NASOPHARYNGEAL CANCER COMMITTED TO CARE
INSPIRED BY HOPE
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CONTENTS 01 Introduction 02 The Nasopharynx 02 What is Nasopharyngeal Cancer? 03 What causes Nasopharyngeal Cancer? 03 Signs and symptoms 03 How is Nasopharyngeal Cancer diagnosed? 04 Staging of Nasopharyngeal Cancer 05 Treatment 08 Preparing for radiotherapy treatment 10 What happens after treatment has begun? 10 How do I manage side effects? 13 Questions you can ask your doctor 14 Supportive care 15 Cancer support services 17 What the future holds 17 Internet resources
Special thanks to the following members who have contributed to the development of this booklet: Dr Terence Tan, Senior Consultant, Dept of Radiation Oncology Dr Leong Swan Swan, Senior Consultant, Dept of Medical Oncology Dr John Low, Consultant, Department of Radiation Oncology Text: Miss Flora Yong, Senior Nurse Manager, Cancer Education & Information Service Disclaimer The National Cancer Centre does not endorse or promote the use of any product mentioned in this booklet. The information is presented in a summary to provide understanding and knowledge only. It does not recommend the self-management of health problems or replace consultation with your doctor. You should never disregard medical advice or delay seeking it because of something you have read here. First edition Oct 2003. This edition May 2008 CopyrightŠ National Cancer Centre (S) All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission from the publisher.
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Introduction Nasopharyngeal cancer is the sixth most common cancer affecting men in Singapore (Singapore Cancer Registry, Interim Report 2001 – 2005). It affects men more frequently than women and it occurs between the ages of 35 to 55 years. This type of cancer is more frequently seen among the Chinese (especially Cantonese). Every year, there are 300-400 new cases being diagnosed. This booklet has been developed to help you understand more about cancer of the nasopharynx which is sometimes referred to as nose cancer. It discusses risk factors, signs and symptoms, how a diagnosis is made, treatment options, managing treatment side effects and supportive care. It is our hope that this booklet will provide you with relevant information and coping techniques as well as answer some of the questions you may have. This booklet only serves as a guide and its contents are not to be taken as medical advice. You will still need to discuss with your doctor the best treatment option for you. If you have any questions about the issues raised in this booklet, or if there is any information that you are seeking which is not covered here, please do not hesitate to contact us. For more information about cancer, please call the Cancer Helpline on tel: 6225 5655 or email cancerhelpline@nccs.com.sg Other patient information booklets are also available from the Cancer Education and Information Service. Please contact the Cancer Helpline for a free copy. For electronic version of this booklet and other publications, please visit National Cancer Centre Singapore’s website: www.nccs.com.sg
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THE NASOPHARYNX
Pharyngeal Tonsil Soft palate Nasal Septum
Hard palate
Nasopharynx Tongue
Oesophagus
Trachea
The nasopharynx is located behind the nose just above the mouth and throat. The pharynx is a hollow tube about 5 inches long that starts behind the nose and goes down to the neck and ends at the top of the trachea (windpipe). Air and food pass through the pharynx on the way to the trachea or oesophagus (the tube that carries food to the stomach). The nostril leads to the nasopharynx. An opening on each side of the nasopharynx leads to the ear. Nasopharyngeal cancer usually starts in the squamous cells lining in the oropharynx, the part of the throat behind the mouth.
WHAT IS NASOPHARYNGEAL CANCER? Nasopharyngeal cancer (NPC) or more commonly known as nose cancer is a disease in which cancer cells develop from the tissues of the nasopharynx. Normal cells grow, divide and replace themselves in an orderly manner. Your body relies on this orderly activity to repair injuries and replace worn-out tissue. Cancer develops when these cells divide too rapidly and grow without control. Too much tissue is produced and a tumour begins to form. This tumour can be malignant (cancerous) or benign (non-cancerous).
National Cancer Centre Singapore
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National Cancer Centre Singapore
WHAT CAUSES NASOPHARYNGEAL CANCER? The exact causes of NPC are still unknown. However, scientists have found that the disease is associated with certain inherited characteristics, dietary habits, use of tobacco products and the Epstein Barr Virus. Nasopharyngeal cancer is not contagious.
