Cancer and Oncology

Blog

  • Radiotherapy and Anti-cancer therapies: Continue or Hold

    Great collection of guides for various anti-cancer medications during radiotherapy by Dr Nina Niu Sanford @NiuSanford on X.com

    There is an ongoing debate about which chemotherapy drugs can be continued or held during radiotherapy. How long do you hold it for? What the safety profile, etc? Dr Sanford has created four slides which cover the majority of medications.

    Overview:

    Chemotherapy, Immunotherapy , TKIs, Monoclonal Antibodies, Hormone blockade:

    Antibody Drug Conjugates (ADCs):

    CDK 4/6 and PARK inhibitors:

  • Alcohol And Breast Cancer

    https://doi.org/10.1016/j.breast.2026.104719

    Great article published in The Breast journal (April 2026) – “Association between alcohol consumption and breast cancer incidence and prognosis: A systematic review and meta-analysis”

    The highlights are:

    • The study included over 2.5 million women
    • Any alcohol consumption +17% higher breast cancer risk
    • Light alcohol consumption +13% risk
    • Intermediate alcohol consumption +28% risk
    • Heavy alcohol consumption +52% risk
    • History of alcohol consumption is not associated with worse prognosis

    The link seems to be stronger for hormone receptor–positive breast cancer, supporting the role of estrogen-driven mechanisms.

    The possible reasons for increased risk with alcohol:

    • DNA damage (acetaldehyde)
    • Oxidative stress
    • Increased Oestrogen levels
    • Impaired DNA repair

    Alcohol and breast cancer incidence seem to be linked. The risk rises as alcohol intake increases.

    Alcohol is a modifiable risk factor.

    Reducing intake = reducing risk

  • Artificial Intelligence (AI) and Cancer Self Therapy

    Desperate times help us to take desperate measures. When the medical teams tell people that there is nothing more which can be done for their cancer therapy… some people take on “the world”.

    A great story:

    # GitLab co-founder Sid Sijbrandij was diagnosed with osteosarcoma. All the standard therapies and clinical trials ran out. He decided to do things in his way. He started using AI platforms to study his tumour type and data. He collected teams for personalized experimental treatments, and open-sourced 25 TB of medical records. He has since then had really good cancer control (since 2025). You can read the story on https://sytse.com/cancer/

    This takes time (and possibly lots of money), but is a start. As AI and software platforms get cheaper and more accessible, this trend will keep rising.

    I can imagine people outsourcing their data to get help from across the world.

    I recently watched a Netflix series called: “Diagnosis”. It is a collaboration between Dr Lisa Sanders and The New York Times. They try to help people with rare and undiagnosed illnesses. Their stories are outsourced online and people from across the world gives suggestions. https://www.netflix.com/title/80201543

    Medicine is changing. Times are changing. People are no longer willing to just take “no more options” as answer. Exciting times (possibly).

  • Sexual Activity During Neutropenia and Immunosuppression: What Do You Tell Your Patient?

    JCO Oncology Practice: https://ascopubs.org/doi/10.1200/OP-25-00618

    This topic is not discussed enough in the clinic. Most of us are not sure about the answers. Also the topic is awkward. A Journal of Oncology Practice article (2016) published a survey of cancer survivors. It found that 46% reported sexual health problems related to the diagnosis and treatment of cancer. Additionally, 71% said they had received no care for sexual dysfunction. There is a significant gap in knowledge and resources in this area.

    This is a good article giving simple guidelines.

    The gist of the article is:

    • Sexual health remains important for quality of life during cancer treatment
    • Evidence for strict sexual restrictions in neutropenia is limited
    • Stable monogamous partners: condoms not routinely required if partner healthy
    • Avoid anal sex/fecal exposure, new partners, or sex during severe mucositis
    • Gentle hygiene is sufficient; over-washing may harm mucosa
    • Condoms may be used briefly after chemotherapy to protect partners from drug exposure
    • Counseling should be individualized and evidence-informed, not based on outdated blanket restrictions.

    Table: Sexual Health Guidance During Neutropenia and Immunosuppression

    JCO Oncology Practice: https://ascopubs.org/doi/10.1200/OP-25-00618

    It is important to talk about:

    Fertility and contraception: Use reliable barrier methods or other contraception. Discuss fertility preservation early.

    Emotions: Several patients notice changes in desire, body image, or function (dryness, erectile issues, pain).

    Partner perspective: The healthy partner should be reassured that risk to them is low with basic precautions.

    Intimacy is still possible and often beneficial. It is important to review the person’s situation and give clear and practical guidance for the patient and their partner.

  • Trust and Advocacy: The Doctor-Patient Relationship

    One of the big privileges of being a doctor is that people trust you and tell you things which are very personal to them. They trust you with information which is not shared with others. It is very humbling and also scary at times.

