At Sunway Medical Centre, we use a variety of tests and procedures to diagnose cancer. The types of tests depends on your age, the type and stage of your disease and the results of previous tests. Patients may need to undergo one or a series of tests (investigations) to determine the right treatment.
Computed tomography (CT) Scan
CT is a diagnostic imaging test used to create detailed images of internal organs, bones, soft tissue and blood vessels. The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images. CT scanning is often the best method for detecting many different cancers since the images allow your doctor to confirm the presence of a tumor and determine its size and location. It can monitor changes in tumor size and assess patient response to cancer therapy as well.
General X-ray uses low dose x-rays to produce pictures of the body's internal structures. X-rays are the oldest and most frequently used form of medical imaging. An X-ray may detect a tumor in an organ such as the lung, and diagnosed fractured bones, look for injury or infection and to locate foreign objects in soft tissue.
Magnetic resonance imaging (MRIScan MRI) is non-invasive test that uses a powerful magnetic field, radio waves and a computer to obtain cross-sectional images of organs, soft tissues, bone and virtually all other internal body structures. It is used to evaluate for a variety of conditions, including tumor.
Digital Mammography is a specific type of breast imaging that uses low-dose x-rays to detect cancer early—before women experience symptoms.
Ultrasound is a non-invasive method of obtaining images of organs and tissues of the body using high frequency sound waves. It is also very useful to provide imaging guidance to needle biopsies or to see and evaluate conditions related to blood flow.
A fluoroscopy is an imaging procedure in which a continuous, real-time X-ray image is projected onto a monitor. Fluoroscopy is used to examine the gastrointestinal tract if a gastrointestinal cancer is suspected, and guide the placement of a PICC (peripherally inserted central catheter) for chemotherapy.
PET/CT (Positron Emission Tomography/Computed Tomography)
PET/CT is a powerful imaging technique that combines both CT scan and PET scan using radioactive sugar (FDG – 18F-fluorodeoxyglucose) as the tracer. It provides comprehensive information on the abnormal activity and function of cells (obtained by PET) as well as the precise location of these abnormalities in the body (obtained by CT). This leads to more accurate assessment of your current medical condition especially cancer and infective/ inflammatory disease.
Combining two imaging technologies- Gamma Camera which shows biological functions in the body, and Computed Tomography (CT), which shows detailed anatomical structures. It is useful for evaluating blood flow, gastrointestinal function, immune activity, thyroid function, tumors, cardiac function and more. SPECT/CT allows your doctor to see how your organs function and to detect and monitor the activity of disease.
Chemical pathology and immunology
We provide both routine and specialised chemistry testing such as those on lipid, liver, kidney function, tumour and cardiac markers, metabolic and hormones.
Tests include but are not limited to blood count, blood film, bone marrow and trephine biopsy, coagulation, blood grouping and antibody screening.
Anatomic Pathology and Cytopathology
We offer routine and complex specimen testing with both basic and Immunohistochemistry stains. Frozen section and second opinion services are also available. Cytopathology tests include liquid based cytology, pap smears, Fine Needle Aspiration Cytology, and fluid cytology.
There are many types of cancer treatment. Your treatment depends on the type of cancer you have and how advanced it is and your general health.
There are different types of treatment you might have. Some people will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. Understanding your treatment and the side effects can help you to cope.
Surgery removes a small piece of tissue from the abnormal area which is called a biopsy. The tissue send for pathological investigation to show what type of cancer it is and how slowly or quickly it may grow.
Remove Entire Tumor
Surgery removes localised cancer that is contained in one area. It may also be used along with chemotherapy or radiation therapy, before or after the surgery.
Surgery removes some, but not all, of a cancer tumor. Debulking is used when removing an entire tumor might damage an organ or the body. It remove as much as possible of the tumor and follow by chemotherapy or radiation therapy.
Palliative surgery is used to relieve side effects caused by a tumor in an individual with incurable illness and improve the quality of life while lengthen their lifespan. Read more about Palliative care here (link to Palliative tab)
Varian TrueBeam STx
The Varian TrueBeam™ STx Linac is a revolutionary innovation in cancer treatment. It expands radiotherapy treatment options for even the most challenging cancer cases in the lung, breast, head and neck, abdomen, liver and other regions.
The system uses sophisticated 3D imaging to target and treat tumours of all shapes, sizes and locations with pinpoint accuracy. Images can be generated using 25% less X-ray dose. These images are used to fine-tune a patient’s position prior to and during the treatment process.
The precision of the system is measured in increments of less than a millimetre. This accuracy is made possible by the system’s sophisticated architecture, which synchronizes imaging, patient positioning, motion management, beam shaping and dose delivery. The system performs accuracy checks every ten milliseconds throughout the entire treatment.
