Others
A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia
Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy.
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Others
Adjuvant Chemotherapy for Patients with Resected Dukes’ C and High-risk B2 Colon Cancer with Fluorouracil and Levamisole
Carcinoma of the large bowel is the second leading cause of cancer mortality in Singapore. Although the great majority of patients are discovered at a stage where resection with curative intent is possible, almost half of the patients afflicted will die of it.
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Commentary
Experience with a Nine-step Policy Dealing with Requests for Medically Inappropriate Interventions for Cancer
Although great strides have been made in treating cancers, a significant number of patients still reach the point at which no curative treatment is available. Physicians then face the difficult task of informing patients that, although palliation is always possible, cure is not.
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Commentary
Invasive Cancer after Treatment of Cervical Intraepithelial Neoplasia
The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix. The impact of the programme depends both on the detection of women with cervical intraepithelial neoplasia (CIN) and upon their being treated effectively.
This article is...
Commentary
The Polarprobe—Emerging Technology for Cervical Cancer Screening
Cervical cancer is a preventable disease that affects nearly half a million women worldwide. The Papanicolaou smear has been used for screening for over fifty years and the test has the advantage of fast and relatively easy sample collection.
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Others
Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case
A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians.
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Others
Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case
A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians.
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Others
Pelvic Spleen Masquerading as an Ovarian Neoplasm
A 53-year-old Caucasian woman, a receptionist in a general practice, was referred to the gynaecology outpatient clinic with an 18-month history of heavy, irregular menses and a pelvic mass on an abdominal ultrasound arranged by her General Practitioner (GP). She was otherwise asymptomatic.
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Others
A Case Report—Delayed Vesicocutaneous Fistula After Radiation Therapy for Advanced Vulvar Cancer
To our knowledge this is the first reported case of an isolated vesicocutaneous fistula related to previous radiation therapy for recurrent vulvar cancer.
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Review Article
Optimal Treatment in Gestational Trophoblastic Disease
Gestational trophoblastic diseases (GTD) encompass a spectrum of interrelated conditions:
Hydatidiform mole (HM)
Invasive mole (IM)
Choriocarcinoma (CC)
Placental site trophoblastic tumour (PSTT)
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Review Article
Fallopian Tube Carcinoma—A Review
Fallopian tube cancer is the least common of gynaecological malignancies. It was first described by Renaud in 1847.
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Review Article
Current Management of Early Vulvar Cancer
Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although patient and physician delay remains common, an increasing number of patients are being diagnosed with early stage disease.
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Review Article
Topoisomerase-I Inhibitors in Gynaecologic Tumours
Topoisomerases are essential nuclear enzymes with a multiplicity of cellular functions involving DNA replication, RNA transcription, mitosis, and chromosome condensation. Two classes have been identified: the class I topoisomerases, named “I” because they induce single-strand breaks and reunions of the DNA double helix, and the class II topoisomerases, named...
Review Article
Screening for Ovarian Cancer
Ovarian cancer is the most common gynaecological malignancy with over 5000 new cases diagnosed every year in the UK and 22 000 in the United States. Four thousand women die each year of ovarian cancer in England and Wales, and 13 000 die in the USA.
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Review Article
Biomarkers in Carcinoma of the Cervix: Emphasis on Tissue-related Factors and Their Potential Prognostic Factors
Accurate staging is of utmost importance in determining the prognosis of carcinoma of the cervix. Demographic features such as race and socio-economic status have been demonstrated as not having significant influence.
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Review Article
The Management Dilemma of the Mildly Abnormal Smear: Fact or Fiction?
Carcinoma of the cervix is still a relatively common gynaecological malignancy. However, despite being potentially preventable it still claims the lives of many women even in those countries where organised screening programmes exist.
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Review Article
Adenocarcinoma of the Cervix
It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the incidence of squamous carcinoma of the cervix but indeed in the last 10 to 15 years has halved the mortality rate from this disease. In...
Original Article
Malignant Ovarian Germ Cell Tumours: Experience in the National University Hospital of Singapore
One of the most remarkable advances in the management of gynaecological cancers is in malignant ovarian germ cell tumours. Before the early 70s, some of the malignant ovarian germ cell tumours had a notoriously bad reputation in terms of aggressiveness and poor prognosis.
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Original Article
A Phase II Study of Combined CPT-11 and Mitomycin-C in Platinum Refractory Clear Cell and Mucinous Ovarian Carcinoma
Platinum resistance, either de novo or acquired, is a major obstacle in the treatment of advanced ovarian cancer. Platinum-resistance has been classified into the following three categories; (1) primarily (intrinsically) platinum-resistant disease: tumours showing no change (NC) or progressive disease (PD) while on initial platinum-based chemotherapy; (2) secondarily platinum-resistant...
