It was a quiet balmy evening as I walked across the compound to visit my parents for a chit-chat. Dad sat next to me as we discussed the economic crisis. As we talked, I glanced at his nose and, to my horror, staring back at me was cancer.
In my shock, I exclaimed aloud: 'Dad, you have cancer on your nose!"
You can imagine the fright he must have had. I quickly recovered my bedside manners and assured him in my professional tone that it was an early cancer and curable with surgery alone.
Still, it was a bolt out of the blue for me. After all, we have a family dinner together every Sunday. Why didn't I notice it earlier? With my parents, siblings and children at one sitting, the table has to be quite big to hold all of us. I always sat across the table from Dad so I never got to look closely at him.
Under my very nose, growing on his nose was a raised pigmented lesion, which is called a basal cell carcinoma. It is a cancer with the ability to invade locally and, given time, can literally 'eat up' the nose. However, this cancer has a low propensity to spread (the risk of metastases is estimated at 0.1per cent). The only treatment is surgery.
Once it is completely cut out, the patient is cured.
I immediately called up my friend, Harry, who is a plastic surgeon, to set up an appointment for my dad to see him the next day at 9am. I also called one of my breakfast 'kakis", a dermatologist called Wai Kee, to ask him to be there to make sure that he concurred with my diagnosis.
Wai Kee belongs to our breakfast group. Every morning, when we finish our ward rounds, a few of us would gather for coffee, solve most of the non-medical problems confronting the world (economic crises, overpopulation, shortage of kidneys) before heading to our clinics to see patients.
We've named our club 'car big cannon', in Cantonese 'chair dai pao", which means to pull a fast one.
Wai Kee and Harry saw my dad and agreed that this was indeed cancer that had to be removed. They rounded up an anaesthetist and alerted the pathologist to be on stand-by. The next day, Harry carried out the surgery in his clinic, made sure that all the margins were clear and happily declared to my dad that he was cured.
My mum was impressed and very grateful to all of them. This is what I proudly call 'multi-disciplinary patient-centric care'.
All the specialists working together to ensure the best possible outcome for the cancer patient.
As it turned out, my parents and his friends had noticed this growth for several months. They assumed that it was one of those age spots that old men get. After all, Dad is hale and hearty, despite his 83 years.
As I leave home at 6.30am every day, I see Dad already doing his morning exercises in the garden. I am glad that everything turned out well - largely due to the fact that we caught the cancer early.
What is disconcerting is that despite our public education efforts on early detection of cancer, many people remain ignorant. Ever since I was a medical student helping out with the Singapore Cancer Society in the 1970s, such efforts have kept on highlighting the eight warning symptoms and signs of cancer.
Despite our efforts, I doubt if most readers can recall four, let alone all the eight symptoms and signs.
It is time for us to re-look how we can be more effective in our public education efforts.
Let's face it. Another campaign will not do the job. If we truly believe that cancer is a serious problem (and it is), we have to bring this message to schoolchildren. Let's teach them when they are still young and eager to learn.
Through them, we can reach out to their parents and grandparents, uncles and aunts.
So, besides talking about the birds and the bees, basic knowledge about cancer should be included as part of essential health education.
Dr Ang Peng Tiam angpt@parkwaycancercentre.com
-Dr Ang, the medical director of Parkway Cancer Centre, has been treating cancer patients for nearly 20 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.
This story was first published in Mind Your Body, The Straits Times on Nov 6, 2008.
