Cryoablation, a promising technique to treat early stage tumours, boosts the arsenal of treatments against breast cancer.
Presented with a choice between accepting a rare invitation to the world-renowned Berklee College of Music that would lead to a career as a performance pianist, and to pursue medicine, many might find themselves in a quandary. Not Dr Jendana Chanyaputhipong, whose love for music extended in particular to Rachmaninoff pieces, which she loved for their intensity and passion. “I have always wanted to be a doctor,” says Dr Jendana simply.
The stalwart surgeon and former clinical tutor at the Yong Loo Lin School of Medicine at National University of Singapore and Duke-NUS Medical School no longer has much time to play the piano, but it is only because something else fires her spirit: her dedication to her work. Over the years, Dr Jendana has received several patient service awards and teaching awards. She says: “We are not rigid robots. We must be sensitive to the concerns and needs of individual patients, guide them and respect their choices, after they’ve been well-informed about their conditions and treatment options.” When she isn’t focused on her work as consultant breast surgeon at PanAsia Surgery Group and caring for patients, she focuses on raising her family. “They, too, need you.”
Dr Jendana, born to Taiwanese parents who immigrated to Thailand, credits her parents and the mentors she has had whose focus on excellence inspired her. She believes there is always room for discovery and change, and this has been particularly true in her speciality. In the field of breast oncology, providing increasingly effective care while minimising risks has been a galvanising force, since she entered the medical profession in 2004.
UNDERSTANDING BREAST CANCER
With the disease being the most common cancer among women in Singapore, Dr Jendana is passionate about educating women about it. She says: “The odds of survival are greatest if you catch it early.” She emphasises going for regular, age-appropriate screenings and being “breast-aware” – learning how one’s breasts look and feel like – from the age of 16.
Dispelling the misconceptions of breast cancer, she clarifies that the absence of symptoms does not mean the absence of problems. Early stage breast cancer does not usually produce visible symptoms, which is why regular screenings are so important. Another myth is that having no family history means one is protected from getting it. In reality, most people diagnosed with breast cancer have no known family history; only 5 to 10 per cent of cases are hereditary. To lower the risk, one should stay physically active and maintain a healthy weight, in addition to limiting alcohol intake, smoking, and the duration of hormonal therapy treatments.
CRYOABLATION
Currently, the mainstay for achieving local tumour control is surgery, which is either in the form of mastectomy, with or without reconstruction, or lumpectomy with radiation therapy. Now, however, there is promising, short-term data showing the usefulness of cryoablation in treating early stage breast cancer. Compared to the other forms of breast cancer surgery, cryoablation is minimally invasive, causes little discomfort (if any), and doesn’t result in deformity, says Dr Jendana.
She explains: “The mechanism of kill is different. Extreme cold is used to destroy the tumour, leaving it inside the breast for the body to remove the dead tissue via natural processes. Researchers believe that this allows the body’s immune system to recognise a certain type of cancer protein called the tumour antigen that is left behind post-cryoablation, and to become better equipped at responding to cancer recurrence or residual cancer. This is currently being studied.”
In the procedure that takes less than an hour, a cryoprobe is inserted into the tumour. Liquid nitrogen flowing into it rapidly cools the tissue around the probe at lethal temperatures below minus 60 deg C, forming an ice ball that engulfs the tumour and a rim of surrounding tissue, killing it. The wound is essentially 5mm in size, about a needle’s diameter. Cryoablation can be performed under local anaesthesia or sedation, with little downtime.
Although it is not yet among the mainstream treatments for breast cancer, the technique has been increasingly performed in a variety of clinical settings in Europe, America and Japan. In the US, this is also a well-recognised option for treating fibroadenoma – a benign lesion – without excision.
Dr Jendana cautions, though, that there are limitations. Cryoablation is neither suitable for all patients, nor all types of breast cancer. It can be performed in select cases where patients are unfit for surgery, have stable metastatic disease, or have tumours smaller than 1.5cm, which is why detecting the disease early is vital. Women should consult a doctor immediately if they detect any breast lumps, she stresses. “I want our women to know that there are effective treatments for breast cancer. Don’t let it win without a good fight, because you mean the world to so many people.”
Meanwhile, Dr Jendana is keeping a close eye on the medical literature, so as to provide comprehensive medical care for patients. “Be it your family, patients or students – you give it your all,” she says.
With expertise in surgical procedures related to breast cancer, Dr Jendana also performs cryoablation. She practises at PanAsia Surgery Group, which has clinics in Mount Elizabeth Medical Centre and Mount Elizabeth Novena Specialist Centre. To book an appointment with Dr Jendana, call 6737-8538 or 6570-2608. Visit their website at www.panasiasurg.com.
