HealthNews Inspiring and informative stories for patients MICA (P) No. 054/02/2010

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1 FREE October 2010 HealthNews Inspiring and informative stories for patients MICA (P) No. 054/02/2010 Conquering cancer at A wonderful testimony for elderly cancer patients, U Gyan fought and won the battle with rectum cancer U Gyan was first diagnosed to have cancer of the rectum several years ago and had surgery in another hospital in Singapore to remove the tumour. He was then recommended to have chemotherapy. However, due to side effects nausea, tiredness and diarrhoea, he stopped receiving treatment after just two cycles. He was well until late 2009 when his cancer recurred in the rectum, giving rise to discomfort and change in bowel habits. The tumour was rather extensive and his doctor in Myanmar assessed that they had to sacrifice his anus in order to remove the tumour completely. He would then have to live with a colostomy. They also felt that surgery was risky because of his age. It was then that Dr Khoo Kei Siong, Deputy Medical Director and Senior Consultant, Medical Oncology, at Parkway Cancer Centre (PCC), visited U Gyan in Mandalay for a diagnosis. I first saw him in Mandalay during one of my visits there, said Dr Khoo. We chatted through an interpreter. He spoke little, but I was struck by his Continued next page U Gyan (centre) with (from left) grandson Phyo Min Thant, CanHOPE counsellor Dr Daphne Thawda Myint, daughter Khin Win Swe and son U Khin Maune Aye. IN THIS ISSUE: Common cancers in the elderly PCC s database on food 癌症与压力

2 Stories of Hope Editorial team Goh Sue Lin, Vincent Tan, Woan Fei Publisher Preston Communications Printer Advance Printing No portion of this magazine may be reproduced in any language, stored in or introduced into a retrieval system, or transmitted, re-sold, redistributed, in any form or by any means without the prior written permission of the publisher. Information provided in this magazine is not intended to replace the advice of your health professional. From cover page calmness and quiet confidence. He was quite clear that living with a permanent colostomy was an option that he did not want. Dr Khoo added: He looked his age, but was physically fit and mentally sharp. I think he stands a chance of cure while getting away with a permanent colostomy. It will not be easy because he will need radiation therapy, chemotherapy. Given his age and this being his second surgery to the pelvis, the risk and degree of difficulty is also higher. Further evaluation in Singapore showed that U Gyan indeed had a locally invasive tumour in the rectum, but it did not spread to other parts of the body. In order to give him the best chance of preserving the anus, U Gyan was treated with radiotherapy, together with chemotherapy first, to achieve maximum reduction in size and extent of the tumour before the surgery was attempted. As Mandalay does not have a direct flight to Singapore, U Gyan had to make his trip to Singapore via Yangon. Despite that, he diligently made his trip down to Singapore for follow-ups and treatments. Dr Khoo said, Overall, U Gyan took to the chemotherapy and radiotherapy reasonably well. His kidney function declined somewhat during the