ACTG Blog

While on a work trip to Penang Adventist Hospital (PAH) on April 13-14, 2016, I was accidentally diagnosed with a huge liver cancer, also known as hepatocellular carcinoma (HCC).

In the wee hour of April 14th I began to experience progressive excruciating pain in my abdomen. I decided to go to the emergency room of PAH for treatment. Three shots of injections weren’t helpful in alleviating the awful pain. Hence, I was advised to admit for further investigations. While processing the admission documents, the fourth injection was given which gradually began to alleviate the pain. By noon I was back to a normal healthy state.

That morning I underwent two ultrasounds and a CT scan and the results were disclosed to me in the afternoon. I was shocked by the devastating news – the impression of the radiologist was that I had a huge ruptured malignant tumor in the caudate lobe of the liver. The tumor had a size of 8.4 cm x 7.4 cm x 7.3 cm. The tumor was so big that it had displaced a few major blood vessels which made the potential of surgery very challenging and nearly impossible.

I returned to Singapore on the same evening. The ordeal in the following weeks was unbearable. I was admitted to Singapore General Hospital (SGH) the following day. SGH repeated the CT scan and the attending surgeon there as well could not assure me any hope – the tumor was indeed very big and could bring about a number of unforeseen challenges during the operation. As such, he could do nothing further and discharged me after two days with a follow up appointment in 30 days. I sought second opinions from several doctors whom all, after studying my CT scan, said unless I undergo liver transplant (if I could find a compatible donor), I may not be around in 2017.

This was an accidental finding because all the while I was well and healthy. There were no apparent signs or symptoms in my body prior to the devastating diagnosis. Being a hepatitis B carrier (I came to know about this in 1980 when I donated blood to my late father), I had gone for regular checkups in SGH since 1999 after I was alerted by my GP-friend who performed a checkup for me. Her overall assessment and lab results were generally good but because my liver functions test demonstrated some abnormality, she referred me to her former professor who is a gastroenterologist in SGH.

In the past 17 years I did numerous tests in SGH such as liver functions test, ultrasound, fibrotic scan and a liver biopsy. The test results were always satisfactory. Moreover, alpha-fetoprotein (AFP) was constantly within the normal range (between 1.25 – 1.30). The only abnormality was that my liver was moderately fatty. (AFP is used as a tumor marker to help detect and diagnose cancers of liver, testicles and ovaries. Abnormal indicator is >15).

I would also like to testify that God answered prayers. My loved ones, colleagues and friends around the world prayed earnestly for my healing. On May 19th 2016 a hemihepatectomy was performed in SGH by a skillful surgeon. Thank God it was successful. After the surgery, my surgeon-sister (Dr. Fiona Tsui-Fen Cheng) in Taiwan recommended me to undergo genomic profiling to monitor the disease course. My blood sample was sent to ACT GENOMICS Co. Ltd in Taiwan for genetic analysis.

One of the benefits of ACT Genomics’ profiling is to help with early detection of genetic mutations that are one of the culprits of liver cancer. If liver cancer does recur or there is development of a secondary cancer, genomic profiling will help the doctors to detect it early and to understand the genetic makeup of the tumor. The analysis was performed using the ACTMonitor sequencing panel which detects hotspot mutations in 50 genes. The lab uses ultra-deep next-generation sequencing to detect genetic variants such as single nucleotide variants, small insertions and deletions.

Regular genomic profiling of the blood can help doctors keep track of cancer cells’ mutations. As such, by the time the cancer recurs, the doctor will be aware of the mutations associated with the cancer and specific drugs could be used that target the mutated cells. In other words, doctors can customize the treatment strategy for each patient according to their genetic mutations. Genomic profiling of the blood is a comprehensive, accurate, reliable and non-invasive technique to detect the disease at an earlier stage, especially compared to some tumor markers that can sometimes give a negative result or demonstrate abnormality only at a later time.

To date I have done three rounds of ACTMonitor profiling to monitor the mutations of my liver tumor semi-annually. In case I will relapse or develop a secondary cancer, I will stand a better chance to detect it at an earlier stage.

Therefore, I highly recommend that cancer patients undergo genomic profiling – the new technology that is helpful to oncologists on the lookout for possible cancer recurrence. This technology can also assist the doctors in treatment selection so that the disease can be managed according to specific needs of the patient. Genomic profiling does provide an opportunity to extend the lives of cancer patients.

Testimony of Andrew Tay, MD. A liver cancer survivor in Singapore.