    Some of the most awkward times is when patients tell me things about their family members or close friends. Issues with money, altering a will, trust, so on and so forth.

    The primary idea being to stand up for your patient and advocate for them. I have found that the best person who know the patient is their GP. It gets harder when the patient does not have a long term GP or keeps changing their GP.

    Social workers are a great resource, but harder to find in the real world setting. The majority of social workers have “been-there-done-that” and seen it all, so speak from a standpoint of pure experience. That is hard to get.

    I had an older patient who has been on treatment for a while. The patient comes independently and we have great chats. The patient was accompanied by their child on one of the visits. The child insisted that my patient was getting dementia and was forgetting things. The patient later broke down and told me that money was disappearing from their bank account. The patient is convinced that the child is responsible for it. Such a difficult situation for the family.

    It is really hard to truly heal the situation. Even if the money issues are sorted, the trust is destroyed.

    Everyday is a blessing. Thank God for it.

  • Arrogance and Humility

    As I grow older and gain experience… the more I realise how little I know and more importantly – how little I control.

    My sense of knowing things gets better over time. I am learning to say “no” more often to people, who I know that giving chemotherapy would be possibly detrimental. I am learning the difference between treating someone and actually giving people hope. I am learning that asking other people for help is vital.

    Nurses who spend more time with the patient and their families give me phenomenal insights into patients. So many patients tell nurses the actual truth about their life circumstances, social supports (or lack of them) and more.

    The Pastoral care person or social work gain immense knowledge about patients and their home situations.

    Everyday is a new day. Learn something new daily.

    God is my guide.

  • The best Oncology app

    The best Oncology app in the world is ONCOAssist (my opinion).

    ONCOAssist

    It is available for various software platforms and tries to be as comprehensive as possible (including a web interface).

    I use OncoAssist for staging cancer staging, decide the grade of toxicity, calculating chemotherapy doses, assess the status of my Geriatric patients and so on.

    I strongly recommend it to my registrars and colleagues.

    https://apps.apple.com/ie/app/oncoassist/id558299114

    https://play.google.com/store/apps/details?id=com.oncoassist.core

    https://webapp.oncoassist.com/public/index.php/login

    Try it.

  • Multi-Disciplinary Meetings (MDMs)

    The standard of care for patients with cancer is to discuss their case with peers and peers of associated specialities. Medical Oncology, Radiation Oncology, Surgery, Pathology, Radiology, Nuclear Medicine, etc. Each of them are vital parts of the multi-disciplinary team.

    We meet weekly to discuss and finalize the management plan for each patient.

    One of the things which changed due to the Covid pandemic was the ability to adapt to video conferencing. Now, nearly all our meetings are hybrid with Face-to-face meeting along with Microsoft Teams or Zoom inputs.

    It was an interesting challenge to convince people to use Teams and Zoom, but it has become the default now. The huge advantage being the ability to engage with people from across the city, state or beyond.

    Most of us now have Teams or Zoom on our phones, ipads and laptops – working from offices and cars.

    Life finds a way.

  • Cancer and Bucket Lists

    What is a bucket list?

    Defined as “a list of things a person wants to achieve or experience, as before reaching a certain age or dying”

    I see a fair number of patients in the clinic – public and private. Most people, rightly so, want to start treatment and get on with things as soon as possible. One of my jobs is to help people understand the various treatment options available and the rationale of each option. This includes talking about the risk versus benefit, the toxicity of treatment and the improvement in survival.

    All this sounds great on paper or when lecturing to students or junior doctors. In the real world, things can get very difficult.

    Some people want absolutely everything done to prolong life, even if it means that they are miserable for the entire time. Other people want nothing done with regard to our treatment, as they pursue alternative therapies. Yet others, can’t decide what they want.

    As the years go past, many of us learn the value of talking to people and understanding what they want. What are their wishes, their fears, their aims, their goals? What does the family want? What are the plans for vacations? Holidays? Time spent with loved one? Major events planned – weddings, waiting for a grandchild to be born, graduation ceremonies. The list goes on.

    I am slowly learning the importance of listening to people. It means a lot to them. And (now) me.

  • Christmas Time

    Christmas time is amazing. People try to be nicer. Families get together. Time for a break and reflection on life.

    It gets harder for people who have been diagnosed with cancer and are on treatment. I try my best to give people a break over this time, time to get away from the hospital setting, time to be with family and friends, time to recover from side effects of treatment, time to re-look at life.

    There are several people who are admitted to hospital and unfortunately cannot be discharged home for a variety of reasons. The idea is to give them a break for a few hours to have Christmas lunch at home.