treatment and his appetite suffered. We had to monitor him closely and make adjustments to the treatment programme in order to keep the toxicity low without compromising its efficacy. Fortunately, there was no major side effects and he completed the treatment as planned. Further evaluation showed a very good response of the tumour to radiotherapy and chemotherapy, with significant reduction in tumour activity and size. U Gyan eventually went for surgery, which was very difficult because the tumour was stuck to the surrounding tissue as a result of local invasion and the previous surgery. Dr Goh Hak Su, colorectal and general surgeon, spent nearly five hours painstakingly dissecting and removing the tumour completely. U Gyan had a temporary colostomy to allow the anastomosis at the rectum to heal. This was closed after three months and he now passes motion normally. Following which, U Gyan underwent chemotherapy for a month. When asked about his treatment at PCC, U Gyan said that he really liked and appreciated the doctors. Other than feeling warm, tired and a loss of appetite, he did not experience any other side effects. U Gyan s family daughter, son, daughter-in-law and grandson stayed with him during his treatments in Singapore. His daughter, Khin Win Swe, would prepare fruit juices with enzymes and bird s nest soup for him. Dr Khoo said, It is always a challenge to manage elderly cancer patients. On one hand, we would like to offer the treatment that offers the best outcome, be it complete removal of cancer or longer survival. On the other hand, we need to be careful not to cause severe or life-threatening side effects. A balanced approach and good judgment is necessary to select the most suitable patients for potentially lifesaving treatment. U Gyan is one such example. 84

3 希望的故事... 战胜癌症的年龄 吴健 ( 左 ) 同直肠癌打了一场仗, 他赢了 这是给年长病人最大的鼓励 几年前, 吴健第一次被诊断出患有直肠癌并在同样位于新加坡的另一家医院动了切除肿瘤的手术 过后, 院方建议他接受化疗 但因为出现恶心 疲倦和腹泻多种副作用, 他只接受了两轮化疗就中断了疗程 直到 2009 年年底直肠癌复发前, 他的健康都安然无恙, 但癌症复发却导致他的如厕习惯出现改变, 上厕所时也出现不适 这次的肿瘤体积相当大, 他在缅甸的医生认为, 要完全切除肿瘤, 吴健就得牺牲肛门 这意味着他手术后的生活都必须仰赖结肠造口 他们也认为吴健的高龄会提高手术的风险 就在这个时候, 百汇癌症中心内科肿瘤高级顾问及医务副主任邱继祥前往曼德勒为吴健诊断病情 邱医生说 : 初次在曼德勒与他会面时, 我们是通过通译员沟通的 他话不多, 但我却对他的淡定和自信留下深刻印象 他很肯定自己不原意长期带着结肠造口活下去 外表看来他就像是个 80 多岁的老人, 但他相当硬朗, 而且精神也很好 我想他无须进行人工结肠造口术也有很高的治愈机会 但这不会是项简单任务, 因为他还需要接受化疗和放射性治疗 再加上他的年事已高, 这次又是他第二次接受盆骨手术, 治疗的风险和难度也就更高了 在新加坡的进一步检查分析也显示, 吴健的直肠确实长了一颗入侵性的肿瘤, 但肿瘤并没有扩散到身体其他部位 为了确保吴健更有可能保留肛门, 医生先让他同时接受放射性治疗和化疗, 以便让肿瘤尽量缩小, 然后再动手术 由于曼德勒没有直飞新加坡的航班, 吴健必须先到仰光, 再转机到新加坡 尽管如此, 他还是勤奋地到新加坡进行复诊并接受治疗 邱医生说 : 整体来说, 化疗和放射性治疗对吴 健起了相当大的帮助, 他也可以承受这两种治疗 治疗期间, 他的肾功能稍微下跌, 胃口也变差了 我们必须严密地监督他, 并调整疗程以便把治疗药物的毒性维持在低水平 所幸, 他并没有出现任何严重副作用, 并按计划完成疗程 我们必须紧密监督他的情况并为疗程进行适当的调整, 以便在不牺牲疗效的情况下确保治疗的毒性保持在最低水平 庆幸的是, 他完成了整个疗程, 过程中没有出现严重副作用 而进一步的检验显示, 电疗和化疗对肿瘤起了不错的效果, 肿瘤变小了, 活动能力也减弱了 吴健终于进了手术室, 但这项手术是艰难的, 因为之前的手术和肿瘤的侵略让肿瘤紧紧贴住周围的组织 结肠直肠癌及普通外科医生吳學士花了将近 5 个小时的时间切割肿瘤, 才能把肿瘤完全切除 为了让肛门的切口可以有足够的时间愈合, 吴健做了个临时结肠造口 该造口在三个月之后愈合 现在他通过正常的方式排便 之后, 吴健接受了一个月的化疗 当他被问及对百汇癌症中心服务的评语时, 吴健表示非常喜欢中心的医生也非常感激他们 除了燥热 疲倦和没有胃口外, 他并没有感受到任何其他的不适 吴健在新加坡接受治疗期间, 他的女儿 儿子 媳妇和孙子都陪在他身边 他的女儿晴文瑞会为他准备带酶果汁和燕窝给他喝 邱医生说 : 医治年长病人永远都具有一定的挑战性 一方面我们希望为他们提供无论在完全割除肿瘤或延长寿命方面都有最佳疗效的治疗 但另一方面我们必须非常小心, 避免造成严重, 甚至会危害生命的副作用 要选出最适合接受可救一命手术的病人需要平衡的治疗方案, 也需要良好的判断 吴健就是一个例子 医治年长病人永远都具有一定的挑战性... 要选出最适合接受可救一命手术的病人需要平衡的治疗方案, 也需要良好的判断 吴健就是一个例子 邱继祥医生

