Signature Cancer Clinics

Asian Alliance Radiation & Oncology has a dedicated clinic in utilising Stereotactic Body Radiation Therapy (SBRT) to treat Liver Metastases. Liver Metastases are tumours or cancers which have spread to the liver from other parts of the body. Click here to find out more about AARO’s Liver Metastases clinic.

The oligo-metastatic state is one whereby the tumor has already spread beyond the primary site of the cancer, but is limited to only a few sites, usually less than 5. This means that there is an intermediate state between localised cancer, and full-blown stage 4 cancer which invariably leads to death. Aggressive treatment of these sites with the use of ablative radiation therapy, surgery and chemotherapy may possibly lead to a cure for the patient.

This is significant for the treatment of cancer as patients with limited numbers of metastasis who were previously thought to be incurable by some clinicians might be cured with cancer treatments such as radiotherapy.

While it is still not possible to determine which of these patients may be totally cured, the specialised multi-disciplinary management of the oligometastatic patient utilising minimally invasive techniques such as stereotactic body radiation therapy and other ablative methods in conjunction with carefully selected systemic therapy will ensure that patients get the best chance with least side effects when doing so.

Stereotactic Body Radiation Therapy (SBRT) is a safe and effective treatment option for prostate cancers. Asian Alliance Radiation & Oncology dedicated Prostate SBRT Clinic utilizes best practice, evidence-based approaches in treating prostate cancer. Click here to find out more about AARO’s Prostate SBRT clinic.

Patients with spinal metastases generally face several critical needs:

1) Pain control from the tumor invading into the spinal vertebral
2) Stability of the skeletal structure after the tumor had weakened the bony structure
3) Preservation of neurological function as the tumor often sits within small distances to the spinal cord and the spinal nerves.

Cord compression occurs when the tumor invades into the spinal canal and encroaches onto the spinal cord, leading to symptoms such as limb weakness or bladder and bowel disturbance. New advances in treatment strategies allow us to combine the expertise of each field to achieve the best results: Durable pain control, Durable tumor control, Spinal stability and Neurological Preservation.

Depending on the extent of the tumor, various modalities can be combined such as the use of spinal instrumentation to stabilise the spine; using minimally-invasive techniques, followed by radiosurgery ablation of the tumor. Such an approach allows the surgeon to minimize exposure and reduce the risk of operation and yet achieves tumor ablation through the use of stereotactic radiosurgery. Our specialists are all trained and experienced in the latest developments in these fields which have only emerged over the past decade.

More than half of patients with advanced cancer experience pain. Cancer pain affects quality of life and therefore pain management is essential. There is also evidence that improving symptom control can help advanced cancer patients live longer.

AARO doctors are oncology-trained and able to provide first-line management of cancer pain. They will:

1. Assess your pain
2. Manage it accordingly with medications, and radiotherapy if indicated
3. Co-ordinate with other specialists as appropriate for specialized pain management procedures or treatment of the underlying cause

Some Frequently Asked Questions (FAQs) about cancer pain management

How will my pain be assessed?

You will first undergo a comprehensive pain assessment where your doctor will talk to you and understand the pain you are experiencing. If necessary, further investigations will be done to identify the cause of the pain. He will also look at your current pain management plan, and how well you are responding to it. Your family and caregivers will also be engaged to optimize your support system. Goals and expectations of pain management will be discussed before a plan is formulated.

What can be done to get on top of cancer pain initially?

Pain medications are the typical first measures to control cancer pain. Your doctor will prescribe the type of pain medication suitable for the severity of the pain, and schedule review appointments to adjust the medications until you are comfortable. During this time, you might be asked to keep a pain medication diary, which will help to determine how well the medications are working.

While opioid medications like morphine are among the most effective medications for moderate to severe cancer pain, patients are hesitant to start them for fear of side effects like constipation and drowsiness, or of addiction and dependence. Your doctor is trained to anticipate, prevent and manage these side effects. Some associate morphine use with the end stages of cancer and dying, however, use under professional supervision can benefit patients at many points of the cancer journey. By balancing the pain relief and alertness levels, patients can maintain independence and a reasonable quality of life.

Besides standard pain medications, there are also complementary medications that help with particular types of pain, like nerve pain which is often shooting or burning in character. Anticonvulsants and antidepressants have been shown to be useful in such situations, and may allow reduction in opioid medication usage.

How can radiotherapy help with cancer pain?

