HKSH Cancer Centre

As the mainstay of cancer treatment, surgery is effective at minimising the risk of cancer recurrence within the same area, sometimes even as a cure. It also provides tumour tissues (by way of biopsy) for special tests by pathologists to predict disease progression and treatment response. Examination of surgical specimens can also reveal the local extent of the disease, which may in turn indicate the need for further treatment. 

Thanks to the recent advance in surgical techniques, minimally invasive surgery (MIS) is now widely adopted in gynaecological (pelvic), abdominal and chest operations. MIS causes less surgical trauma and smaller scars, benefitting patients in terms of less postoperative discomfort, quicker recovery and earlier discharge. It also reduces the need for blood transfusion and risk of infection. 

For more details about specific cancers, please click here.

Chemotherapy is administered to cure a specific cancer or control tumour growth when cure is not possible. It is also recommended as an adjuvant treatment after surgery to reduce the risk of metastases or a tumour recurrence, or performed before surgery to reduce the size of tumour and render it operable. 

At our Chemotherapy Centre, chemotherapy is given on an outpatient basis for same-day discharge. All fittings, decorations and fixtures are specially designed to ensure the privacy and comfort of patients and their families. Treatment is delivered with care and efficiency by our experienced Oncology Nurses, who also provide guidance and support to patients on possible side effects after treatment. Thanks to recent medical advances, many new chemotherapy drugs are available with higher efficacy and fewer side effects. They are better tolerated and/or more targeted against cancer, thereby sparing healthy tissues and enhancing patient comfort.

Molecular targeted agents are currently the focus of active cancer research. With better understanding of the molecular mechanisms of tumorigenesis of various cancers, drugs can be developed to interfere with specific molecular targets that are involved in the growth and spread of cancer. 

For a specific targeted therapy to work, the corresponding molecular target must be present in the tumour cell, and this is usually verified by tumour biopsy or blood test. The drugs are either in the form of small molecular oral inhibitor or monoclonal antibody given intravenously. They target at different levels of signal transduction pathway that control cell proliferation, cell death, tumour microenvironment, and tumour blood supply. In contrast to chemotherapy which makes no distinction between normal and cancer cells in its attack, targeted therapy causes less damage to normal cells and is therefore associated with less treatment side effects. 

Many different targeted therapies have been approved for use either as monotherapy or in combination with chemotherapy. A wide variety of targeted drugs have been approved for the treatment of leukaemia, lymphoma and multiple myeloma. For example, chimeric antigen receptor T-cell (CAR-T) therapy genetically modulates autologous T cell to target specific tumour antigen, and indicated for the treatment of leukaemia and relapse of lymphoma. i) paediatric and young adult patients up to 25 years of age with B-cell acute lymphoblastic leukaemia (ALL) that is refractory, in relapse post-transplant or in second or later relapse; and ii) adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) after two or more lines of systemic therapy. 

Mabther/Rituximab is a monoclonal antibody commonly used to treat all kinds of B-cell lymphomas. Imatinib is a protein kinase small molecular inhibitor that is effective in treating chronic myeloid leukaemia. 

A proportion of lung cancers harbor specific driver mutation, such as the EGFR mutation, ALK rearrangement, ROS1 rearrangement, and BRAF V600E mutation. Specific Tyrosine Kinase Inhibitors, such as Erlotinib, Gefinitib, Afatinib, Decomitinib and Osimertinib are popular drugs used to treat EGFR mutated lung cancers. 

Targeted therapy is also widely used to treat breast cancer. Breast cancer can be classified into three distinct phenotypes: Hormone receptor positive type, HER-2 positive type, and Triple negative type. Cyclin-D kinase 4/6 inhibitors and mTOR inhibitors have been approved for use in combination with hormone therapy to overcome endocrine resistance in hormone receptor positive tumour. Anti-HER2 antibody (Herceptin and Pertuzumab) and HER2 antibody-drug conjugate (TDM-1) are monoclonal antibodies that are effective in HER2 positive disease. Polyadenosine Diphosphoribose Polymerase (PARP) inhibitor (Olaparib) has been approved for use in triple negative breast cancer with germline BRCA mutation. 

A number of drugs that inhibit multiple receptor tyrosine kinases have been established as the standard of care treatment in advanced kidney (Cabozantinib, Sunitinib, Pazopanib, Axitinib, Lenvatinib, Sorafenib) and liver cancer (Sorafenib, Lenvatinib, Regorafenib). 

Antibody against the vascular endothelial growth factor (VEGF) or VEGF-receptor (VEGFR) has been developed to inhibit vascular growth in tumour. Bevacizumab, an anti-VEGF antibody, has been widely used in colorectal cancer, cervical cancer, glioblastoma (a type of brain tumour), lung cancer, ovarian cancer and kidney cancer. Ramucirumab is an anti-VEGFR antibody that is approved for use in stomach cancer, colorectal cancer, and lung cancer. 

Epidermal growth factor receptors (EGFR) are over-expressed in colorectal cancer and head and neck squamous cell carcinoma. Cetuximab and Panitumumab are anti-EGFR antibodies used to treat these types of cancers.