4 Fighting Cancer The risk of cancer is higher for those above the age of 65 Older people face a higher risk of cancer. About 77 per cent of all cancers are diagnosed in people 55 years and older, and those who are past 65 years old are 10 times more likely to be hit by the disease than younger people and are also 15 times more likely to die from it. Older people not only have been exposed to environmental and dietary factors for a longer time, suffering a greater cumulative effect, but are also less able to repair cellular damages, which are potentially cancerous if not removed. Aware of the rising numbers of elderly cancer patients, the medical community is carrying out more studies on the pharmacology of chemotherapy drugs for the elderly. Common cancers that hit the elderly include breast, lung, colon and prostate cancers. Here s a look at some of them. Prostate cancer Men who are 65 or older face a high risk of getting cancer of the prostate, which is a male gland located below the urinary bladder and in front of the rectum. Growing more slowly than other cancers, prostate cancer can take as many as 10 to 30 years before Common cancers doctors can diagnose it. It can be treated with prostatectomy, a surgical procedure to remove the tumour, or brachytherapy, which is a form of radiation therapy. Symptoms Problems with urinating: frequently, difficulty holding back, weak/interrupted flow, or pain Difficulty having or sustaining an erection, or painful ejaculation Blood in urine or semen Frequent pain or stiffness in lower back, hips or upper thighs Pancreas cancer This can be difficult to diagnose, as the pancreas lies behind other organs and pancreatic cancer is usually discovered late. Treatment options include surgery, radiation therapy and chemotherapy. Symptoms Nausea, loss of appetite, weight loss Pain in upper or middle abdomen Jaundice 年长者患上的普遍癌 年长者面对较高的患癌风险 大约 77% 的癌症病人都是在 55 岁或以上才诊断出患有癌症的 超过 65 岁人患癌几率比年轻人高出 10 倍, 因此死亡的可能性则比年轻人高出 15 倍 年长者接触致癌环境和饮食因素的时间较长, 因此面对累积效应 虽然如此, 他们修复可能致癌的受损细胞的能力又较差 由于年长癌症病人的人数有上升的趋势, 医药界人士开始展开更多的研究, 希望了解化疗药物对年长者的效用如何 年长者较常患上的癌症包括乳癌 肺癌 结肠癌和前列腺癌 下面让我们认识一些癌症 前列腺癌 65 岁或以上的男性较有可能患上前列腺癌 前列腺指的是位于膀胱下方, 直肠前方的部位 前列腺癌恶化的进度比其他癌症来得慢, 医生可能在病人患上该癌症的 10 至 30 年后才能作出诊断 病人可以接受前列腺切除手术 - 一种切除肿瘤的手术程序 - 或短距离放射治疗来医治这类癌症 征状 排尿出现问题 : 频率 失禁 无力 / 不顺 疼痛 勃起困难或不持久 射精时疼痛 尿液或精液带血 背部下端 髋骨或大腿上段经常疼痛或僵硬 胰脏癌由于胰脏位于其他器官后方, 胰脏癌一般较难诊断 因此, 胰脏癌被发现时通常已经是较晚期 治疗方 式包括手术 放射性治疗及化疗 征状 恶心 胃口不佳 体重下跌 上腹或下腹疼痛 黄疸 膀胱癌患上这类癌症的人通常在 50 岁到 70 岁之间, 而在新加坡, 男性患上这类癌症的几率是女性的 5 倍 治疗包括手术 放射性治疗或化疗或三种疗程并施 征状 排尿困难 尿液出血或带有血块 排尿时疼痛或下腰疼痛 淋巴腺癌随着年龄的增长, 患上打击淋巴系统 免疫系统的一部分 的非霍奇金淋巴癌的几率就会提高 一般上, 病人只需接受化疗便能治疗淋巴癌, 但那些病情复发或面对顽强的淋巴瘤的病人可能需要接受骨髓移植手术 征状 颈项 腋下或腹股沟重大或出现无痛的淋巴结 持续的倦意 体重下降 夜汗

5 对抗癌症 in the elderly Bladder cancer This hits people especially between 50 and 70 years old, with men five times more likely to be hit than women in Singapore. Treatment options include surgery, radiation therapy or chemotherapy, or a combination of the three. Symptoms Difficulty passing urine Blood or blood clots in urine Pain during urination or in the lower back Lymphoma The risk of Non-Hodgkin s Lymphoma, which hits the lymphatic system part of the immune system rises with age. Lymphoma is usually treated with chemotherapy, but patients who have a relapse or are struck by aggressive