Bone metastases (spread of cancer to the bone) is a common cause of cancer pain, and are particularly common in patients with advanced breast, lung and prostate cancers. Radiotherapy to affected bones has been shown to be effective, with 60-80% of patients reporting pain improvement after radiotherapy. With improvement in pain from radiotherapy comes other benefits like improved mood, less insomnia, less constipation and better quality of life.
Radiotherapy for bone pain can be given in a single or multiple (usually 5 or 10) sessions, depending on the patient’s overall condition. Studies also show that if radiotherapy is given when pain is moderate, there is a higher chance of the pain completely going away than if the pain was severe at the start of treatment. Therefore, early assessment of bone pain by a radiation oncologist will be helpful in determining the right time to use radiotherapy.

Tumour masses can press on or invade nerves and cause nerve pain. They can also stretch or irritate the normal tissues around it. Radiotherapy can be used to target these tumour masses and shrink them, thus relieving the pressure on the nerves or normal tissues, and reducing pain.

Are there specific drugs that can help with bone pain caused by cancer?

The weakening of bones affected by cancer can result in bone pain. There are drugs that can prevent or slow down this weakening. These include Denosumab which is injected just under the skin every four weeks, or Zometa which is injected through a vein every 4 or 12 weeks. These drugs also reduce complications of bone metastases like fracture, compression of the spinal cord and high blood calcium levels.

What are the other measures available for persistent or hard to treat cancer pain?

If opioid medications or non-invasive measures like radiation therapy do not improve pain sufficiently, various interventional techniques can help, depending on the specific pain condition. Interventional techniques usually involve injections but are less invasive than open surgery. These should be performed by specialists in the technique.

A backbone that has been weakened by cancer can fracture and become flatter. This leads to instability that gives rise to severe back pain. In some cases, there are techniques to restore the height of the backbone and improve stability, without going through open surgery. One way is to inject bone cement into the backbone (vertebroplasty). Sometimes, a special balloon is introduced into the backbone via a needle and inflated to restore its height, before filling the space created with bone cement (kyphoplasty). Both are done under x-ray guidance by a specialist in the technique.

Tumours can press on or surround nerves and cause neuropathic pain. These nerves give off pain signals that can difficult to manage with just conservative measure. Nerve blocks can be done to give relief. This involves injection of local anaesthesia to the affected nerve or nerve network. For particularly persistent pain the affected nerve networks are injected with substances that destroy them. One classic example of this is in pancreatic cancer whereby the tumour invades the nearby celiac nerve plexus. A celiac axis block is usually a safe and effective way to alleviate the pain.

In Summary

Patients with advanced cancers often experience cancer pain that can be overwhelming. Fortunately, there are a wide range of methods to overcome this pain and its disabling effects on their daily lives. It can range from something as simple as understanding the pain process and prescribing the right painkillers to undergoing an appropriate interventional procedure.

Oncologists are trained to be first-line responders for patients with cancer pain, and to assess which cancer treatment method can give patients the most benefit for their symptoms, be it chemotherapy,radiotherapy or an interventional procedure. They can also co-ordinate referrals to the relevant specialists for hard to treat, persistent pain. Having your oncologist coordinate all efforts for cancer treatment and pain control at the same time will benefit patients by ensuring the optimal sequencing of all therapies as well as reducing unnecessary consultations and treatments. For a comprehensive pain assessment at AARO, kindly send us an enquiry or contact us at the provided hotline number.

What is Lung Stereotactic Ablative Radiosurgery?

Lung Stereotactic Ablative Radiosurgery (SABR) is a non-invasive, highly targeted form of radiation treatment that is recommended in international cancer guidelines as an alternative to surgery in early stage lung cancers for selected patient groups.

* The NCCN guidelines on NSCLC is written by 30 leading cancer centres in the U.S and is regarded as the gold standard internationally

SABR works by using technologically advanced machines to deliver extremely focused beams carrying high doses of radiation directly to the tumour to destroy it.  With SABR, an entire treatment course can be completed in three to five outpatient sessions over two weeks, with no surgical or anaesthetic risk. Read more

Wounds and Wellness Clinic

Our Radiation side Effects and Complications OVERcome (RECOVER@AARO) Clinic is set up to provide a holistic approach in managing your cancer as well as minimizing your side effects.

Click here to find out more.

Rehab & Diet Clinic

Theranostics is derived from a combination of the words “Therapy” and “Diagnostics”. These personalised nuclear medicine technologies are able to simultaneously or sequentially diagnose and treat cancer. Theranostics@AARO is a specialized clinic harnessing the capabilities of Theranostics in delivering cutting edge cancer treatment.

We have made it possible to have cancer treatment safe and fast with our highly coordinated one-stop virtual cancer centre, all from the comfort of your home as consultations will be conducted through video conference.

Visit our Virtual Oncology Clinic now.