One chef’s real experience with lung cancer in Singapore
Living with Cancer
Stories of strength, support and hope
THE sight of the 2,500cc of liquid extracted from his chest cavity terrified Mr Cheong Weng Kee.
“There was a layer of oil floating on top of the water in the container,” said the 77-year-old restaurateur. “And the smell coming from it was of stale cigarettes. You know, like those left in the ash tray for days? It was awful.”
“I asked the nurse if that was all the water from my lungs, and she simply nodded.”
That was his wake-up call. He had been diagnosed with stage 4 lung cancer.
Mr Cheong, the founder of Capital Restaurant, a Michelin-starred restaurant known for its hairy crab dishes, had been smoking since he was 18.
“I would smoke a pack a day. That is equivalent to 20 sticks of cigarettes. But in recent years, because of the restaurant business, I was experiencing high levels of stress, I started smoking about 30 to 40 sticks a day,” he said.
In May 2017, Mr Cheong developed a bad cough and found it difficult to breathe. He didn’t think much of it and assumed a trip to a general practitioner for a course of antibiotics would solve the problem. Instead he became increasingly breathless.
"Whenever he cooked, it was for a short while before he had to stop,” said his daughter Ms Cheong Wai Ching. “He couldn’t carry on and my brother had to take over the cooking.”
By the fourth day of his cough, Mr Cheong’s condition worsened. Unbeknown to him, his lung had collapsed because of the fluid accumulation between his lung and his chest wall.
“He had just returned home from the restaurant,” said his daughter. “He had taken public transport and walked. That was when we noticed he could not breathe properly.”
She rushed her father to Raffles Hospital where he was admitted immediately. Mr Cheong was intubated to discharge the water, and a sample was taken from his lung for testing.
Maglignant pleural effusion
Medical oncologist Dr Donald Poon said this is common for those who suffer from stage 4 lung cancer.
“We all have fluid secreted into the space between the lungs and the chest wall to prevent friction between the two surfaces during lung expansion and contraction. Equal volume is drained through lymph flow channels. But in advanced lung cancer, there is influx of fluid and the drains are blocked by cancer cells, resulting in a net inflow per day and accumulation of the fluid. This causes compression of the lung within the chest wall cavity. We call it malignant pleural effusion,” he explained.
Dr Poon said that Mr Cheong has adenocarcinoma of the lung, part of a common group of lung cancers called non-small cell lung cancer.
“He had fluid accumulation in his chest cavity compressing on his right lung where the primary cancer arose, spreading to several lymph nodes in the middle of the chest and the other side of the right lung,” he said.
Mr Cheong’s family was informed of the diagnosis.
“Dr Poon showed us all the scans and explained that the cancer cells were ‘lit’ in the scan because of the dye. We could see that it was quite bad,” said his daughter. “In fact, the right side was really illuminated and the top part of the left lungs had already started to have cancer cells.”
Not wanting their father to give up and sink into depression, Ms Cheong and her siblings told their father about his condition but kept its severity from him.
“The doctor only spoke to my children and told them about this new treatment just out on the market. It’s expensive but effective, so I decided to go for it,” Mr Cheong said.
Using his own immune system to fight cancer
Instead of chemotherapy, the restaurateur underwent an anti-PD1 (an inhibitory receptor expressed by T cells) therapy, which is a form of immunotherapy, as the appropriate treatment for his stage 4 lung cancer.
“His treatment is a 30-min intravenous infusion that is given once every three weeks,” said Dr Poon.
The infusion costs around S$10,000 to S$14,000 for 200mg of immunotherapy, and was paid for mainly by Mr Cheong’s health insurance, according to his daughter.
Dr Poon explained that the difference between chemotherapy, the traditional go-to treatment, and immunotherapy is that the latter has an “innate intelligence in recognising cancer cells and evolves itself to seek out these cancer cells”.
“Chemotherapy is designed to have an effect by disrupting a particular part of the cancer cell DNA. It can only do that and nothing else. Soon enough, the tumour population will start growing after four to six cycles of chemotherapy in lung cancer. This is because it contains several different clones of cancer cells. The already-resistant clones have a way of evading that disruption of DNA in the above example,” he said.
Mr Cheong was chosen for this treatment because his tumour cells have 90 per cent PD-L1 expression, which is a sign for a very good response to immunotherapy.
“We do find that with patients who are current or ex-heavy smokers, the expression of PD-L1 being more than 50 per cent in their lung cancer cells, makes for a better response to immunotherapy,” said Dr Poon. “We believe this is because smoking triggers a more varied form of protein expression on the surface of the cancer cells that renders these cancer cells more vulnerable to recognition by the body's immune T-cells.”
He added that this does not mean immunotherapy will not work in non-smokers.
Fortunately, Mr Cheong did not experience any side effects from the immunology treatment, which could potentially be serious as a result of the immune system going into overdrive and attacking the normal organs and tissues in the body. He said he is now “breathing well and not coughing as much”.
Two months after he was discharged, his family agreed to let him return to what he loved doing –cooking in his beloved restaurant.
“I used the time in hospital to reflect upon my life and my smoking habit,” he said. His goal now is to share his experience living with cancer with those facing a similar situation.
“I can help them understand more and not be afraid. They have to maintain a strong will to beat their cancers and treat it.”
If you or your loved ones suffer from cancer, speak to your oncologist to find a suitable treatment.