Original Article
Single Agent Paclitaxel in Resistant and Relapsed Epithelial Ovarian Cancer After First-line Platinum-based Chemotherapy—Experience in an Asian Population
Ovarian carcinoma ranks fourth among causes of death in women and is the leading cause of death from gynaecological malignancies in Western countries. In Singapore, the incidence of this cancer has been rising for the last 25 years.
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Original Article
Uterine Papillary Serous Carcinoma—The KK Hospital Experience
Endometrial carcinoma comprises a morphologically heterogeneous group of tumours. Several authors during the 1960s and 1970s described an unusual variant of endometrial cancer containing psammoma bodies.
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Original Article
Radiotherapy as Local Adjuvant Treatment for Endometrial Carcinoma—A Review of 45 Patients
Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control as well as to achieve excellent survival rates. Over the years, however, the specific role and relative benefit of postoperative radiotherapy for this particular cancer...
Original Article
Outcome of Obstructive Uropathy After Pelvic Irradiation in Patients with Carcinoma of the Uterine Cervix
Radiotherapy is the mainstay treatment for locally advanced carcinoma of the cervix. It is also administered as an adjuvant therapy to patients deemed at high risk for local recurrence after radical hysterectomy.
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Original Article
The Surgical Management of Colorectal Complications from Irradiation for Carcinoma of the Cervix
Radiation bowel injury is a significant clinical problem because of the technical difficulties of surgery. Among the more common causes is radiation of carcinoma of the cervix, because radiotherapy is the principle mode of treatment for this fourth most common malignancy in women in Singapore (after carcinoma of the...
Original Article
Adjuvant Chemotherapy in “High Risk” Patients after Wertheim Hysterectomy—10-year Survivals
Wertheim radical hysterectomy has today become an accepted method of management of stage IB and early stage IIA cervical carcinoma, particularly in young patients in whom preservation of ovarian and coital function cannot be achieved if they were subjected to radiotherapy instead. However, a group of patients undergoing radical...
Original Article
A Review of Patients with High-risk Carcinoma of the Cervix Treated with Combined Surgery and Postoperative Radiotherapy
It is generally accepted that early stage invasive carcinoma of the cervix, stage I to stage IIA disease, can be treated with equal effectiveness with either radical hysterectomy or radical radiotherapy. However a proportion of patients treated with surgery may be classified as having a significant risk of relapse...
Original Article
Outcome of Early Cervical Carcinoma Treated by Wertheim Hysterectomy with Selective Postoperative Radiotherapy
Cancer of the cervix is the fourth most common cancer in females in Singapore after breast, colorectal and lung cancers. It forms 7.8% of all cancers in females for the period 1988 to 1992.
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Editorial
Gynaecologic Oncology—The Next Lap
Cancer of the pelvic reproductive organs and external genitalia accounts for one in six cancers in women. It can occur in women of all age groups: rhabdomyosarcoma in young girls, germ cell tumours in teenage girls and young women, cervical cancer in the middle age women, and epithelial ovarian...
Original Article
Concurrent Chemoradiotherapy in Patients with Locally Advanced Nasopharyngeal Carcinoma of the Undifferentiated Type
Nasopharyngeal carcinoma (NPC) of the undifferentiated type has a unique geographic distribution and is rather different, biologically and aetiologically, from squamous cell cancer of the head and neck. This disease is of epidemiological concern in Singapore, with an age-standardized rate of 18.4 per 100,000 in Chinese males and 7.3...
Review Article
Cancer Gene Therapy—Fantasy or Foresight?
Genes define life, at least in its biological sense. The prospect of being able to manipulate human biological processes through genetic engineering understandably evokes a sense of excitement and omnipotence. Indeed, the birth of recombinant DNA technology in the 1970s immediately opened the floodgates for the successful manipulation of...
Original Article
A Preliminary Study of the Immunohistochemical Detection of a Novel Tumour Marker, 22-1-1 Antigen, in Gynaecological Cancer Specimens
Monoclonal antibodies expressed against specific tumour cells can play a useful role in the study and management of such cancers. Such antibodies have been useful in diagnosis and treatment of certain cancers (as tumour markers) and many such antibodies have now been described.
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Others
3rd Yahya Cohen Lecture: The Role of the Myofibroblast-Like Cell in Hepatocellular Carcinoma—Host Defence?
It is indeed a great honour for me to be named the third Yahya Cohen lecturer and I would like to express my deepest thanks and appreciation to the Academy of Medicine Singapore for having selected me for this award. At this lecture, I would like to share with...
Others
1998 Runme Shaw Memorial Lecture: Somatic Evolution of Cancer
The interpretation of cancer as a somatic evolutionary process involving genetic mutation followed by selection, goes back to the early years of this century. Boveri’s hypothesis put forward in 1914 that cancer was associated with abnormalities of the chromosomes and Tyzzer and Strong’s experiments of transplantable tumours in 1916...