SIGNS AND SYMPTOMS TO REPORT TO YOUR DOCTOR:
R A sore throat that does not go away
R Hoarseness of voice, difficulty in swallowing
R Difficulty breathing or speaking
R Hearing problems – a change or loss in hearing, ringing in the ear
R Ear ache or discharge from the ear
R Frequent headaches
R Nasal obstruction or stuffiness
R One or more lumps in the nose or on the neck
R Frequent nosebleeds
R Bloodstained sputum
R Fatigue
R Weight loss of unknown reason
Other conditions may cause the same symptoms and do not always mean cancer, but if they persist, see the doctor immediately.
HOW IS NASOPHARYNGEAL CANCER DIAGNOSED? The doctor will examine you carefully. This will include taking a complete medical history, conducting a physical examination and performing several other tests such as the following: Nasendoscopy is the use of a long narrow flexible, lighted, tube that is inserted through the mouth or nose to look at the nasopharynx for abnormal growths, bleeding, or other signs of disease. Biopsy is taking a sample of abnormal tissue for examination under microscope to help in diagnosing the disease. This can be done during nasendoscopy. A report describing the type and extent of the cancer will be sent to the patient’s treating doctor.
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Computer Tomography (CT scan) is a technique for constructing pictures from crosssections of the body by imaging the body from different angles. Radio-opaque dyes are usually injected first to enable the body structures to show up clearly under x-ray. The information is then fed directly into a computer to build up detailed cross-section pictures of the head and neck structures. Magnetic Resonance Imaging (MRI) uses magnetic fields instead of x-ray to detect tumours and look out for any spread to the lymph nodes. Positron Emission Tomography (PET) builds up clear and detailed pictures of the body. An injection of a glucose solution containing a very small amount of radioactive material is given to the patient. The PET scanner will detect and show the areas where the radioactive substance is being used in the body. Cancerous cells show up at areas where glucose is being used by growing cells. Chest x-ray is done to check for any cancer spread to the lungs. Bone Scan uses low level radioactive substance that is injected into the patient to pick up cancerous areas in the bones. The aim of this procedure is to detect any cancer spread from the nasopharynx to the bones. Cancerous areas pick up more of this substance than normal bones. These show up as hot spots on pictures taken with a special camera. The level of radiation is low and does not cause any side effects and most of the radioactive material will leave the body within a few hours.
STAGING OF NASOPHARYNGEAL CANCER Stage 0 Cancer is found only in the lining of the nasopharynx. Stage I Cancer is contained within the nasopharynx only. Stage 2 Cancer is divided into Stage IIA and Stage IIB. In Stage IIA, cancer has spread from the nasopharynx to the oropharynx (the middle part of the throat that includes the soft palate) and/or to the nasal cavity. In stage IIB, one of two situations might occur: The cancer is found in the nasopharynx and has spread to the lymph nodes in one side of the neck, or has spread to the area surrounding the nasopharynx and might have spread to lymph nodes on one side of the neck.
National Cancer Centre Singapore
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National Cancer Centre Singapore
Stage 3 In this stage, the cancer: R has spread into the soft tissues (oropharynx and/or nasal cavity) and to lymph nodes on both sides of the neck R has spread beyond the soft tissues into areas around the pharynx and to lymph nodes on both sides of the neck R has spread to nearby bones or sinuses and might have spread to lymph nodes on one or both sides of the neck Stage 4 Cancer is divided into Stage IVA, Stage IVB, and Stage IVC as follows: Stage 4A The cancer has spread beyond the nasopharynx and might have spread to the cranial nerves, the hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the bone around the eye. Cancer might also have spread to lymph nodes on one or both sides of the neck, but the lymph nodes involved are smaller than 6 centimeters. Stage 4B This stage of cancer has spread to lymph nodes above the collarbone, and/or the lymph nodes involved are larger than 6 centimeters. Stage 4C The cancer has spread beyond nearby lymph nodes to other parts of the body.
