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Advances in medicine and medical technologies have greatly improved patient management and treatment outcomes. These advances have made a major impact in the treatment of critical illnesses such as cancer and heart disease.

It is estimated that 1 in every 4 individuals in Singapore will get cancer in their lifetime. Between January 2014 and December 2018, almost 1 in 3 deaths was due to cancer, making it the leading cause of death in Singapore.

A question that many ask is: why so? The answer, Dr Ang Peng Tiam explains, lies in the fact that the chance of getting cancer is high and that cancer patients often present with advanced disease. This may be due to a variety of reasons: cancers in their early stages do not have any symptoms; symptoms shown can be non-specific, making the diagnosis of cancer easy to miss; or patients may even be in denial of their symptoms and refuse treatment out of fear.

Treating cancer

Cancer is widely perceived to be an untreatable illness and is often likened to a death sentence. However, this is not so. Over the last 30 years, advances in cancer research have led to better understanding of the disease at the molecular level, discovery of new treatments, and improvements in medical technology. Examples include the use of the PET-CT scan to accurately determine the extent of cancer spread, if any. Improved techniques in pathology have also allowed for more specific subtyping of cancers at the molecular level.

These advances have led to new and innovative ways to manage cancer.

The new era of targeted agents offers novel and more effective treatment options for some cancers. Lung cancer patients who are found to have actionable mutations (e.g. EGFR, ALK, ROS-1) often do not need to undergo traditional chemotherapy. These patients can simply take daily pills that are targeted against that particular genetic abnormality in the cancer cells. These treatments are superior to chemotherapy because they are more effective, have lesser side effects, and can remain effective for longer periods of time.

There is also much interest in the use of immunotherapy in cancer treatment. Immunotherapy involves harnessing the body’s own immune system to attack and kill the cancer cells.

Targeted agents and immunotherapy can be used on its own or in combination with surgery, radiation therapy and chemotherapy to offer patients better results and higher quality of life.

Second cancers

Many think cancer is a one-time event, shares Dr Ang. However, there are patients who develop a second cancer, that is, a new or additional cancer that is different from the original cancer.

This may be attributed to a rising incidence of cancer, improved survival of cancer patients (where patients live long enough and get a chance of developing a second cancer), or cancer arising from treatment side effects.

A second cancer can occur at the same time as the original cancer, or at a different time. Various studies have reported a 2–17% likelihood of getting multiple primary cancers.

However, getting cancer or a second cancer is not the only critical illness we should be concerned about and plan for; other critical illnesses such as heart disease and stroke are even more common in our society, and thus it is important that we take strides to take care of our health.

Understanding heart disease

Heart disease is the single most common cause of death worldwide. There are different types of heart disease: heart failure, coronary artery disease, heart attack, valvular heart disease, and cardiac arrhythmias. The most common form of heart disease is coronary artery disease, which accounts for about 80% of all heart disease-related deaths.

According to Dr Stanley Chia, coronary artery disease is usually caused by atherosclerosis: the narrowing of arteries supplying the heart muscle due to a buildup of cholesterol deposits (or plaques) within the walls of the coronary arteries. Coronary artery disease is often clinically silent initially. However, the cholesterol plague may become progressively obstructive over time or suddenly rupture, causing catastrophic occlusion. When that happens, patients may present with stable angina, heart failure, heart attack or even sudden cardiac death.

In Singapore, the incidence of heart attack is increasing with a crude incidence rate of 321 per 100,000 of the population. While the average age of presentation is 69 years, a significant proportion of individuals do suffer from heart attacks at a younger age. 90% of heart attacks are associated with risk factors such as smoking, diabetes, high cholesterol, abdominal obesity and hypertension, which is why preventative health is key to reducing incidence of heart disease.

Treating heart disease

Advances in medical treatment have led to better clinical outcomes, improved quality of life and longevity for heart disease patients. One of the common treatments for heart disease is coronary angioplasty (ballooning) with stenting, a procedure performed under local anesthetic to unblock the coronary lesions and restore blood flow to the heart muscles. In patients with more severe disease and multiple coronary blockages, they may have to consider undergoing coronary artery bypass grafting surgery to fully treat the disease.

Like cancer, heart attacks are not a one-off event, and relapses do unfortunately happen, as coronary atherosclerosis is a progressive disease. Therefore, heart disease is one of the most common critical illnesses we have to confront.