lymphomas could be recommended to go for bone marrow transplants. Symptoms Swollen, painless lymph nodes in neck, armpits or groin Constant fatigue, weight loss Sweating at night Coughing and breathing problems, chest pains Swelling or feeling of fullness in the abdomen Liver cancer The elderly can be hit by two types of liver cancer: Primary liver cancer, which begins in the liver; or secondary liver cancer, which is the result of cancer spreading from other organs or sites. Men above 40 are more prone to primary liver cancer. Liver cancer is closely linked to chronic Hepatitis B infection. With few noticeable symptoms, Hepatitis B and liver cancer are often diagnosed only when patients donate blood or undergo health screening. Hepatitis B can be prevented through vaccination, while liver cancer can be cured if discovered early. Treatment is mainly through surgery, while advanced liver cancer can be treated through chemotherapy. New options are also emerging for patients with advanced liver cancer who may not be suitable for surgery or chemotherapy, such as percutaneous ethanol injection (where ethanol is injected through the skin directly into the liver) and radiofrequency ablation (which uses heat to destroy the cancer cells). 症 咳嗽和呼吸问题 胸口疼痛 腹部肿胀或感觉饱足 肝癌年长者可能面对两种肝癌 : 原自肝脏的原肝癌 ; 或因为其他器官或身体部位的癌细胞扩散到肝脏的次肝癌 40 岁以上的男性较有可能患上原肝癌 肝癌和慢性 B 型肝炎有着紧密的关系 由于两者所呈现的明显征状非常少, 肝癌和慢性 B 型肝炎通常要在病人捐血或接受身体检查时才会被检验出来 B 型肝炎可以通过注射疫苗防御, 而肝癌只要及早发现, 也可被治愈 肝癌的治疗通常有赖于手术, 但晚期肝癌也可通过化疗治愈 对于那些不适合接受手术或化疗的病人, 一些新的疗程现也出现, 例如把酒精直接通过皮肤注射进肝脏的 经皮酒精注射法 (percutaneous ethanol injection) 和利用热能破坏癌细胞的射频消融术 (radiofrequency ablation)

6 Serving You Can foods heal? Parkway Cancer Centre develops a database on cancer diet myths For more information, contact CanHOPE at: Cancer Counselling and Hotline: (65) enquiry@canhope.org CanHOPE is a non-profit cancer counselling service and hotline by Parkway Cancer Centre There are many stories in the media and old wives tales about anti-cancer diets which are supposed to fight the illness. Parkway Cancer Centre s dietician Fahma Sunarja and intern, Juhanis Juwasa, 19, are out to help patients understand and dispel such myths. From 3 May to 24 July, Juhanis, who studies applied food science and nutrition at the Temasek Polytechnic, aided Fahma on a database project to ascertain the effectiveness of these so-called anticancer diets. This student internship programme is part of the three-year diploma study. It aims to provide students with a hands-on working experience in their chosen industry. In return, the industry will have a helping hand in carrying out projects or work in the food science and nutrition related field. To make things simpler, Fahma narrowed down the research topics to the four main areas: 1. Dietary therapy, such as Gerson diet, macrobiotic diet, alkaline diet. 2. Oral supplements, such as glutamine, omega 3 fatty acids, prebiotics and probiotics. 3. Traditional herbs, such as turmeric and buah merah. 