TREATMENT Treatment may involve surgery to remove the cancer, or radiotherapy and/or chemotherapy to destroy the cancer cells. The following factors are taken into account: R location of the cancer R extent of the disease R any presence of cancer spread R how far is the spread R the general health of the patient R age of the patient 5
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RADIATION THERAPY Radiotherapy or radiation therapy remains the primary treatment for NPC. Radiotherapy uses high-energy x-rays to kill cancer cells or to stop them from growing further. Although radiotherapy can affect both cancer as well as normal cells but normal cells are better able to resist or recover from its effects. Generally, cancer cells are more sensitive to radiation damage than normal cells. Radiotherapy will not leave you radioactive. The radiation is not hot; in fact you will not hear, see or feel the radiation at all. It is just like when you have an ordinary x-ray examination. The area of treatment for nasopharyngeal cancer involves the back of the throat and sometimes to the lymph glands in the neck. The treatment is planned carefully to ensure that the rays are targeted precisely onto the cancer, and do as little harm as possible to the surrounding healthy tissues. Two types of radiation methods may be used for NPC. The radiation oncologist will decide this after assessment of the patient. It can be given as External Beam Radiotherapy and/or Internal Radiotherapy.
External Beam Radiotherapy (EBRT) External beam radiotherapy uses high-energy rays from the treatment machine directed towards the area to be treated. There is no discomfort during the treatment. As this treatment does not make you radioactive, it is safe for you to be with other people. External beam radiotherapy is usually given 5 days a week for 6 to 7.
Internal Beam Radiotherapy Internal Beam Radiotherapy (also called Brachytherapy) is another form of radiation treatment where a small radioactive material or tiny radioactive ’seeds’ are placed directly into the cancer or very near it. It will be removed once the treatment is completed. This treatment can be given alone or in combination with external beam radiotherapy. Internal beam radiotherapy is usually given once or twice to give an extra boost to external beam radiotherapy.
CHEMOTHERAPY Chemotherapy is the treatment of cancer using anti-cancer drugs. The aim is to destroy cancer cells while causing the least possible damage to normal cells. These drugs stop cancer cells from growing and reproducing themselves. National Cancer Centre Singapore
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National Cancer Centre Singapore
Chemotherapy can be used on its own or together with radiotherapy for treating advanced NPC. These drugs are usually given by injection. A course of treatment usually lasts for 4 days, followed by a rest period of 3 weeks to allow the body to recover from side effects of the treatment. Each treatment plan is tailored according to the individual.
SURGERY The aim of surgery is to remove the cancer. In some people, the surgeon needs to remove only a small area, and healing is quick. For others, the operation may need to be more extensive. If there is evidence that the cancer has spread to the lymph nodes in the neck, the surgeon may remove the nodes on one or both sides of the neck. This is called a neck dissection. Ask your surgeon what you want to know and make sure you understand what is involved, what exactly will be removed and how it will affect you afterwards.
NASOPHARYNGEAL CANCER TREATMENT BY STAGE You have learnt that Nasopharyngeal cancer can be treated with radiation therapy, chemotherapy, and occasionally surgery. In some cases, the best approach involves two or more of these strategies. The treatment of Stage I nasopharyngeal cancer usually involves radiation treatment to the tumor and the lymph nodes in the neck. In Stage II nasopharyngeal cancer, chemotherapy might be combined with radiation therapy. This stage also involves radiation therapy to the tumor and lymph nodes in the neck. The treatment of Stage III nasopharyngeal cancer might include: R chemotherapy combined with radiation therapy R radiation therapy to the tumor and lymph nodes in the neck R radiation therapy, followed by surgery to remove cancer-containing lymph nodes in the neck that persist or recur after radiation therapy R a clinical trial of chemotherapy before, combined with, or after radiation therapy The treatment of Stage IV nasopharyngeal cancer can include:
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R chemotherapy combined with radiation therapy R radiation therapy to the tumor and lymph nodes in the neck
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R radiation therapy, followed by surgery to remove cancer-containing lymph nodes in the neck that persist or recur after radiation therapy
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R chemotherapy for cancer that has spread to other parts of the body R a clinical trial of chemotherapy before, combined with, or after radiation therapy
PREPARING FOR RADIOTHERAPY TREATMENT Before starting radiotherapy, there may be a few procedures required to prepare you for treatment. Depending on each individual case, the patient may need one or more of the following: R Mask or Shell (Immobilization device) R Mouth piece R Shielding cut-out R Simulation
R Computerized Tomography (CT) Simulation
R Verification
Mask or Shell The purpose of the mask or shell is to enable the affected area to be held in the same precise position for treatment. Not all patients are required to have a mask or shell during their treatment. It depends upon the particular type of treatment prescribed by the doctor. The mask or shell is made in the mould room by trained technicians or radiation therapists. The mask or shell, which is made of a special plastic material, is designed mainly for patients who need to undergo treatment on the head and neck regions. This will ensure a fast yet very accurate set-up for your daily treatment. The shell is custom made to fit you alone. The process of shell making takes about 15 minutes. The plastic material is immersed in a basin of warm water to soften it for moulding. Once the plastic is softened, it is taken out of the basin, dried with a clean towel and then placed snuggly over the relevant area of the patient. The technician will mould the material over the surface and allow the plastic to cool to room temperature. The plastic sheet will gradually harden to fit the impression of that body surface. This shell is then removed and labeled with your identification. The mask or shell will be used during simulation and treatment.