Review Article
Prognostic Factors in Endometrial Carcinoma
In the United States of America, endometrial carcinoma is the most common cancer of the female genital tract and has an annual incidence of 72 per 100,000 women. In Singapore it is the third most common female genital tract cancer after cancer of the cervix and ovary.
This article is...
Original Article
Continuous Infusion 5-fluorouracil as Salvage Chemotherapy in Patients with Advanced Colorectal Cancer
Studies have shown beyond doubt that chemotherapy for metastatic colorectal cancer prolongs survival, impedes progression and stabilises disease. Compared with supportive care alone, it could also provide considerable benefits in terms of improved quality of life.
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Commentary
Effect of Antiangiogenic Agents on Experimental Animal Models of Hepatocellular Carcinoma
Metastatic spread is the principal reason of treatment failure in solid tumours. Surgery, radiation therapy and chemotherapy have not manifestly altered the prognosis for metastatic tumours.
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Review Article
Murine Metastatic Tumour Models for Cancer Gene Therapy Research
In the evaluation of any new cancer treatment, the use of appropriate experimental animal tumour models to bridge the gap between in vitro discovery and its eventual clinical testing is an important step. In vitro experimentation does not take into consideration the complex biological interplay among the host tissues,...
Original Article
An Animal Model for the Study of Hepatic Stellate Cell and Hepatocellular Carcinoma Interaction
Hepatic stellate cells (HSC) are mesenchymal cells that are prominent in various forms of liver injury, in particular with cirrhosis or carbon tetrachloride-induced fibrosis. HSC are also being increasingly reported around and within hepatocellular cancers (HCC), and have been thought to be responsible for the capsule formation in these...
Original Article
Synergistic Effect of Hepatitis B Virus and Aflatoxin B1 in Hepatocarcinogenesis in Tree Shrews
Primary hepatocellular carcinoma (HCC) is one of the commonest cancers in some parts of the world including several areas in China. The geographically distinct distribution of HCC indicates there are some special factors which play key roles in hepatocarcinogenesis.
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Original Article
The Expression of Insulin-like Growth Factor II, Hepatitis B Virus X Antigen and p21 in Experimental Hepatocarcinogenesis in Tree Shrews
Hepatocarcinogenesis is a multistage and multifunctional process. Epidemiological studies indicate that contamination of food with aflatoxin B, (AFB,) and chronic infection with hepatitis B virus (HBV) are the major risk factors for human primary liver cancer.
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Original Article
Extended Resection of Locally Advanced (T4) Stomach Cancer
Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years, it is the third (10.1%) most common cancer in males and the fifth (6.5%) most common cancer in females in Singapore.
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Others
Design of Phase I and II Clinical Trials in Oncology and Ethical Issues Involved
Drug development is costly and time-consuming in terms of economic, patient and research resources. An integrated effort involving academia, industry, and regulatory authorities is needed to ensure novel, effective therapies continue to be approved for clinical use.
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Original Article
Spectrum of Abnormal Mammographic Findings and Their Predictive Value for Malignancy in Singaporean Women from a Population Screening Trial
While screening mammography can detect early breast cancers, a significant proportion of asymptomatic women are subject to unnecessary workup and surgery when biopsies for abnormal mammograms are proven to be benign on histology. An accurate correlation between abnormal mammographic features detected on screening and their corresponding histology or predictive...
Others
Hereditary Breast Cancer: A Brief Overview
Worldwide, breast cancer is the third most common form of cancer, after lung and stomach cancer, and it is the most common form among women.1 The age-adjusted incidence rates of breast cancer are 176% higher in developed than developing countries.
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Others
Update of Genetics in Colorectal Carcinomas: Genomic Instability and Somatic Evolution
The hypothesis that carcinogenesis occurs through stepwise accumulation of mutations1 has now been generally accepted. However, there is continual dispute over how carcinogenesis can be achieved over the lifetime of an individual.
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Others
Pseudomembranous Colitis in a Patient Treated with Paclitaxel for Carcinoma of the Breast: A Case Report
Paclitaxel was discovered in 1963 as a crude extract from the bark of the pacific yew Taxus brevifolia. Since its development, a range of anticancer activity has been demonstrated.
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Others
Early Hepatocellular Carcinoma Presenting with Biliary Ductal Invasion—A Case Report
Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide. The local incidence of HCC is 40 per 100,000 in males and 20 per 100,000 in females.
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Others
Pathology of Ductal Carcinoma In situ of the Breast: A Heterogeneous Entity in Need of Greater Understanding
Breast cancer is the commonest malignancy in Singapore women, with an age-standardised rate of 46.1 per 100,000 per year and an annual increase in incidence of 3.68%. It comprises 22.8% of all local female cancers, with an annual mortality of 13.7 per 100,000 per year.