4. Traditional Chinese medicine. Fahma said: There are many things the interns can do. It s up to PCC to decide on the tasks they will be given, with the approval of the interns lecturers. I chose to develop a database on nutritional therapy for cancer care because with so many types of so-called diets for cancer patients, they ll be questioning to find out which diet is the most suitable for them. As for Juhanis, she has been interested in nutrition since her secondary school days. She said: I wanted to deepen my knowledge further in this area and moreover, I like to cook. On the other hand, I got to learn of a few diseases that are caused by the lack of specific nutrients. Fahma said the problem with these anticancer diets is the lack of scientific proof on their effectiveness. She said: Many of these diets are predominantly vegetarian and there is almost zero red meat in the diets. This would also mean a lack of protein and iron for the patients and should this be the case? So this project aimed to find out more about these diets. For example, the macrobiotic diet, which is used by some patients with prostate, breast and pancreatic cancers, sees them consuming organic whole grains, fruits and vegetables, as well as soups made with vegetables, seaweed and miso. It has been claimed that the macrobiotic diet helps to slow down the progression of cancer by starving the cancer cells. It is also said that the diet boosts patients morale by improving their spirits. Juhanis did the research through reading materials on the Internet, looking up medical journals and summarising all the available information. She said the main challenges were that evidencebased information regarding different cancer diets was not readily available. PCC dietician Fahma Sunarja (left) and intern Juhanis Juwasa teamed up to work on the database. She said: Some of the diets that were stated in the homepages of the respective websites, claimed that research had been done, but there was no supportive evidence to prove that. That led to more confusion. Some of the articles could not be accessed as they had to be purchased or the abstracts could not be shown due to the articles being written in foreign languages. Eventually, Juhanis chose to obtain information from journal articles and medical databases like PubMed. She found detailed descriptions of the cancer diets, their advantages and disadvantages and most importantly, scientific evidence to support whether these cancer diets have any benefits on cancer patients or vice versa. For example, there was no scientific proof that the macrobiotic diet helped to prolong the lives of cancer patients or alleviated the unpleasant side effects of radiotherapy and chemotherapy. While vitamin D offers some protection against prostate cancer, which has an inverse relationship with sunlight, there is inconsistent proof that the nutrient fights pancreatic and breast cancers. With meat and dairy products completely excluded from the macrobiotic diet, the research also showed that patients could end up being malnourished due to the lack of fats, protein, calcium, folic acid and iron. Of the findings, Fahma said: You shouldn t rely on these so-called diets to reduce the risk of cancer. They cannot substitute for a healthy, balanced diet. In fact, cancer patients must eat well during the treatment process. The database will soon be made available to doctors and nurses in Parkway Cancer Centre. Fahma said: Should patients ask about the diets, the doctors and nurses will be able to advise on the benefits of such diet or otherwise.