National Cancer Centre Singapore
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National Cancer Centre Singapore
Mouthpiece / Mouth bite A mouthpiece is a small contoured piece of wax that is placed in your mouth during simulation and radiation treatment. The purpose of the mouthpiece is to depress your tongue onto the floor of your mouth. This will help to minimize movement of your tongue and jaw during the radiation procedure and can also displace your mouth away from the radiation field to minimize side effects. When the mouthpiece is placed in the mouth, you will be asked to clench firmly on it.
Care of the mouthpiece R Wash the mouthpiece with water and wipe it dry. Do not use hot water as heat may melt the material. R Dry the mouthpiece thoroughly and keep it in the container provided. This will keep the mouthpiece clean and hygienic for use.
Simulation This is a form of x-ray examination that is used for defining the treatment areas before actual treatment can be given. Once the treatment area is determined, localization markings are drawn on your skin to indicate the treatment area(s). These markings MUST NOT BE REMOVED until the whole course of treatment is completed. This is essential so that the radiation therapist can carry out the daily radiation treatment accurately and quickly.
Computerized Tomography (CT) Simulation Sometimes the treatment area may need a more complex planning technique. This can be done using CT simulation which requires the patient to go through a similar procedure as a normal diagnostic CT scan except that images captured in the CT simulation can be used for detailed treatment planning which may include a 3 dimensional view.
Verification This is an intermediate procedure of the treatment planning process. This is often done for very complex treatment techniques where confirmation of planned settings is required. Once these plans have been verified and confirmed, the radiation treatment can begin. 9
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WHAT HAPPENS AFTER TREATMENT HAS BEGUN? During your course of treatment, your doctor will review your condition at least once a week. Your radiation therapist will inform you of your review dates. Once your whole treatment is completed, you will be required to come for follow-up visits at the Specialist Outpatient Clinic.
How do I manage side effects? Different people react differently to radiation therapy and the intensity of the side effects may also vary from person to person. It is important to remember the type and severity of any side effects has nothing to do with the success of your treatment. These possible side effects will be explained to you before the treatment starts. The type of side effects that you have will depend a great deal on the area that is being treated. The majority of these side effects can be controlled or reduced if they do occur. If your reaction is severe, inform your doctor or radiation therapist. Below are some of the common side effects that may occur and we offer some suggestions to minimize the discomfort.
SKIN CHANGES The skin around the treated area and ear canal may become red. This effect is temporary and subsides soon after the treatment is completed. You can ask your doctor for topical creams or gels to soothe the soreness. Do not self-medicate.
Helpful tips a. Protect the treatment area from the sun. Wear a hat or carry an umbrella to avoid exposing your skin to direct sunlight. b. Inform your doctor at once if cracks or blisters, rashes, infection and peeling appear on your skin. c. Avoid scrubbing or scratching the skin on the treated area or any sensitive spots. Be careful not to rub off the treatment marking or dye outlines after your treatment. Let them wear off gradually. d. Do not apply soap, creams, deodorants, medicines, perfumes, cosmetics, talcum powder or other substances on the treatment area without approval from your doctor. Many of such products can leave a coating on your skin that can interfere with radiotherapy. e. If you need to shave on the treatment area, use an electric razor to prevent accidental cuts. Check with your doctor or radiation therapist first.
National Cancer Centre Singapore
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National Cancer Centre Singapore
HAIR LOSS There will be mild hair loss at the hairline at the base of the neck. Hair loss may be temporary or permanent. While you are on treatment avoid exposing your scalp to the sun. Gently shampoo your hair with a mild shampoo to prevent irritation to the treatment area.