Under normal circumstances, an immune response is triggered when cancer cells are identified by the immune system. However, certain types of cancer may interfere with this mechanism and suppress immune responses, making one prone to cancer attack. 

There are several forms of immunotherapy on the market. They can either help the immune system to recognise the cancer, or stimulate the immune system in various ways. Checkpoint inhibitor is a class of drugs (e.g. Pembrolizumab, Nivolumab, Atezolizumab, Durvalumab, Avelumab) that can successfully treat melanoma, kidney cancer, bladder cancer, lymphoma, lung cancer and many other tumour types. It helps the immune system to respond more strongly to a tumour by removing the inhibitory effects of tumour on the immune T-cells.

Hormone therapy, also called endocrine therapy, is a cancer treatment that slows or stops the growth of cancer that is dependent on hormones to grow. Hence, hormone therapy is commonly used to treat breast cancers and prostate cancers. It may be given in different ways, such as the oral route, injection, or surgery to remove the hormone-producing organs (ovaries or testes). 

About 70–80% of breast cancer patients belong to the hormone-receptor positive category. Hormone-receptor positive patients will derive benefits from hormone therapy in the adjuvant setting after breast surgery (Tamoxifen with or without Gonadotrophin releasing hormone analogue for premenopausal patients, and aromatase inhibitors for postmenopausal patients). The duration of hormone therapy in this situation is usually 5 years or longer. 

Hormone therapy is also an effective treatment in metastatic hormone-sensitive breast cancer, and provides substantial tumour control with relatively less toxic side effects when compared to systemic chemotherapy. At the time of development of endocrine resistance, further hormone therapy, such as Fulvestrant or Exemestane, may be used alone or in combination with other targeted therapies, such as the Cyclin-dependent kinases 4/6 inhibitors or the mTOR inhibitors, to overcome endocrine resistance. 

Almost all prostate cancer cells rely on male sex hormone (androgens) to grow. Androgen deprivation therapy (ADT) can thus effectively suppress prostate cancer by eliminating testosterone production from the testes. In intermediate- to high-risk non-metastatic prostate cancer, ADT can be used before and after radiotherapy to enhance tumour control and reduce tumour recurrence, whereas in metastatic prostate cancer, ADT can be used alone or in combination with chemotherapy to palliate symptom and delay disease progression. ADT can be achieved by surgical removal of testes or regular injection of Luteinizing-releasing hormone analogue. 

At the time of acquired endocrine resistance, also called castration resistance, additional hormone therapy, such as antiandrogens or androgen synthesis inhibitors, may be used in combination with ADT to overcome endocrine resistance. Enzulutamide is a new antiandrogen that binds to the androgen receptors of tumour cells to reduce signal transduction and cell proliferation. Abiraterone Acetate is a new androgen synthesis inhibitor that inhibits androgen production from the adrenal glands, tumour cells, and the testes more comprehensively.

At HKSH Radiotherapy Centre, cancer patients can receive advanced treatments using the most advanced machines and radiotherapeutic techniques, including intensity modulated radiation treatment (IMRT) with state-of-the-art linear accelerators, Cyberknife, M6 helical radiation therapy Radixact X9 and others. All of these enable precise irradiation of tumour targets while sparing the normal organs, thus achieving maximum efficacy with minimum side effects. 

Other groundbreaking technologies include Unity MR Linac and Hong Kong’s first proton therapy (PT) system at HKSH Proton Therapy Centre in A Kung Ngam. 

Proton Therapy 
As a form of particle beam therapy, PT is currently the most advanced radiotherapy modality in tumour treatment. It is suitable for various cancer types, including brain cancer, head and neck cancer, lung cancer, liver cancer, breast cancer and prostate cancer. It is particularly beneficial for paediatric cancer patients who are still in the developmental stage. By optimising the radiation dose, PT can minimise the exposure of health tissues to radiation and lower the risk of complications and side effects associated with conventional radiotherapy. 

Unity MR Linac
HKSH pioneers the clinical application of 1.5T Unity MR Linac in Asia, treating treating malignancies such as prostate, bladder, gynaecological, pancreas and liver cancers. Integrating linear accelerator technology with real-time 1.5 Tesla (T) Magnetic Resonance Imaging (MRI), it allows for unprecedented accuracy in image-guided daily adaptive radiotherapy. 

Key features: 

• Sees and tracks difficult-to-visualise soft-tissue anatomies with MR Imaging;
• Provides insights into any changes in tumour size and position;
• Allows for adaptive radiation doses at the time of treatment;
• Increases the precision in localising tumour; and
• Reduces treatment margins and fraction regimens

Radionuclide therapy utilises biochemical molecule labelled with radioisotope to trace and treat targeted lesions by radiation with high linear energy transfer (such as α and β) at molecular distance. Because the biochemical properties of the molecule are highly specific to pathophysiology, radiation treatment is mostly delivered to abnormal tissues and effect on normal tissues is minimised.