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Diagnosed with uncommon ovarian cancer at 28, former air stewardess hangs on to hope of having baby after marriage

SINGAPORE — When Ms Natasha Fong felt a wave of intense abdominal pain and bloating in June 2020, she thought she had caught a stomach bug.

Ms Natasha Fong (pictured) is one of more than 6,000 adolescent and young adult patients aged 16 to 45 seen at the National Cancer Centre, Singapore between 2016 and 2021.

Ms Natasha Fong (pictured) is one of more than 6,000 adolescent and young adult patients aged 16 to 45 seen at the National Cancer Centre, Singapore between 2016 and 2021.

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  • More adolescents and young adults are having cancer and they face unique challenges in fighting the disease
  • Most have long-term survival rates but it means more people need survivorship care, an oncologist said
  • There is the risk of cancer recurrence as they live longer and those planning to have children may have fertility problems as well as body image issues
  • Between 2016 and 2021, the National Cancer Centre Singapore saw more than 6,000 young patients
  • A former flight stewardess recalls her struggles and fears when she was diagnosed at 28 during the Covid-19 pandemic

SINGAPORE — When Ms Natasha Fong felt a wave of intense abdominal pain and bloating in June 2020, she thought she had caught a stomach bug.

She sought medical attention two days later when the bloating did not subside. The sudden symptoms turned out to be an uncommon type of ovarian cancer called ovarian yolk sac tumour.

Scans showed a cyst about the size of a soccer ball in the ovary on her right side. A tumour was wrapped around the massive growth.

Only 28 at the time, Ms Fong, a former flight attendant, was thrown into the bleakest period of her young adult life. Facing a cancer diagnosis at the first peak of the Covid-19 pandemic also tested her mental resilience like never before.

She lost an ovary and self-confidence while experiencing severe side effects from cancer treatment. There was also the fear that her ability to have children would be affected.

“Dealing with the side effects from treatment was one of the toughest things I’ve experienced. Another was having to deal with the changes in appearance and body image,” Ms Fong, now 30, said in an interview with TODAY to mark awareness week this month for adolescents and young adults who have cancer.

The annual global movement aims to raise awareness of the unique challenges young cancer patients and survivors face.

MORE TEENAGERS AND YOUNG ADULTS HAVE CANCER

Worldwide, cancer in younger people is becoming more common.

Ms Fong is one of more than 6,000 adolescent and young adult patients seen at the National Cancer Centre, Singapore (NCCS) between 2016 and 2021. They are between the ages of 16 and 45.

Together with other young cancer survivors, she will talk about her cancer experience at a webinar organised by NCCS and Singapore General Hospital on Saturday (April 30) from 1pm to 4.30pm.

The thought that I might have to remove (my ovaries and) everything and not be able to have kids next time made me quite sad. But my priority at the time was to get well and save my life rather than get emotional thinking about the future.
Ms Natasha Fong

Dr Eileen Poon, a consultant with NCCS’ division of medical oncology, said that worldwide, the number of adolescent and young adult cancers is expected to rise.

A reason for the increase could be better and earlier diagnostic rates.

Other factors include more exposure to harmful toxins such as alcohol and smoking, as well as patients previously diagnosed with childhood cancers living longer to get secondary cancers, Dr Poon added.

Some studies suggested a link between rising obesity rates in the young and an increase in certain cancers, such as colorectal cancer.

Family history and genetics may also play a part in the development of cancer in some young people.

Lymphomas, sarcomas, germ cell tumours, breast cancer and central nervous system tumours tend to be more common in the younger age group.

Ovarian cancers, which form up to 15 per cent of cancer cases in women in Singapore, are among the more commonly seen cancers in female adolescents and young adults.

However, ovarian yolk sac tumour is not as common, and NCCS sees fewer than 10 of such cases each year.

Dr Poon said that yolk sac tumours primarily occur in younger women and can affect girls even before they hit puberty. About 30 per cent of patients are diagnosed before their menstruation starts.

SYMPTOMS MAY MIMIC PREGNANCY SIGNS

Besides intense abdominal pain and bloating, Ms Fong also felt an unusual lump on her lower abdomen, which she said made her look “four to five months’ pregnant”.