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Others
Two Cases of Medullary Thyroid Carcinoma
A 44-year-old Indian man was found to have a raised carcinoembryonic antigen (CEA) (49.5 μg/L) detected on routine medical examination in February 2000. His past medical history included asthma, chronic anal fissure and haemorrhoids, cervical spondylosis and mild hypercholesterolaemia.
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Others
Primary Anorectal Malignant Melanoma: Clinical Features and Results of Surgical Therapy in Singapore—A Case Series
Malignant melanoma arising from the anal canal was first described in 1857. It is uncommon, comprising only about 1% of all anal canal tumours.
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Others
A Case of Alpha-Fetoprotein-Producing Gastric Cancer
A 57-year-old accountant presented to her doctors in a neighbouring country in early October 1998 with problems of easy bruising, bleeding gums, one single episode of gross haematuria and 2 months of back pain. Investigations showed evidence of disseminated intravascular coagulation (DIVC) and compression fracture of T10 vertebra.
This article...
Others
Case Report: Acute Tumour Lysis Syndrome
Acute tumour lysis syndrome (ATLS) is one of the most urgent of all oncological treatment-related complications. It has a broad impact on organ dysfunction, the most important and life threatening complication being acute renal failure. Early implementation of preventive measures can have a drastic impact on reducing the associated...
Others
12th Chapter of Surgeons Lecture: Shifting Paradigms in the Management of Breast Cancer—A Surgical Perspective
The recorded history of breast cancer management spans four millennia. This story about breast cancer management is also one about change, about resistance to and acceptance of change.
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Review Article
CerbB2 Status in Breast Cancer: Pathologic Issues
The cerbB2 gene, also known as Her2/neu, encodes a transmembrane cell receptor with tyrosine kinase activity and epidermal growth factor receptor homology. All normal and the majority of breast cancer cells contain 2 copies of the cerbB2 gene and produce low levels of the corresponding protein.
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Original Article
Cancer Incidence in Singapore, 1998 to 1999
The Singapore Cancer Registry has been monitoring the trends in cancer incidence since 1968. It publishes 5-yearly incidence figures for the periods 1968-1972, 1973-1977, 1978-1982, 1983-1987, 1988-1992 and 1993-1997.
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Original Article
Efficacy and Tolerability of Irinotecan in Patients with Advanced Colorectal Cancer in Singapore
Colorectal cancer is the second most commonly encountered malignancy in the developed countries; in Singapore, it is the commonest cancer. With early detection, patients can be cured with surgery.
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Original Article
The Mastectomy Clinical Pathway: What Has It Achieved?
In an era of increasing healthcare cost and scarce resources, the tension between the cost and quality of healthcare demands not only effective but also cost-efficient healthcare systems.
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Others
Agreement or Prediction: Asking and Answering the Right Question
In an article published in this journal, Chia discusses the difference between measuring association and agreement. In this paper, we extend the discussion to the difference, in terms of the concepts as well as the practical usage, between analysing agreement and prediction.
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Original Article
Preliminary Experience in Radionuclide Therapy of Hepatocellular Carcinoma Using Hepatic Intra-arterial Radio-conjugates
Hepatocellular carcinoma (HCC) is a common malignancy worldwide. In Singapore, the age-standardised incidence rate is 18.9 per 100,000 per year.
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Original Article
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours.
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Letter to the Editor
Re: 188Rhenium-TDD-Lipiodol in Treatment of Inoperable Primary Hepatocellular Carcinoma—A Case Report
Hepatocellular carcinoma (HCC) is a common malignancy that is best treated by surgery. However, in the vast majority, surgery is not possible and alternative treatment options have to be attempted.
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Others
Carcinoma of the Cervix: Role of MR Imaging
In females with cancer, cervical carcinoma is second to breast cancer in both incidence and mortality worldwide. About 465,000 new cases are diagnosed each year in both developing and industrialised nations, with a higher incidence in women of low socioeconomic status.
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Review Article
Radionuclide Therapy of Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is a common malignancy worldwide. It is a major cause of death from cancer in East Asia, especially China, Japan, Korea, Taiwan and Singapore, and sub-Saharan Africa, particularly Zimbabwe, Ethiopia and Mozambique.
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Original Article
Non-consensual Double Reading in the Singapore Breast Screening Project: Benefits and Limitations
Double reading of mammogram is not the standard practice in the United Kingdom National Health Service Breast Screening Programme (NHSBSP). Rather, single reading of the mammogram remains the basic policy, as was recommended in the Forrest report.
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Original Article
Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)
Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point. Most QOL instruments are developed in English, although about one-fifth of the world’s population is ethnic Chinese.
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Review Article
The Molecular Biology of Peritoneal Carcinomatosis from Gastrointestinal Cancer
The term “peritoneal carcinomatosis” was first used by Sampson in 1931 to describe the intra-abdominal spread of ovarian carcinoma. Although ovarian cancers account for the majority of cases, peritoneal carcinomatosis is also frequently associated with gastrointestinal malignancies.
