FAQ for patient

What is Cancer?
  • Cancer is a disease of the cells characterized by uncontrolled growth of abnormal cells.
  • Under normal circumstances, the cells in our bodies replicate in an orderly manner under the control of a set of genes.
  • When the genes become mutated, our body’s control mechanism stops working and lead to abnormal cell growth.
  • These extra cells may lead to formation of lumps or masses of tissue known as tumour. Some cancer, such as leukaemia (blood cancer which is characterized by abnormal cell division in the blood stream), do not form tumours.
  • Cancer can occur at any place in the body
  • Cancer can sometimes spread to other parts of the body (a process known as metastasis) where it can grow and form secondary tumour in the newly affected site.
How does Cancer occur?
  • Normally, the cells in our bodies replicate in an orderly manner to make sure that new cells are produced to replace old and damaged cells.
  • When a cell is dividing, changes in the genes (known as mutation) can happen.
  • Usually, cells can detect and repair the changes or undergo self-destruction or destroy by the immune system.
  • However, when the mutations occur in important genes, especially in genes involved with cell division or genes that regulate defective cell to die, the cell no longer understands its instructions and starts to multiply out of control.
  • It usually takes multiple mutations before a normal cell turns into a cancer cell.
  • Cancer can occur in anyone at any age but the risk increases with age. The exact cause of cancer is not fully understood but certain risk factors that can increase the risk of a person getting cancer have been identified.
  • Genetic changes that cause cancer can be
    1. inherited from our parents or
    2. acquired during a person’s lifetime due to unhealthy lifestyle and diet or due to exposure to certain environmental factors. Long term exposure to substances (such as chemicals in tobacco smoke) or radiation (such as UV light from the sun) may damage the DNA and increase a person risk of getting cancer.
How is Cancer treated?

According to World Health Organisation, the primary goal of a correct cancer diagnosis and effective treatment is to cure cancer or to considerably prolong the life of cancer patients, and also to improve the quality of their life. The major types of cancer treatment are:

Surgery
  • Surgery is a procedure where a tumour is directly removed (either partially or completely)
Chemotherapy
  • Chemotherapy is a type of treatment that uses chemicals or drugs to kill cancer cells or slow down their growth
Radiation Therapy
  • Radiation therapy is a type of treatment that uses high doses of radiation to kill cancer cells and shrink tumours
Targeted Therapy
  • Targeted therapy treats cancer by targeting specific genes or proteins in cancer cells that help them grow, divide and spread
Immunotherapy
  • Immunotherapy is a treatment that boosts the ability of our body’s immune system to fight cancer
Stem Cell Transplant
  • Stem cell transplant is a treatment that uses healthy blood-forming stem cells to treat cancers affecting the blood or immune system or to restore stem cells for cancer patients who received high doses of chemotherapy and/ or radiation therapy.

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What treatment is best for me?
  • The types of treatment that you receive will depend on the type of cancer, the stage of the cancer (whether the cancer has spread) and also your general health.
  • The same cancer type in one individual is different from the cancer in another individual and so do the treatments they will be receiving.
  • Some people will only need one treatment but most people will need a combination of treatments.
What is Precision Medicine?
  • Precision medicine, or also known as personalized medicine, is an approach that helps the doctors to understand a person’s genetic makeup and select the suitable treatments that may be more effective for the patients.
  • Before precision medicine, when you are diagnosed with cancer, you usually will receive the same treatment as others with the same type and stage of cancer. However, it has been noted that certain treatments worked better for some people while ineffective in others.
  • Researchers have discovered that different responses of patients to the same treatment is due to the genetic differences in them that cause cancer to grow and spread.
How can Cancer Profiling help in my cancer treatment?
  • Cancer profiling is able to help the doctors to understand the genetic mutations that cause your cancer and decide a more effective treatment plan that targets these mutations.
  • The genetic profiling report will not only list the available drugs that are effective against these mutations but also drugs that are not likely to work on you.
  • Cancer profiling can also help to identify the presence of new mutations through continuous monitoring for genetic changes during and after treatment. The occurrence of these new mutations may indicate resistance to the previous treatment, and in these cases, another drug that targets this new mutation can be used for cancer control.
What are targeted cancer therapies?
  • Targeted cancer therapies are drugs approved by the FDA that have been proven to be effective against cancer with specific genetic mutations.
  • Targeted therapies generally have fewer side effects as compared to conventional chemotherapy.
  • If there is a targeted drug or treatment approved for your cancer type, you can be tested to see whether the genetic mutation targeted by the drug is present in your cancer.
  • If there is no approved targeted drug or treatment for your cancer type, you may still be tested for genetic mutation to see whether you are eligible for drug clinical trial of targeted therapy.
Who should be tested for BRCA1 and BRCA2 mutations?
WOMEN
  • Breast cancer diagnosed at age 50 or younger
  • Ovarian cancer at any age
  • Both breast and ovarian cancer
  • Uterine cancer diagnosed <50 years of age or with abnormal microsatellite instability
  • Multiple primary cancers in one person (e.g. uterine and breast or thyroid cancer)
  • Triple-negative (hormone-receptor negative and HER2/neu negative) breast cancer
  • Pancreatic cancer with breast or ovarian cancer in the same individual or on the same side of the family
  • Multiple close family members with breast or ovarian cancer
MEN
  • Has breast cancer at any age
  • Pancreatic cancer or prostate cancer at any age
  • Two or more family members with breast, ovarian, pancreatic, and/or prostate cancer at any age
Can I do the test if I have already received chemotherapy treatment?
Yes, you can still be tested after received chemotherapy treatment. Oncode tests can help to identify the presence of new mutations through continuous monitoring during and after treatment.
References
1) Cancer Research UK. Available at https://www.cancerresearchuk.org/
2) My Cancer Genome. Available at https://www.mycancergenome.org/
3) National Cancer Institute (NCI). Available at https://www.cancer.gov