DRY AND SORE MOUTH Your oral cavity is in the treatment area and the salivary glands will be affected by radiotherapy. Saliva lubricates and cleanses the teeth, regulates the pH in the mouth, which controls normal oral bacteria. However, these can change when the salivary glands are affected by the treatment. Oral and dental problems can arise when the consistency and amount of saliva is changed. Dental cavities and gum infection are also common problems when radiotherapy is given to the head and neck area. These problems are usually not severe and will subside after treatment. Pay extra attention to mouth care and hygiene to boost the natural defense system in the mouth. Follow the advice of your doctor and radiation therapist to minimize severity of the side effect. Your doctor will also ask you to see a dentist before you start your radiation treatment. Keep regular appointments with your dentist so that any dental cavities or oral infection can be detected early.
Helpful tips 1. It is important to see a dentist before starting your treatment to have your dental health checked. You will not be allowed to go for any dental procedures once radiation treatment has begun. It is crucial to inform your dentist that you are about to start radiotherapy so that dental problems can be corrected before your treatment. 2. Practice good oral hygiene to prevent buildup of plague and debris in the mouth, which may cause oral infections. 3. Rinse your mouth every 2 hours with baking soda solution (1teaspoon of baking soda/sodium bicarbonate to 250mls of water) or use the mouthwash prescribed by your doctor to keep your mouth moist and clean. Do not use commercial mouthwash as they may contain alcohol, which may increase mouth dryness. If you have a sore mouth or mouth ulcers avoid the use of salt water. 4. Inspect your mouth at least once a day for areas of dryness, redness and presence of white or yellow patches, which are signs of oral infection. Use a torchlight and look into your mouth. If you have dentures, remove dentures before inspection. 5. Brush your teeth with a soft bristled toothbrush after every meal and before bedtime. Avoid eating sweets and sticky foods especially before bedtime to prevent dental caries. You may be advised not to wear dentures during your treatment period to prevent abrasions to your gums.
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6. Drink plenty of fluids throughout the day to keep hydrated even if you have difficulty swallowing. Suck on ice cubes or sugarless sweets to stimulate the salivary glands to work to moisten your mouth. 7. Avoid eating foods that are very hot or very cold in temperature, spicy, sour, hard or coarse such as potato chips and crackers as these can irritate the mouth lining. Use a lip balm to soothe or prevent chapped lips. 8. Eat softer foods or add gravy and sauce to make swallowing easier. Drink soups if your throat is sore from the side effects of treatment. Eat small frequent meals. Liquid nutritional supplements may be necessary if you are not eating well. 9. Smoking is strictly not allowed while receiving radiotherapy. This includes cigarettes, cigars, pipes and tobacco chewing. 10. Drinking alcoholic beverages such as liquor, beer and wine is also not allowed because these will dry the mucous lining of the mouth.
LOSS OF TASTE AND SMELL Radiotherapy to the head and neck area affects the taste buds so food may not taste the same. Although the side effect is temporary but your sense of taste will not completely return to normal. Your body will adapt to these changes.
Helpful tips 1. Try eating different foods. Add spices and herbs to enhance the flavour of your meals. Food you may not have liked before may taste good to you now. 2. Chew your food longer to allow more contact time between the food and your taste buds. 3. Gargle after meals to freshen your mouth and also to remove food residual. 4. Ask your doctor to refer you to a dietician or nutritionist if you need more information or help with managing your diet.
MAKING DECISIONS ABOUT TREATMENT Sometimes it is difficult to make decisions about what is the right treatment for you. You may feel that everything is happening so fast that you do not have the time to think things through. While some people feel they are overwhelmed with information, others may feel that they do not have enough. It is very important to realise that there is no single ’correct’ way to cope with cancer. You need to make sure that you understand enough about your illness, the possible treatment and side effects to make your own decision. National Cancer Centre Singapore
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National Cancer Centre Singapore
SEEKING A SECOND OPINION You may feel that you want to ask for a second opinion from another specialist. The reasons for wanting a second opinion vary. Sometimes it is the wish to make sure that everything possible is being done to get the best treatment, sometimes it is to get confirmation of bad news that is otherwise difficult to accept and sometimes it is just to get clarification of what is going on. This is understandable and can be a valuable part of your decision making process. You can still ask for a second opinion even if you have already started treatment or still want to be treated by your first doctor. Before you see the doctor, it may help to write down your questions. To assist you, below is a list of questions to ask your doctor. Taking notes during the session can also help. Many people like to have a family member or friend to go with them, take part in the discussion, take notes or simply listen.