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Review Article
Colorectal Hepatic Metastases: Role of Radiofrequency Ablation
Colorectal cancer is the second most common cancer in Singapore, accounting for 15.9% of all cancers registered with the Singapore Cancer Registry in the years between 1993 and 1997. Despite recent advances in surgery, radiotherapy and chemotherapy, more than half of those afflicted will die from their cancer.
This article...
Review Article
Neoadjuvant Chemotherapy in the Management of Colorectal Metastases: A Review of the Literature
Colorectal cancer accounts for the most number of deaths after lung cancer, both in the West as well as locally in Singapore. Liver is the most common site of metastasis in colorectal cancer; an estimated 15% of patients will present synchronously, whilst approximately 50% will develop hepatic secondaries at...
Original Article
Hepatic Resection for Colorectal Metastases to the Liver: The National Cancer Centre/Singapore General Hospital Experience
Colorectal carcinoma is the fourth most common malignancy and the second leading cause of death worldwide. Although surgical resection in combination with adjuvant chemotherapy in certain cases provide curative treatment, more than 50% will develop metastases in the course of their disease.
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Original Article
Computed Tomographic Appearance of Colorectal Hepatic Metastases
It is important to recognise the computed tomography (CT) appearance of hepatic metastases from colorectal primaries, as resection in a selected group may offer a 20% to 40% rate of five-year survival compared to 5% to 10% with non-surgical management.
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Review Article
Current Status in Imaging of Colorectal Liver Metastases
Colorectal cancer is a common primary that metastasizes to the liver. About 20% of patients with colorectal cancer will have detectable metastases at the time of clinical presentation, with an additional 30% developing clinical evidence of hepatic disease within 24 months.
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Review Article
Current Concepts of Tumour Metastasis
Tumour metastasis, or the spread of cancer cells from a primary tumour to distant sites, remains the principal cause of treatment failure and poor prognosis in patients with cancer. Early metastasis concepts were based upon the premise of uninterrupted tumour growth, stepwise spread of tumour cells with the inevitable...
Review Article
Chemoprevention of Colorectal Cancer – Experimental Approach and Clinical Applications
The age-old adage of “Prevention is Better than Cure” is still very relevant in today’s practice of medicine. Many randomised population trials have already shown that colorectal cancer mortality is reducible through early detection and screening.
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Review Article
Practical Issues in Adjuvant Therapy for Rectal Cancer
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Review Article
Total Mesorectal Excision (TME) – Twenty Years On
In 1982, Heald et al1 at the Basingstoke District General Hospital introduced the concept of total mesorectal excision (TME) as a means of performing optimal tumour clearance for patients with rectal cancer. Five cases were described where minute foci of adenocarcinoma was demonstrated in the mesorectum several centimetres distal...
Original Article
Flat and Depressed Lesions of the Colon and Rectum: Pathogenesis and Clinical Management
It was previously thought that the vast majority of colorectal cancers were derived from polypoid adenomas. However, several investigators have noted that most colorectal cancers which developed from flat or depressed neoplastic lesions remained undetectable by conventional colonoscopy.
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Others
Surgical Management of Colorectal Metastases to the Liver
Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver is the most common site of distant metastases from colorectal cancer.
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Editorial
Recent Advances in the Total Management of Colorectal Cancer
Considerable improvements in the survival and outcome of colorectal carcinoma have been made in recent years. These have been the result of advances in investigations, intervention as well as in follow-up management.
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Others
Unusual Case of Bowel Infarction with Invasive Aspergillus in an Immunocompromised Patient
The role of neoadjuvant chemotherapy for locally advanced breast cancer has been established and there has been a growing interest in its role in early and operable breast cancer.1 Most neoadjuvant chemotherapeutic regimes contain an anthracycline and are usually combined with cyclophosphamide, with or without 5-fluorouracil.
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Original Article
The HercepTest and Routine C-erbB2 Immunohistochemistry in Breast Cancer: Any Difference?
The proto-oncogene c-erbB2 (also known as HER2/neu) is located on chromosome 17q21 and encodes a 185-kD transmembrane glycoprotein. It belongs to the human epidermal growth factor receptor (tyrosine kinase receptor) family that plays an important role in the regulation of fundamental processes such as cell growth, survival and differentiation.
This...
Others
A Case of Metastatic Squamous Cell Carcinoma of the Hypopharynx Manifesting as Acute Abdomen
T, a 23-year-old female, was previously well until November 2000 when she presented with 1-year history of sore throat associated with neck lumps for 2 months. Clinically, she had left cervical lymphadenopathy measuring 3 cm.
