Wednesday, June 17, 2009

STI: The news that shook her world

June 18, 2009

The news that shook her world

When technopreneur Grace Cheng's biopsy results on a lump in her neck revealed she had thyroid cancer, her perfect world turned upside down. POON CHIAN HUI reports

Ms Grace Cheng's world turned upside down in January when she found out that she had thyroid cancer. The 28-year-old technopreneur and first-time book author who founded, a financial news and opinions website, discovered a lump on the right side of her neck last November.

Then, she had just returned to Singapore after a year-long trip around the world with her husband, Mr Pedro Pla, 27, an IT consultant.

'I thought that it might be a swollen lymph node,' said Ms Cheng, who is also a forex trader. 'I was feeling energetic from the trip and completely normal; there were no signs to suggest that there was a problem with my health.'

As the lump was painless, she did not think too much about it. However, it grew bigger over the next month and she decided to consult a general practitioner (GP) in January.

What followed was a whirlwind two weeks. On her GP's instructions, she went to a radiology clinic for an ultrasound scan. She returned to the GP a few days later with the results of the scan and was promptly referred to Raffles Hospital.

The following day, she had a biopsy done at the hospital. Two days later, the results were out - she had papillary thyroid cancer.

Papillary tumours are the most common type of thyroid cancer. This cancer typically affects people between 20 and 50 years old and occurs more in females than males.

'I was devastated to hear that I had cancer,' she said. The shock was even more acute considering that she had everything going for her at that time.

'My website was less than a year old, my book on forex trading was selling well on the Amazon website and my husband and I were putting finishing touches to our new condominium home,' she said.

'I couldn't help thinking that I was just buying lights the week before without knowing about the poison inside of me.'

Mr Pla, who was there with his wife when the doctor broke the news, was equally taken aback.

'It was a big shock that she had cancer at her age,' said Mr Pla, who is Spanish. 'Plus, she has always been very conscious of her health.'

Ms Cheng, who confesses to be a hypochrondriac, has had annual medical check-ups since her early 20s.

During the anxious two-day wait for her test results, she researched thyroid cancer thoroughly in a bid to banish the rising uncertainty.

'The uncertainty created havoc in me; I couldn't sleep,' she said. 'I felt strangely relieved when I got the results. Although it confirmed that something was wrong with me, at least I knew what it was.'

The good news was that papillary thyroid cancer can be treated by surgically removing the thyroid gland.

Although she spent Chinese New Year in hospital for the surgery, she was glad to be rid of the cancer.

Because her entire thyroid gland was removed, she will have to take hormone pills for the rest of her life. She also requires two sessions of radioactive iodine treatment to erase any remnants of cancer cells.

The first round was in March and the second will be in September. That is a small inconvenience for overcoming the disease. The experience has given her a renewed zest for life.

'It has made me more determined to be happy and not to sweat the small stuff,' said

Ms Cheng, who is already looking forward to building her business and travelling abroad once more.


Thyroid cancer refers to tumours that sprout in the thyroid gland, a butterfly-shaped structure that sits at the base of the neck.

In Singapore, about eight in 100,000 people get thyroid cancer a year. There are four types - papillary, follicular, medullary and anaplastic.

The most common and treatable form is papillary cancer, which makes up about 85 per cent of all thyroid cancers. Only 1 to 2 per cent of sufferers die from it as the cancer grows very slowly, said Dr Loh Keh Chuan, a consultant endocrinologist and physician at Mount Elizabeth Hospital.

Another reason is that papillary cancer does not spread easily, said Dr Stanley Liew, an endocrinologist at Raffles Hospital.

Follicular thyroid cancer is the next most common form, followed by the medullary form, which is rare.

Dr Loh estimates that fewer than 20 people in Singapore have medullary thyroid cancer.

Meanwhile, anaplastic thyroid cancer is also a rare and deadly form. Sufferers usually die within two years because of the quick spread of cancer cells to other parts of the body, said Dr Loh.

The main problem is that the majority of thyroid cancer tumours are painless and symptom-free.

'I had a patient who had a lump growing in her neck for more than 10 years before she sought medical help,' he said.

Other than a visible lump, sufferers may also experience symptoms like hoarseness of voice, difficulty in swallowing and pressure in the neck, said Dr Liew.

While thyroid cancer can hit people at any age - Dr Loh's youngest patient is nine years old - it most commonly affects adults who are 25 to 50 years old.

Females are also three times more likely to get it, said Dr Liew. Thyroid cancer is the 10th most common cancer in women in Singapore, representing 2.8 per cent of all cancers.

Previous exposure to radiation, such as external radiotherapy around the neck, is known to increase the risk of getting this disease.

A biopsy is the only way to diagnose thyroid cancer. This is a process where a sample of cells is extracted and analysed under a microscope for any abnormalities.

Treatment involves surgery - usually done a few days after diagnosis - to remove the thyroid gland, followed by radioactive iodine treatment four to six weeks later to eliminate any residual cancer cells, he said.

The person will also have to take a thyroid hormone pill for life.

Radioactive iodine treatment is exclusive to thyroid problems. This is because only thyroid cells will absorb iodine. Hence, patients do not suffer hair loss and side effects that are associated with chemotherapy for other cancers, said Dr Loh.

Age heavily influences one's chances of recovery. Patients above 45 years old tend to fare worse, he said.

The key is not to hesitate to get help quickly if a lump emerges.

'As thyroid cancer is mostly curable, see a doctor immediately if you notice a lump. Don't wait until it gets worse,' said Dr Loh, adding that complications may develop with time.

For example, a relatively tame papillary form may progress to a more aggressive anaplastic tumour.

People who have survived thyroid cancer should not become negligent either, as up to 20 per cent may suffer a recurrence of the disease in their lifetime, said Dr Loh.

One can learn how to perform a simple neck check at home from the American Association of Clinical Endocrinologists' website,

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