QUESTIONS YOU CAN ASK YOUR DOCTOR You may find the following list of questions helpful when thinking about what to ask your doctor.
About your illness 1. What type of cancer do I have? 2. What is the stage of my cancer? 3. Is my type of cancer hereditary?
About tests 1. What are these tests for? 2. What will these investigations involve? 3. What are the risks for doing this test? 4. Will the results of this test make any difference to the treatment you provide? 5. How much will these tests cost?
About Treatment 1. What are the treatments available for my type of cancer? 2. What treatment would you recommend and why? 3. What is the aim of the treatment?
• Is it for cure?
• Is it for temporary control?
• Is it to reduce symptoms? 4. What are the benefits of this treatment?
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5. What are the possible side effects of this treatment? 6. Can these be prevented or controlled? 7. Are the side effects temporary or permanent? 8. How long is the treatment? 9. How does the treatment work and how is it given? 10. Can I take any herbal medicine or supplements during my treatment? 11. What will happen if I choose not to have any treatment? 12. Can I go back to work while I am on treatment? 13. Will I receive treatment as an outpatient or be admitted to the hospital? 14. What difference will this treatment make to my quality of life e.g. work, social, physical and sexual activity?
About follow-up 1. How often must I come back for doctor’s check-up? 2. Whom should I contact if I want to change my appointments? If you have other questions, please add on to the list. Feel comfortable to ask the doctor to explain the answers to you again if you do not understand them. It is also useful to write down the points you have discussed to act as a reference and reminder when you need them.
SUPPORTIVE CARE Recovery and follow-up are different for each person and depend on the treatment you have received. Supportive care helps people and their families to cope with cancer and its treatment and to continue with their lives as normally as possible. It should begin from the moment cancer is suspected, through diagnosis and treatment, and for as long afterwards as is necessary. It takes time to recover. There are physical and emotional changes to cope with, maybe in your appearance, your speech or what you can eat. Your family and friends may need as much support and guidance in coping with their feelings as you do. There is no right or wrong way to feel and you do not need to struggle with your illness alone. Coping or overcoming cancer is easier for both the patient and family when there are helpful information and support services. Here are some support services you may wish to consider contacting if you need them.
Medical Social Services The Medical Social Service Department at the hospital provide quality patient care which would enhance emotional support, financial aid, home care, transportation or rehabilitation. You will need a doctor’s referral to the medical social worker. National Cancer Centre Singapore
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National Cancer Centre Singapore
Cancer Support Groups Cancer support groups offer mutual support and information to people with cancer and their families. It helps to talk with others who have gone through the same experience. Support groups can also offer many practical suggestions and ways of coping. You may like to join a support group either now or at some time in the future. You can check with your doctor, nurse or social worker if your treating hospital has a cancer support group. You can also contact the Cancer Helpline on telephone 6225 5655 or email cancerhelpline@nccs.com.sg for information on support groups.