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Others
A Case of Maffucci’s Syndrome With Pleural Effusion: Ten-year Follow-up
A 23-year-old male patient was admitted to Ataturk Chest Disease Hospital with non-productive cough, dyspnoea, chest pain and back pain. These complaints had begun 15 days before he was admitted.
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Others
Clinical Indications for Positron Emission Tomography (PET) Scanning
The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their patients. PET imaging is a rapidly evolving field, with ongoing developments in imaging technology, radiochemistry, isotope production, animal research and clinical applications.
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Editorial
Positron Emission Tomography – A Vital Component of Molecular Imaging
Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of such modalities as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). As far back as 1951, positron-emitting radiotracers have...
Others
Two Case Reports of Metastases from Colon Carcinoma to the Thyroid
Metastases to the thyroid are not as rare as previously believed and have been shown, in autopsy series, to be more common than primary thyroid malignancy. The overall incidence, not surprisingly, varies from 1.25% in unselected patient autopsy series to 24% in autopsy of patients with widespread malignant neoplasms.
This...
Original Article
Trends in Cancer Incidence Among Singapore Malays: A Low-risk Population
Cancer is now one of the most common causes of death in the world. Inspection of changes in cancer incidence in ethnically or geographically diverse populations is important for the understanding of cancer patterns and also to provide clues for aetiologic studies.
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Original Article
Image-guided Radiofrequency Ablation of Liver Malignancies: Experience at Singapore General Hospital
Radiofrequency (RF) ablation for the treatment of focal liver malignancies is a relatively new image-guided procedure that is gaining increasing acceptance in the radiologic and surgical community, particularly as an alternative treatment option for patients who have inoperable tumours. The potential benefits of minimally invasive image-guided ablation, as compared...
Original Article
Detection and Quantification of the Abelson Tyrosine Kinase Domains of the bcr-abl Gene Translocation in Chronic Myeloid Leukaemia Using Genomic Quantitative Real-time Polymerase Chain Reaction
Chronic myeloid leukaemia (CML) is a clonal stem cell malignancy characterised by massive proliferation of mature and immature granulocytes, basophils and spleen cells, but not cells of T cell lineage. The molecular hallmark of CML is the reciprocal translocation between chromosomes 9 and 22, t(9;22), which produces the Philadelphia...
Review Article
The Feminist Approach in the Decision-making Process for Treatment of Women With Breast Cancer
The ethical theories employed in healthcare today generally assume a modern Western philosophical framework, which is applied to many issues such as abortion, euthanasia, consent for treatment and organ transplantation. The application of this approach to non-Western cultures needs critical examination.
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Others
Postirradiation Sarcoma of the Sphenoid Bone – A Case Report
Radiation-associated tumours of the temporal and maxillary bone have been reported in patients treated with radiotherapy for nasopharyngeal carcinoma. There was no previously reported case of postirradiation sarcoma of the sphenoid bone after radiation therapy for nasopharyngeal carcinoma.
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Original Article
Phase II Trial of Gemcitabine and Cisplatin Sequentially Administered in Asian Patients With Unresectable or Metastatic Non-small Cell Lung Cancer
Lung cancer is the most common cause of cancer-related death worldwide. It ranks first among males and third among females in the incidence of cancers in Singapore.
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Images in Medicine
Putting Together Lesions in the Brain, Retina, Kidney and Pancreas
A 40-year-old Malay lady presented with a 6-month history of headache. She had a past history of a left nephrectomy 6 years ago.
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Letter to the Editor
Tuberculosis Masquerading as Recurrent Metastatic Carcinoma of the Cervix
The incidences of certain malignancies are increasing and are major causes of mortality. Diagnosis can be difficult and delayed.
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Review Article
Association of Epstein-Barr Virus with Nasopharyngeal Carcinoma and Current Status of Development of Cancer-derived Cell Lines
Although nasopharyngeal carcinoma (NPC) has been reported in almost all parts of the world, most cases of NPC are found in South East Asia, Southern China (including Hong Kong), North Africa and in the Eskimo population of Alaska, USA. For reasons that still remain unclear, the Chinese are more...
Letter to the Editor
Massive Retroperitoneal Adrenal Haemorrhage as the First Manifestation of a Lung Cancer
A 74-year-old man was admitted with sudden onset of right upper quadrant abdominal pain radiating towards right shoulder and right thigh. Pain was aggravated by deep breathing and movements.
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Others
4th FY Khoo Memorial Lecture 2008: Nasopharyngeal Cancer Workgroup – The Past, The Present and The Future
Thank you Madam Chairman. First, I would like to thank the Singapore Radiological Society and the College of Radiologists, Academy of Medicine Singapore for giving me the honor of delivering this the 4th FY Khoo Memorial Lecture, 2008.
