics of anti-transcriptional intermediary factor 1 gamma autoantibody-positive dermatomyositis patients in Singapore

Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of acquired, systemic autoimmune conditions characterised by muscular and extramuscular manifestations. As a subset within the family of IIM, dermatomyositis is distinguished by cutaneous features and has twice the risk of associated malignancy than polymyositis.1-3 Various meta-analyses have shown that between 10%...

A recurring nasal mass

A 56-year-old Chinese man presented to the Ear, Nose and Throat clinic with months of unilateral right-sided nasal obstruction. He reported occasional mucopurulent discharge and denied any hyposmia, episodes of epistaxis, or loss of weight and appetite. Nasoendoscopy revealed a right-sided nasal mass between the septum and middle turbinate....

Early rehabilitation to improve functional outcomes in childhood cancer in Singapore

Dear Editor, We conducted a prospective, single-centre cohort study to review the impact of a multidisciplinary rehabilitation programme in children with cancer in Singapore. The Template for Intervention Description and Replication (TIDieR) checklist was used to allow sufficient details for replication of the study (see Appendix in online Supplementary...

Low-dose computerised tomography screening for lung cancer in Singapore: Practical challenges of identifying participants

INTRODUCTION In March 2022, the European Commission on cancer screening suggested the inclusion of low-dose computerised tomography (LDCT) for lung cancer, targeted at current and former smokers.1 The aim of LDCT screening is to increase early detection, decrease diagnoses at metastatic stage of the disease and improve overall 5-year...

Cause of vaginal spotting in an older woman

A 77-year-old Chinese woman with a past medical history of Sjogren’s syndrome, nodular goitre and right-sided neck lymphadenopathy, presented to the gynaecological service for per-vaginal spotting. On clinical examination, she was noted to have a cervical polyp. A polypectomy was performed and the specimen was sent for histological examination. The...

Intravascular large B-cell lymphoma associated with sudden stridor arising from thyroid mucormycosis and concomitant bacterial infection

Dear Editor, Mucormycosis is a life-threatening fungal infection that mainly affects immunocompromised patients. It typically has low prevalence, but fatality rate is as high as 50%. We present a patient with intravascular lymphoma with secondary bacterial infection and invasive mucormycosis involving the thyroid gland, who experienced good outcomes following surgical...

The Need for Collaboration Between Clinicians and Statisticians: Some Experience and Examples

Many areas of medical research require the application of statistical techniques. Although most clinicians are taught some statistics as part of their basic medical training, the important role of statistics in medical research has led to many pharmaceutical companies, hospitals and medical research institutions employing full time statisticians to...

Characteristics of unplanned hospitalisations among cancer patients in Singapore

Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the rise and accounts for nearly 30% of total population mortality.4,5 Singapore data suggests that cancer patients accounted for 13% of total healthcare costs in 2016,...

Complementary and Alternative Medicine among Singapore Cancer Patients

Worldwide, the use of Complementary and Alternative Medicine (CAM) by cancer patients is highly prevalent. For cancer specialists, knowledge on CAM use in their patients is particularly important as there can be potentially hazardous drug interactions between some forms of oral CAM and chemotherapy or radiotherapy. This article is available...

Demographic Determinants of Survival in Osteosarcoma

The treatment of osteosarcoma has seen tremendous improvements over the last 3 decades of the twentieth century. Over the last decade it appears that results of treatment have stagnated. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Routine intraoperative frozen section adds little value to the management of thyroid nodules with Bethesda III cytology

Dear Editor, We would like to highlight the need to reduce intraoperative frozen section (FS) during diagnostic hemithyroidectomy performed on thyroid nodules with Bethesda III cytology. Thyroid nodules are increasingly diagnosed and subjected to fine needle aspiration cytology. Bethesda III is a cytological category that consists of atypia or follicular...

Singapore Rhabdomyosarcoma (RMS) Experience: Shall We Change Our Practice?

Rhabdomyosarcoma (RMS) constitutes nearly 4% of all children diagnosed with cancer in the ethnically diverse small island city of Singapore. It is the most common primary soft tissue malignancy of childhood and one which is highly sensitive to chemotherapy and radiation therapy leading to excellent overall survivals. In KK...

How do English-speaking Cancer Patients Conceptualise Personhood?

Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral and legal status of an individual, is central to the protection of rights and privileges and is pivotal to the maintenance of the distinctiveness of...

Prevalence of thyroid malignancy and hormonal dysfunction following radiation exposure in childhood

The incidence of thyroid cancer has been steadily increasing worldwide. Childhood radiation exposure is a known risk factor for thyroid malignancy. However, data on the incidence of thyroid cancer in this high-risk cohort in Singapore are limited. Thus, we assessed data from patients treated in our institution with a...

Pelvic mass mimicking advanced tubo-ovarian malignancy with hepatic metastasis

A 49-year-old woman presented with mild pain in her lower abdomen and changes in bowel habits for 2 months. She also experienced 20kg of weight loss over 7 months. She previously had an intrauterine device (IUD) for 5 years, removed 2 years prior to presentation. Vital signs were stable,...

Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry

Ophthalmic cancers are commonly encountered in clinical practice and are an important cause of morbidity and mortality. Globally, the incidence of ophthalmic cancers have been increasing in the past 2 to 3 decades.3-6 Data on recent incidence of primary ophthalmic cancers, comprising intraocular and extraocular cancers, have not been...

An unusual submandibular tumour

A woman in her 60s presented with a non-tender, non-enlarging swelling in the left submandibular triangle of the neck for 3 months. She had no significant past medical or surgical history. Examination showed a 2cm firm round lump in the left submandibular triangle, not attached to the skin, mandible...

Penile preserving surgery in penile cancer management

Penile cancer is a condition that accounts for approximately 0.4% of cancers among Singapore males. Overall, this is an uncommon cancer with higher rates in developing countries (2.8–6.8 per 100,000) compared to Western countries (as low as 0.3 per 100,000). However, in the UK, which is a developed country,...

Primary cutaneous umbilical melanoma

A 59-year-old woman with a pre-existing asymptomatic pigmented nevus on the umbilicus for the past 20 years was seen in the outpatient dermatology clinic for a 2-week history of a raised, bleeding pigmented papule overlying the nevus. Physical examination showed a 7 x 7mm ulcerated papule overlying a 2.2...

Cervical screening in foreign domestic workers in Singapore

Cervical cancer is the most common gynaecological cancer in many countries in Southeast Asia, with a cumulative age-standardised incidence rate (ASRI) of 17.2 per 100,000 and a corresponding mortality rate (ASMR) of 10 per 100,000. In Singapore, cervical cancer is the 10th most common cancer in women with an...