Oncology Support Group This support group is suitable to both cancer patients and their family. This is a self-help group for patients undergoing chemotherapy, radiotherapy or surgery for cancer. It is conducted primarily by cancer patients themselves. Doctors, cancer-trained nurses and cancer survivors facilitate the support group. These interactive sessions offers opportunity for new patients to interact with cancer survivors and share their experiences, voice their thoughts and fears and share coping strategies. The Oncology Support Group meets at the Singapore Cancer Society. Admission to meetings is free-of-charge and patients are encouraged to bring along one or more family members. For more information, you can call their Nurse Coordinator on telephone: 6221 9577 or fax 6222 7424
Cancer Helpline The Cancer Helpline at the National Cancer Centre Singapore provides information, counselling and linkage to services for people affected by cancer. This service is manned by cancer-trained nurse counsellors who will answer your queries and concerns about cancer. The nurse counsellors do not give medical advice and treatment recommendations but can assist in clarifying your doubts and putting into perspective whatever information you may have received from your own treating doctor. Callers can also make an appointment to speak with a counsellor face-to-face or email their queries to the helpline. Each contact with the nurse counsellor is anonymous, private and confidential. The nurse counsellor can be contacted via: Telephone Fax Email
: 6225 5655 : 6324 5664 : cancerhelpline@nccs.com.sg
Operating hours: Monday – Friday Saturday
: 8.30 am – 5.00 pm : 9.00 am – 1.00 pm
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Sunday and Public Holiday : Closed
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Look Good Feel Better (LGFB) This free program is specially developed to teach women how to restore their appearance and self-image when they experience the side effects of cancer treatment. The participants learn beauty techniques in skin care, make-up and hair care in a 3 hours hands-on class using actual products. Demonstrations of the use of wigs, hats, turbans and scarf tying techniques are also included. Participants will take home a complimentary kit of cosmetics. LGFB is supported by a reputable cosmetic company and is coordinated by Singapore Cancer Society. Sessions are held on a regular basis. However, enrollment for each session is limited and reservations must be made with participating hospitals listed below. These hospitals take turns to conduct the programme. Patients who are interested will have to call the respective hospitals to enquire about the programme schedule. Changi General Hospital
: 6850 3669
Gleneagles Hospital
: 6738 9333
KK Women’s and Children’s Hospital : 6394 5815 (Breast Unit) Mount Elizabeth Hospital
: 6738 9333
National Cancer Centre
: 6225 5655
National University Hospital
: 6773 7888
FOLLOW-UP CARE Follow-up checks always cause anxiety. This can make it difficult to put the experience of cancer behind you. But regular follow-up with your doctor is necessary and very important in monitoring your recovery. These check-ups may include x-rays, blood tests and other physical examinations. If you have any concerns or suspicions about your health in between check-ups, make an earlier appointment to see your doctor.
When should you call the doctor? After treatment, you are likely to be more aware of your body and the slight changes in how you feel from day to day. If you have any of the problems listed below, tell your doctor at once. 1. 2. 3. 4. 5. 6. 7.
Pain that does not go away, especially if it is always in the same place Lumps, bumps or swelling Nausea, vomiting, diarrhoea, loss of appetite, or difficulty swallowing Unexplained weight loss Fever or cough that does not go away Rashes, bruises, or bleeding Any other signs mentioned by your doctor or nurse
National Cancer Centre Singapore
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National Cancer Centre Singapore
WHAT THE FUTURE HOLDS Treatment side effects last for a few months even after you have completed the treatment. When the body cells have recovered the discomfort will disappear. Eating a well balanced diet and keeping a healthy lifestyle will enable you to keep in good general health. Perform activities and exercises within your own limits and do not over exert yourself. You can also return to work if you and your doctor feel that you are well enough to do so. Some people prefer to return to work between treatments while some defer returning to work until after they have completed all treatments. Treatment times can be arranged to suit your needs.
TREATMENT AND SUPPORT UNITS AT NCCs Dept of Radiation Oncology (Basement 2) For enquiries
: 6436 8058
For appointments : 6436 8181 Dept of Radiation Oncology (Block 2, Basement 1, SGH) For enquiries
: 6321 4210 / 6326 5147
For appointments : 6321 4211 Ambulatory Treatment Unit (ATU) (Level 3) Jasmine Suite
: 6436 8134
Morning Glory Suite
: 6436 8130
Appointment Scheduling Unit : 6436 8088 Dept of Psychosocial Oncology : 6436 8126 Pharmacy Helpdesk
: 6438 8282
Cancer Helpline
: 6225 5655
Foreign Patient Service
: (65) 6236 9433
Customer Service
: 6436 8082
Fax: (65) 6536 0611
CANCER RESOURCES ON THE INTERNET (Information is correct at time of printing)
National Cancer Institute, USA www.cancer.gov/cancerinfo/pdq/treatment/nasopharyngeal OncoLink: Head and Neck Cancers www.oncolink.upenn.edu/ University of Newcastle upon Tyne: Head and Neck Cancers www.cancerindex.org National Cancer Centre Singapore www.nccs.com.sg
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For more information on cancer, call the Cancer Helpline on tel: 6225 5655 or email: cancerhelpline@nccs.com.sg Monday to Friday : 8.30am to 5.00pm Saturdays : 9am to 1.00pm Sundays & Public holidays : Closed This is a public education initiative by: Cancer Education & Information Service Division of Medical Affairs National Cancer Centre Singapore 11 Hospital Drive Singapore 169610 Tel: 6236 9438 Fax: 6324 5664 Reg. No. 199801562Z SPONSORED by:
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