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Learn @ HCA Session 3 – Radiotherapy for Palliation of Cancer
29 February 2016

Everyone sat on the edge of their seats in rapt attention, listening to what the distinguished-looking gentleman had to share. On the 30th January 2016, at the HCA auditorium, we had the distinct privilege of having Dr Lee Kuo Ann with us, speaking about the importance of radiotherapy (RT) and what it can do for patients.

Dr Lee is a consultant radiation oncologist at Mount Elizabeth Novena Hospital. He obtained his medical degree in 1996 from the National University of Singapore and was awarded the HMDP fellowship to train in Clinical Oncology at the renowned Royal Marsden Hospital in London from 2001- 2003. He is a fellow of the Royal College of Radiologist (UK) and has worked as consultant Radiation Oncologist at the National Cancer Centre Singapore.

“50% of the work RT does is dedicated to palliative care which helps to relieve symptoms for advanced incurable cancer,” says Dr Lee as he presented an overview of how radiotherapy works, the techniques and machines used in treatments, and how it can help patients.

What is Radiotherapy (RT)?

RT has a history of more than 100 years. It uses ionizing radiation and the X-rays shine into the tumour, targeting only the tumour and trying to avoid and spare the normal tissue surrounding it. The X-ray is similar to visible light waves but it goes beyond being reactive to ensure survival and quality of life.

What is the difference between RT and Chemotherapy?

For Radiotherapy, X rays locate the affected area and only has effect on where it shines on.

Chemotherapy is an intake of drugs which flows through the bloodstream affecting the whole body which may result in side effects.

What is Tomotherapy?

It is an image-guided intensity modulation which establishes the precise contours for each tumour – treating only the affected part and sparing parts that are not affected by cancer cells. Tomotherapy treatment calculates the appropriate pattern, position and intensity of the radiation beam to be delivered. This increases the accuracy of the delivery as the X rays match the positioning and activate the shift which will fine-tune the process and locate the tumour position on the actual day, rather than depend solely on the skin marks taken previously.

How does the RT machine work?

The machine will perform calculations and make adjustments as it moves along the patient’s body at different angles, targeting the tumour regardless of form or shape. The Ionizing radiation will damage the DNA and kill the cells. After several days of treatment, the cancer cells are weakened and damaged as they are unable to recover as fast as the normal cells (the normal cells are able to repair their DNA damage better than the cancer cells). That is the ideal opportunity for another dose to be given, killing and getting rid of the cancer cells.

Proper care of oneself

The situation has improved tremendously compared to the past, with the development and use of more effective painkillers. The side effects depend largely on the parts of treatment. Here are some aspects of proper care to take special note of:

Hygiene and Diet

  • Practise proper hygiene because the presence of bacteria will aggravate the state of the wound.
  • Eat well! The patient will need adequate nutrition to survive through the cancer and treatment. A good proportion of calories, proteins and fats will do the job. RT produces chemicals that kill the patient’s appetite. If you are not able to eat a lot, take smaller meals frequently and drink less water. Make every little meal you eat count! Soft diet – For example, partake of food with gravy, porridge or a milkshake. If you experience nausea, have small meals or snacks with high calories frequently.


  • Avoid vitamin C tablets temporarily as it makes RT less effective.

 Dry mouth/skin

  • Drink lots of water
  • Use a saline spray
  • Chew sugar-free gum
  • Use a non-alcoholic mouth wash
  • Moisturize and avoid sunburn


  • Use hearing aids


  • Engage in regular neck and jaw-stretching exercises

Swallowing problems

  • Engage in speech therapy
  • Use thickeners in your food

Is RT more harmful to the elderly?

RT is safe even for the old. On the other hand, children are more vulnerable as they have growing cells and a lifetime for late effects to manifest; older patients do not live long enough to face the late effects.

DO NOT believe these myths!

  • “Patients are radioactive” – Do NOT worry! Patients are NOT radioactive and are safe to be around. You can freely share your food!
  • “RT causes cancer to spread, resulting in death” – NO, they DON’T! The cancer cells have already spread and RT is often administered during terminal stages. Eventually, the cancer cells will still take their natural course and the patient passes on. RT is palliative and helps to relieve pain and manage symptoms.

In conclusion, Dr Lee reiterated his position that radiotherapy is an effective and safe treatment for the cure or palliation of cancer. The side effects of RT are mild, taking into consideration how much it can help to alleviate a cancer patient’s suffering.

Once again, we would like to express our sincere thanks and appreciation to Dr Lee for an extremely informative and eye-opening talk and spending his Saturday afternoon with us.

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