    The saddest thing is when people are just diagnosed with cancer and need more investigations and reviews; and so many services or people are on leave. These patients and families are upset and frustrated. It does not really help them, when I explain that waiting for a few days will not make a huge difference in the bigger scheme of things. They want something done now. I can understand them.

    What about people who know that this is their last Christmas on earth? It is important to tell people to enjoy their time with families and loved ones, not just for the patient, but also for the loved ones who will cherish the memories.

    I continue to be amazed at the generosity of my patients – who will gift me and the team with cards, chocolates, gifts and so on. There are people who take the time to thank other members of the team (who are forgotten otherwise) – cleaners, support staff, pharmacy, reception staff, etc.

    I love this time of the year. It brings joy to most people. It also helps us understand that Jesus is the reason for the season.

  • First-line Maintenance Therapy for HER2+ Metastatic Breast Cancer

    HER2CLIMB-05: A Phase 3 Study of Tucatinib Versus Placebo in Combination with Trastuzumab and Pertuzumab as First-line Maintenance Therapy for HER2+ Metastatic Breast Cancer

    https://ascopubs.org/doi/10.1200/JCO-25-02600

    The HER2CLIMB study shows that the addition of Tucatinib to Trastuzumab and Pertuzumab maintenance after 4-8 cycles of THP induction prolongs PFS in 1st line HER-2 +. The benefit was present in both ER+ and ER- subsets.

    The improvement of maintenance therapy gives people longer time off chemotherapy.

    Tucatinib addition to Trastuzumab and Pertuzumab demonstrated improvement in PFS with no new safety signals identified and may be an option for 1L maintenance therapy in patients with HER2+ MBC.

  • Research and Clinical Trials

    Clinical Trials for medications, drugs and devices are broadly divided in four groups or phases:

    • Phase 1: Very early type of research. In some types, it would be a “first in human” study
    • Phase 2: Studies would have shown the medication to be relatively safe and it is now being tested for efficacy
    • Phase 3: The safety and efficacy have been shown to be favourable, and now it is being tested against the present standard of care
    • Phase 4: This study is primarily to gain more information about the medication, as it has already been approved for routine use in the market

    Enrolling onto clinical trials is a good thing. It gives access to newer molecules or different ways of using older molecules. The full benefits of the study medication may not be seen in patients enrolled on the study, but others would gain.

    All trials are governed via a Human Research and Ethics Committees, which may be local or centrally based. They are the guardians of patients and their families, and would not give permission to conduct a study, unless they are convinced about safety.

    The first principle remains – “First do no harm”

  • Decoding Positive and Negative Terms in a Cancer Diagnosis

    English and Medicine are not always the most complimentary areas.

    Patients are told by their doctors that:

    • The disease has progressed – patients are happy, progress is a good word – but doctors mean that the disease has worsened
    • The lymph nodes are positive – patients are happy, positive is a good word – but doctors mean that the cancer has spread beyond the primary organ
    • HER2 is positive – patients are happy, positive is a good word – but doctors mean that the cancer is more aggressive
    • KRAS is positive – patients are happy, but negative KRAS is better
    • EGFR is mutant – patients are sad, but mutant is better

    It is important to explain the terminology to the patient and their support members. Most times during the first consultation, after the patient hears that the cancer diagnosis is confirmed, they shut down internally. They do not hear most things after that.

  • Start Afresh

    I started a blog site nearly a decade ago (when blogging was just starting to get popular). I worked on it and then slowed down. It has been a long break.

    Am starting afresh.

    This site is about sharing knowledge and learning together. I would talk about various treatment options for patients. Clinical trials. New cancer targets. New medications. Things to discuss with your treating teams.

    I’ll work on some of the older blogs and update them. The information can be reviewed with your families and friends. The idea is share information and help people. Communicate. Interact.

  • Cancer & Oncology

    I have spoken to several thousands of people over the years. Cancer continues to be one of the most feared illnesses known to us as humans. Cancer affects millions of people across the world.

    What is Cancer? Cancer occurs when cells grow in an uncontrolled manner and do not die when they should. These abnormal cells can form tumours and spread to other parts of the body. These can occur due of genetics, lifestyle, or environmental exposure. It is vital to know that most times – we have no idea why the cancer occured. While cancer can affect almost any part of the body, early detection and proper care can greatly improve outcomes.

    What is Oncology? Oncology is the medical field that studies cancer. It focuses on cancer prevention, diagnosis, and treatment. Doctors who treat cancer are called oncologists, who use different treatments such as surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy.

    Why this blog? I am starting this blog to help people understand more about cancer. My goal is to explain cancer and oncology in simple terms, raise awareness, and help people feel informed.

    Godspeed.