It offers the following therapy options:
a. 3D conformal radiation therapy
Three-dimensional conformal Radiation Therapy uses CT simulator to create three-dimensional maps of a tumor and the surrounding tissue which helps oncologists uses the targeting information to focus precisely on the tumor, while avoiding the healthy surrounding tissue.
b. Intensity-modulated radiation therapy (IMRT)
IMRT is an advanced mode of high-precision radiotherapy that uses computer-controlled linear accelerators to deliver precise high radiation doses to a malignant tumor or specific areas within the tumor while minimizing the dose to surrounding normal critical structures. IMRT allows for the radiation dose to conform more precisely to the three-dimensional (3-D) shape of the tumor by modulating—or controlling—the intensity of the radiation beam in multiple small volumes.
c. Volumetric modulated radiation therapy (VMAT)
Volumetric Arc Therapy (VMAT) is an advanced form of IMRT that delivers a precisely-sculpted 3D dose distribution with a 360-degree rotation of the gantry in a single or multi-arc treatment. VMAT can deliver the dose to the entire tumor in a 360-degree rotation, typically in less than two minutes. It uses special software and an advanced linear accelerator to deliver IMRT treatments up to eight times faster than what was previously possible. The algorithm ensures treatment precision, helping to spare surrounding healthy tissue.
d. Image-guided radiation therapy (IGRT)
IGRT is the use of frequent imaging during a course of radiation therapy for the purpose of improving the precision and accuracy of the delivery of treatment. It is used to treat tumors in areas of the body that move, such as the lungs.
e. Stereotactic radiosurgery (SRS)
SRS is a non-surgical radiation therapy used to treat functional abnormalities and small tumors of the brain. It can deliver precisely-targeted radiation in fewer high-dose treatments than traditional therapy, which can help preserve healthy tissue.
f. Stereotactic Body radiation therapy (SBRT)
SBRT is a non-surgical radiation therapy used to treat tumors on the body. It can deliver precisely-targeted radiation in fewer high-dose treatments than traditional therapy, which can help preserve healthy tissue.
High Dose Rate Brachytherapy (HDR)
High dose rate brachytherapy allows clinical oncologists to deliver the radiation quickly during an outpatient procedure. In HDR, applicators are placed in or adjacent to the cancer tissue after which a computer driven apparatus, called a remote after loading device, transfers the radiation source through the catheters to the tumor site. The source remains in place for a predetermined amount of time. When the desired dose has been achieved, the remote afterloading device withdraws the radioactive source.
INTRABEAM Intraoperative Radiation Therapy (IORT)
This innovative therapy is administered at the time of surgery (lumpectomy or colorectal surgery), following cancer removal. INTRABEAM IORT is delivered using a miniaturised radiation device which is inserted into the tumour bed. Therapeutic radiation is then directed immediately and precisely right where it is needed most – the location where the cancer was removed. Localising the radiation on the tumour bed is effective because studies show that this is where cancer is most likely to recur.
The Gamma Knife is not a conventional surgical knife in the traditional sense. In fact, there are no knives or scalpels involved, no incisions made. This “knife” refers to an array of 192 precise beams of gamma radiation that produces a powerful dose of concentrated radiation when converged at the treatment site. It targets tumours and abnormalities, stunting their growth and shrinking them over time while sparing the surrounding healthy brain tissues. This advanced radiation technique provides an outpatient treatment option to patients suffering from brain conditions that typically requires surgery, an alternative method for a number of conditions whereby an open neurosurgery may be highly risky or not practicable. It can be used to treat a number of neurological disorders including brain metastases, arteriovenous malformations, facial nerve pain (trigeminal neuralgia), meningioma, acoustic neuromas, gliomas and pituitary tumours.
Lo Dose Radioisotope Therapy
Radioisotope therapy delivers radiation directly into the cancer cells. You are given the radioisotope or radionuclide usually as a capsule. Cancer cells absorb the radioactive substance more than normal cells. This means they receive a higher dose of radiation, causing the cells to die. There are different types of radioisotope treatment available depending on the type of disease:
Low Dose Radioiodine
This is the most common type of radioisotope treatment. It uses Iodine 131 to treat:
a. Benign diseases such as overactive thyroid disease.
b. Post thyroidectomy patient to destroy any remaining cancer cells.
It is given as capsules in our centre and patients can be treated as outpatients.
Chemotherapy usesanti-cancer drugs to kill cancer cells. It works by stopping or slowing the growth of cancer cells. Chemotherapy is used to treat cancer and ease cancer symptoms e.g. pain. You might have treatment with a single chemotherapy drug or a combination of drugs.
Hormone therapy blocks or lowers the amount of hormones in the body to stop or slow down the growth of cancer. Hormone therapy is also called hormonal therapy, hormone treatment, or endocrine therapy. It is often used in combination with other treatments such as chemotherapy, radiation therapy or after surgery.
Targeted therapy is the foundation of precision medicine. It is a type of cancer treatment that using drugs that specifically block certain receptors or proteins that control the growth of cancer cells.
Radiofrequency ablation (RFA)
RFA uses image guidance to place a needle through the skin into a tumor. In RFA, high-frequency electrical currents are passed through an electrode in the needle, creating a small region of heat to destroy tumor cell. RFA is effective treatment option for patients who is not fit for surgery.
Microwave Ablation (MWA)
MWA use image guidance to place a needle through the skin into a tumor. In MWA, microwaves are created from the needle to create a small region of heat. The heat destroys the cancer cells. MWA is effective treatment option for patients who is not fit for surgery.
Catheter embolization places embolic agents through a catheter into a blood vessel to block blood flow to an area of the body. It used to close off vessels supplying blood to a tumor.