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Original Article
Phase II Trial of Gemcitabine in Combination with Cisplatin in Inoperable or Advanced Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) has a high incidence rate in Asia. In Singapore, it is the third most common cancer amongst males, and constituted 8% of all cancers diagnosed between 1998 and 2002.
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Letter to the Editor
Pancreas-only Metastasis from Nasopharyngeal Carcinoma
A 51-year-old Chinese man presented with a 3 month’s history of left cervical lymphadenopathy, rhinorrhoea, tinnitus and nasal congestion. On nasopharyngoscopy, a fungating mass was found in his nasopharynx and was biopsied.
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Original Article
Induction Concurrent Chemoradiotherapy Using Paclitaxel and Carboplatin Combination Followed by Surgery in Locoregionally Advanced Non-Small Cell Lung Cancer – Asian Experience
Lung cancer is the leading cause of cancer mortality in Singapore. The age standardised incidence rate is 45 per 100,000/year.
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Letter to the Editor
Successful Surgical Treatment of Renal Cell Carcinoma With Calvarial Metastases
Renal cell cancer (RCC) accounts for 3% of all cancers. Isolated haematuria or pain is the most common form of presentation.
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Original Article
The Toxicity and Outcomes of Continuous 5-fluorouracil/Cisplatin-based Chemotherapy Followed by Chemoradiation in Patients with Resected High-risk Gastric Cancer: Results of a Single Institute
Gastric carcinoma is the second most common cause of cancer mortality worldwide. Surgery is the only curative therapy, although 5-year survival rates remain poor even after curative resection.
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Original Article
Local Experience of Endorectal Magnetic Resonance Imaging of Prostate with Correlation to Radical Prostatectomy Specimens
Prostate cancer ranks among the top 10 cancers in Singapore. The incidence of prostate cancer has risen by 5% to 118% in most Asian countries.
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Original Article
MMP-2, TIMP-2 and CD44v6 Expression in Non-small-cell Lung Carcinomas
Studies have provided data that matrix metalloproteinases (MMPs) facilitate tumour invasion, the establishment of metastases. On the other hand, matrix metalloproteinase inhibitors have been shown to inhibit tumour growth and dissemination in non-small-cell lung carcinomas (NSCLCs).
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Original Article
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore
As only 5–10% of thyroid nodules harbour malignancy, fine-needle aspiration (FNA) is important in triaging nodules requiring surgical excision from nodules that may be observed.1,2 This approach allows risk stratification that can reduce the rate of benign lesion removal by diagnostic lobectomies3 and its associated postoperative morbidity.4 However, thyroid...
Original Article
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,...
Editorial
The case for better hospitalisation selection in cancer patients
Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been a significant strain on public healthcare systems to balance the demands of the pandemic and usual medical care.
There is little literature detailing emergency department (ED)...
Original Article
Outcomes of Oral Tongue Cancer: Does Age Matter?
Oral cancer (including oral cavity and oropharynx) is the eighth most common cancer worldwide with oral cavity cancer among the 3 most common malignancies in south central Asia. Oral cavity cancer, including oral tongue, is associated with a relatively high mortality rate particularly in the developing countries.
This article is...
Original Article
Surgical Metastasectomy in AJCC Stage IV M1c Melanoma Patients with Gastrointestinal and Liver Metastases
The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent revised version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma has further sub-divided melanoma metastatic sites to 3 specific categories;...
Letter to the Editor
Coexistence of Unicentric Castleman’s Disease and Locally Advanced Papillary Renal Cell Carcinoma: More Than a Coincidental Association?
Castleman’s disease (CD) is an enigmatic lymphoproliferative disorder due to its rarity, uncertain aetiopathogenesis and heterogeneous clinicopathologic forms. This case report presents an unusual case of concomitant hyaline-vascular type CD of unicentric retroperitoneal localisation and stage IV (T2N2M0) papillary renal cell carcinoma (RCC).
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Letter to the Editor
Management of Thrombotic Thrombocytopenic Purpura in Metastatic Prostate Cancer with only Endocrine Therapy
Thrombotic thrombocytopenic purpura (TTP) is a systemic disorder that presents acutely with multiple organ failure. Although defined classically as a syndrome with a pentad of features, it is accepted now that a diagnosis can be made with the dyad of microangiopathic haemolytic anaemia and thrombocytopenia.
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Original Article
Phosph-Akt1 Expression is Associated with a Favourable Prognosis in Pancreatic Cancer
Pancreatic cancer is the fourth leading cause of cancer related mortality worldwide with an estimated 34,290 deaths recorded in the United States in 2008. Of these, pancreatic ductal adenocarcinoma (PDAC) accounts for ~90% of all cases.
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Original Article
Prospective Audit of Febrile Neutropenia Management at a Tertiary University Hospital in Singapore
Febrile neutropenia (FN) is considered a medical emergency and remains a major cause of morbidity and mortality in Oncology and Haematology units worldwide. A study analysing pooled FN data from 115 US academic medical centres between 1995 and 2000 showed that the overall in-hospital mortality was 9.5%, whereas pooled...