7 The Doctor Is In don t let her die! he pleaded with tears rolling down his eyes. He had every Please reason to be upset. They were facing a cancer, which was initially said to have a good prognosis, but somehow was not responding to treatment. Sock Cheng was first diagnosed to have malignant lymphoma (cancer of the lymph nodes) two years ago. She presented with cough with a shortness of breath on exertion. Her chest X-ray showed a huge mass overshadowing the image of her heart. After a minor surgery to confirm the diagnosis, she was started on an aggressive chemotherapy programme comprising a monoclonal antibody called rituximab with a standard cocktail of chemotherapy drugs. This treatment promised a 70 per cent chance of cure. She responded well to treatment initially, but after the fifth treatment cycle, she ran into problems. She developed a drug-induced inflammation of the lungs and treatment had to be abandoned. Her doctor attributed it to the rituximab and advised that it was too risky to continue with the antibody. As there was still remaining viable cancer, her oncologist decided to push on with a secondline chemotherapy programme minus the rituximab. U n f o r t u n a t e l y, after two cycles of chemotherapy, the cancerous lymph nodes in the chest stubbornly refused to budge. It was at this point that Sock Cheng came to see me. While she was very upset with the bad news, she was determined to fight on. I want to get married! she wept. The two of them have apparently been together since school days. Despite her illness and guarded prognosis, he still wanted to marry her. Treatment of recurrent lymphoma is often difficult. Firstly, the fact that the initial chemotherapy programme(s) did not successfully eradicate the disease, suggests that these cancer cells are not as sensitive to killing by the chemotherapy. Secondly, the cancer cells that have survived the initial onslaught by the chemotherapy have the advantage of being trained and thereby have developed mechanisms to defend themselves against the chemotherapy. Thirdly, the patients tend to be weakened by the repeated treatments and it is not unusual for patients to have impaired bone marrow function (leading to higher risks of bleeding from low platelets or infection from low white blood cell counts), kidney, lung or liver problems. In any case, Sock Cheng had no choice but to reconsider further chemotherapy. I proposed a new combination of chemotherapy drugs, which she had not been exposed to before. Although there was a risk of lung inflammation to rituximab, I strongly advised her to accept the risk and carry on with the drug. Sock Cheng experienced many of the expected side effects mouth sores with difficulty in eating, fever from infection associated with low white blood cell counts and tiredness from anaemia that needed blood transfusion. Her body took a beating but her spirit remained strong. After two cycles of chemotherapy, we were all delighted to see the lymph nodes shrink in size and diminish in activity on the PET-CT scan. We pushed on with more chemotherapy until the cancer showed no activity. Can I get married? she asked as we sat down to review her final PET-CT scans. When I smiled and nodded, tears again streamed down their faces. But, after the wedding, you must go for a stemcell transplant, I