1. Myths About Cancer (or the 13 questions you ask your oncologist but are surprised by the answers!) Albert Lim Kok Hooi Gleneagles Oncology Centre Kuala Lumpur

2. Cancer is incurable, painful and death is inevitable and imminent

3. We don’t know what causes cancer  We do  Accumulated genetic mistakes  Disease of ageing  Chemicals, radiation, viruses  ‘Unknown’

4. Can we prevent cancer?  Stop smoking  Maintain ideal/ less than ideal body weight  Vaccinate against Hepatitis B  Secondary prevention – mammography, pap smear, faecal occult blood test, PSA

5. Does smoking cause cancer? Is cancer largely a lifestyle disease? YesNo

6. Is cancer inherited?  Only 10% are inherited  Remember, you inherit the risk, not the cancer

7. What food should I avoid once I have cancer?  None  However, a good diet helps

8. Can food prevent cancer?  No  However, a well-balanced, scientifically-crafted diet will do wonders for your heart, body and psyche. It will possibly reduce your cancer risk as well

9. “I don’t want to undergo cancer treatment because good cells are killed”  No such thing as a free lunch  Side effects are mostly self-limiting, temporary and reversible  Much progress in combating side effects of treatment  Untreated cancer leads to suffering and death

10. GOOD OUTCOME with FEW SIDE EFFECTS GOOD OUTCOME with MANY SIDE EFFECTS POOR OUTCOME with FEW SIDE EFFECTS POOR OUTCOME with MANY SIDE EFFECTS Doctor, if I suffer no side effects, does that mean the treatment is not working?

11. What about alternative and complementary therapy?  Albert Lim’s nemesis  ‘Holistic’, ‘boosts immune system’, ‘does not kill good cells’….. seductive words but devoid of meaning and substance  Anecdote vs sample vs population  Scientific medicine vs. non-scientific medicine (not Western vs Chinese/ Malay/ Oriental/ etc.)  The randomized clinical trial (RCT)

12. Is cancer contagious?  Again, no  Cancer and viruses  Cancer and transmissibility  Cancer and love

13. Doctor, can I have sex? (usually asked in a whisper, just before patient exits doctor’s office)  Yes

14. Isn’t cancer very painful?  Not necessarily  Advances in cancer pain control and prevention: including opioids, fentanyl, PCA, interventional procedures.

15. Is there a cure for cancer?  Presently one third of cancers are curable (stage I/ almost all stage II)  For ‘incurable’ cancers, prolongation of good quality life is a realistic therapeutic goal  With advances in cancer genetics, proteomics, biology, clinical trial methodology and translational research, the future is bright

16. WHAT HAVE WE LEARNT?  Forget about received wisdom about food, food taboos and alternative therapy  Most cancer pain can be adequately controlled  Cancer is curable in a significant proportion of patients with a judicious combination of surgery, radiotherapy, chemotherapy and molecularly targeted therapy  Cure of the rest is on the horizon THE PRESENT IS BRIGHT, THE FUTURE IS EVEN BRIGHTER

17. ‘I have nothing new to teach the world. Truth and non violence are as old as the hills’ Mahatma Gandhi