Original Article
An Audit Study of the Sensitivity and Specificity of Ultrasound, Fine Needle Aspiration Cytology and Frozen Section in the Evaluation of Thyroid Malignancies in a Tertiary Institution
Thyroid lesions constitute a considerable bulk of surgical practice, majority of which are thyroid nodules. A large population study revealed that clinically apparent thyroid nodules were present in 6.4% of women and 1.5% of men.
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Original Article
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...
Original Article
rTSβ as a Novel 5-fluorouracil Resistance Marker of Colorectal Cancer: A Preliminary Study
Although colorectal cancer is common in Western countries, in the past, it has been uncommon in Asian countries. However, its prevalence has gradually been increasing. Since 1982, malignant cancers have been the leading cause of death in Taiwan.
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Letter to the Editor
Dilemmas in Management of Brain Tumours in Pregnancy
Brain tumours in pregnancy are rare with an incidence of 15 per 100,000 and previous reports have shown variable outcomes. We present a case of glioblastoma multiforme (GBM) in pregnancy in which the patient underwent emergency craniotomy and adjuvant radiotherapy before delivering a healthy baby with good outcome.
This article...
Review Article
Peritoneal-based Malignancies and Their Treatment
Peritonectomy or cytoreductive surgery has been described as the treatment of choice for selected patients with evidence of peritoneal carcinomatosis (PC) from the gastrointestinal tract, peritoneum, ovaries and the disease of pseudomyxoma peritonei. Median survivals in a carefully selected patient population have been shown to exceed that of systemic...
Original Article
Immunophenotypic, Cytogenetic and Clinical Features of 113 Acute Lymphoblastic Leukaemia Patients in China
Acute lymphoblastic leukaemia (ALL) is a heterogeneous disease with abnormal proliferation and accumulation of immature lymphoblasts within the bone marrow (BM), peripheral blood and lymphoid tissues, and is composed of different genetic, biological, and clinically relevant subtypes. Morphological and cytochemical methods were the main tools for diagnosis and classification...
Letter to the Editor
Managing buccal space tumours
Dear Editor,
The buccal space is an infrequently addressed fascial space of the head and neck region. Intrinsic tumours of the buccal space are rare and hence present a management challenge. In a recent systematic review of 217 patients, 4 main surgical approaches were identified (intraoral, extended parotidectomy/rhytidectomy, transcutaneous...
Letter to the Editor
Acute Marjolin’s Ulcer: A Forgotten Entity
Marjolin’s ulcers are malignancies that arise from areas of chronic irritation or injury that undergo malignant transformation after a period of many years. Such lesions are predominantly squamous cell carcinomas (SCC) and have long been associated with burn scars. Here we describe an unusual case of Marjolin’s ulcer that...
Original Article
Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan
Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000
man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...
Letter to the Editor
Bilateral Polychromatic Crystalline Keratopathy as the Initial Manifestation of IgG-Lambda Multiple Myeloma
Dear Editor,
Multiple myeloma is a subgroup of plasma cell dyscrasias with neoplastic proliferation of plasma cells or their precursors. Crystalline keratopathy is a well-recognised but rare ocular manifestation of multiple myeloma. We present a rare case of IgG-lambda multiple myeloma that manifested as polychromatic crystals in the cornea—a presentation...
Letter to the Editor
Low-Grade Fibromyxoid Sarcoma of the Thyroid: A Case Report
Dear Editor,
Low-grade fibromyxoid sarcoma (LGFMS) is a rare form of neoplasm that usually occurs in the deep soft tissue of the lower limbs with a tendency towards local recurrence and
distant metastasis. LGFMS affects mainly the young and middle-aged, with both gender having an equal chance of being affected. To...
Letter to the Editor
Five Patients with Medullary Thyroid Carcinoma Presenting as Asymptomatic Elevation of Carcinoembryonic Antigen Level
Early detection of malignancies is not easy. Few methods of health screening have been proven to be of value. The use of carcinoembryonic antigen (CEA) in health screening has never been proven to result in early detection of cancers but requests to test tumour markers continue to be made....
Editorial
Too Much Medicine: Time to Stop Indiscriminate Cancer Screening
Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in Singapore today is as a result of cancer. It is therefore unsurprising that cancer screening has become an integral part of health screening in primary...
Original Article
Outcomes of oesophageal cancer treated with neoadjuvant compared with definitive chemoradiotherapy
Oesophageal cancer is the 7th most common cancer in the world, with 572,034 new cases diagnosed in 2018, and is the 6th most common cause of cancer-related mortality worldwide. Oesophageal squamous cell carcinoma (SCC) is the predominant histological subtype. However, the incidence of adenocarcinoma has risen among the Western...