said. Although she had done well with the chemotherapy, the chances of a cure would have been no higher than 40 per cent. By hitting her with high doses of chemotherapy, the chances of success would be raised to 60 per cent. Most patients with recurrent lymphoma would need to have high-dose chemotherapy followed by stem-cell transplant. Unlike the leukaemia patients, who need to have a donor (allogeneic transplant), We want to marry A young couple fight the odds to make it down the aisle together patients with lymphoma make use of their own stem cells (autologous transplant). The rationale is rather simple. If the standard doses of chemotherapy can kill the cancer cells, and cure some patients with lymphoma, shouldn t higher doses of chemotherapy cure more patients? The main problem with the high-dose treatment is the damage to the bone marrow and sepsis associated with prolonged impairment of the immune system. By harvesting the stem cells from either the bone marrow or the peripheral blood before the high dose of chemotherapy is given, these back-up cells serve to replenish and revitalise the bone marrow after the assault by the high-dose chemotherapy. After her wedding, Sock Cheng had to go through her bone marrow transplant and radiotherapy. Despite that, she had another scare when a follow-up PET- CT scan showed activity in the residual mass. Thankfully, when the mass was surgically removed, there was only scar tissue seen with no evidence of viable cancer. Sock Cheng s story speaks of the courage and tenacity of a young lady against a ferocious cancer and how true love can firmly bind two people together despite life s adversity. Dr Ang Peng Tiam

8 医生执笔 癌症与压力 人类和动物研究都显示, 慢性压力让免疫系统变得脆弱 科学总是要求超出所需的实证 我身为医生, 一般上都会遵照实证医学来行医, 任何诊断治疗都必须有一连串反复检测 临床实验 专文学术讨论等等为基础 我从来不在没有科学实证的情况下妄下任何定论 但有一个例外 我相信精神压力足以导致癌症 尽管至今我仍然无法用科学的方法来证实这一点 多年来我一直在钻研, 希望找出癌症与精神压力的关系 过去三十年, 许多研究都在探讨患癌风险与心理因素 ( 包括精神压力 ) 之间的关系, 但始终无法得出一个结论 其中一些研究报告确实显示了某些心理因素可能提高患癌风险, 只是两者之间直接的因果关系, 至今仍无法具体厘清 自己行医 26 年了 我总觉得就算是缺乏确切的科学实证, 自己也有义务跟大家分享一些假设性观察 这些年来, 一有病人癌症复发来问诊, 我总会轻声地问, 最近生活上是不是起了什么变化 只要是愿意敞开胸怀向我倾诉的病患, 十之八九会开始谈起丈夫不忠 财务出状况 在工作上遭遇不快 或为子女成长与学习问题忧心 最近, 一位友善亲切的妇女在丈夫的陪同下来问诊 她刚被确诊患上末期胃癌 最想知道的是 : 我为什么会患上胃癌? 胃癌的导因不少, 如食物内的防腐剂 熏肉或烤肉 ( 顺便一提, 这是我的最爱 ) 内的致癌物质 或称为 幽门螺杆菌 (Helicobacter pylori) 的慢性胃炎 但我同时也向这名妇女指出, 压力也可能导致胃癌 她没说什么 光是她转身看着先生的神情, 就足以说明一切 只见她先生点了点头, 等于是同意我的说法, 他太太确实承受着不少心理压力 当然, 如此说法毫无科学根据, 但我可以理解为什么要确认压力导致癌症会这么难 说到底, 两个人可能做着同一份工作, 其中一人享受工作上的各种要求, 视之为挑战, 另一人面对相同的工作量却得苦苦挣扎 我还记得跟北京肿瘤专家孙燕教授的一段对话 孙教授曾在 1992 年到访新加坡 我问他精神压力是不是癌症导因 他毫不犹豫地答道 : 当然! 压力 当然会致癌! 他如此确切的回应让我惊讶, 于是追问他怎么得出这样的结论 孙教授谈起中国文化大革命期间, 一股新的意识形态高涨, 使人民在精神上饱受压制折腾 : 朋友家人背信弃义 思想压抑 被迫接受新的社会道德常规, 这些现象都让普通老百姓的生活起了翻天覆地的激变 孙教授说 : 那段期间我已经在执业, 医院里的癌症患者突然显著激增 我们看了好些癌症病人, 他们之间的一个共同点是, 都经历了惨烈的精神折磨 这也就是为什么我确信压力是导致癌症的其中一个因素 记得那个时候我对他的结论还有所保留 今天, 在肿瘤学领域执业二十多年之后, 我倾向于相信他这番话 那压力又是怎么致癌呢? 人类和动物研究都显示, 慢性压力让免疫系统变得脆弱 我们体内的免疫系统犹如病菌与癌细胞的监视器, 严密监视着时不时在体内神出鬼没的癌细胞 ; 一发现任何异常的细胞出没, 免疫系统就会立即把他们揪出来销毁 而一旦监视器失灵了, 癌细胞就能为所欲为任意繁衍, 进而形成恶性肿瘤 同样的道理, 爱滋病患者或刚接受了肾脏移植手术而须服食免疫制疫力药物 (immunosuppressive drugs) 的人, 因为免疫系统受损, 所以比别人更容易患癌 也有数据显示, 自怨自艾 沮丧无助的癌症患者, 因为受负面情绪困扰, 治疗效应也变得较差 虽然不是所有调查研究都发现同个现象, 但负面情绪确实助长了癌细胞的滋长与蔓延 所以, 我们该如何处理压力问题? 特别是患上癌症的病人? 一个方法是宗教信仰 ; 把生命交托给神明, 可以减轻自己肩上的担子 其他如运动 静坐 消闲活动 接受精神辅导, 或者服食抗焦虑药物, 皆有助于改善心理健康, 让身心保持愉快平和 对我来说, 有时候也会因为诊所候诊的病人太多而忙得分身乏术穷于应付 但我总是提醒自己 : 时时保持心境愉快, 好好渡过每一个日子 这个道理, 并不需要科学来证实 洪炳添医生