Dr Poon said that ovarian yolk sac tumours often produce hormones such as human chorionic gonadotropin (hCG), which can result in symptoms of pregnancy, such as nausea, morning sickness and tiredness. They may also cause precocious puberty and abnormal vaginal bleeding.

“The tumour can cause bloating and abdominal girth enlargement. It may present as a lump in the abdomen and this can be a result of the tumour itself, or fluid accumulating in the abdomen due to the tumour.”

Some patients also experience pain. As the pain can be rather acute, it can sometimes be misdiagnosed as appendicitis, Dr Poon said.

Some yolk sac tumours can also potentially result in encephalitis, which is an inflammation of the brain caused by an infection or an autoimmune response. It can lead to abnormal behaviour, changes in personalities and swinging heart rates, Dr Poon added.

If left untreated, the tumour in Ms Fong’s ovary would have continued to grow and could potentially rupture.

Dr Poon said that recovery is generally good for patients with ovarian yolk sac tumour. When the cancer is at stage 1, almost all patients will survive.

“Even when they are diagnosed at stage 3, the five-year survival rates can be higher than 70 per cent.”

INFERTILITY FEARS, BODY IMAGE ISSUES

Ms Fong recalled everything moving at a fast pace after the tumour was discovered. An emergency surgery was scheduled on the same day.

She struggled to accept the possibility that her fertility may be severely affected, if the tumour had spread and the surgeon had to remove her entire reproductive system.

“It was quite difficult for me to accept that because I’m still young and not married yet,” she said.

“The thought that I might have to remove everything and not be able to have kids next time made me quite sad. But my priority at the time was to get well and save my life rather than get emotional thinking about the future.”

Thankfully, she added, the tumour was confined to her right ovary and at stage 1. Her ovary on the left side was spared.

Ms Natasha Fong (pictured) said that the toughest part of fighting cancer was not having her family members, who live in Malaysia, around her during treatment due to Covid-19 border restrictions.

Ms Fong underwent six months of chemotherapy, during which she spent a total of four weeks in hospital.

The treatment left her feeling drained and with severe side effects such as decreased lung function, fatigue, hair loss and intense body aches and pain.

“I expected (the side effects from cancer treatment) to be bad, but didn’t realise that it would be so bad.”

The toughest part, however, was not having her family members around during treatment.

As it was during the early part of the Covid-19 pandemic, her family living in Malaysia could not travel to Singapore due to travel restrictions.

Her fiance and close friends, one of whom would cook healthy meals for her when she was hospitalised, were her pillars of strength.

When she decided to shave her head while experiencing hair loss from chemotherapy, they rallied around her and did the same as well.

One of her friends organised a fundraising drive in support of cancer research and ovarian cancer awareness, raising around S$11,000 for Singapore Cancer Society.

Over in Malaysia, Ms Fong’s mother shaved her head to show support for her daughter’s struggles.

Ms Fong said: “I remember crying a few times when I realised my hair was falling out, even though I told myself that it would be okay. But I took it quite well in the end because people around me were supportive.”

She decided not to freeze her eggs due to the costs and time involved. Going ahead with fertility preservation would lead to a delay in the cancer treatment, which was a risk that she chose not to undertake.

The Singapore permanent resident said that she was not able to get a subsidy for fertility preservation procedures at the time because she was not married. This was explained to her by a doctor before her cancer treatment, she added.

Adolescents and young adults are ‘supposed’ to be at the peak of their physical health, going through major life milestones... To manage all of these while coping with a cancer diagnosis can be devastating.
Dr Eileen Poon, a consultant with the division of medical oncology at National Cancer Centre, Singapore

About 85 per cent of adolescent and young adult cancer patients achieve long-term survival beyond five years, but Dr Poon from NCCS pointed out that this would also mean an increasing population of people who will need survivorship care.

A cancer diagnosis is difficult for anyone, but young people deal with many challenges that are unique to their age group.

An example is the risk of recurrence and living with the damage caused by the cancer, Dr Poon said.

“Some of the challenges they face can also be treatment-related, where the toxicities of treatment can be acute or long-term. There is also the risk of a second cancer that can develop later on,” she added.

For instance, fertility problems and premature menopause are possible issues that can develop — as a direct result from treatment or as a late side effect.

The patient may also face significant emotional and social challenges, such depression, anxiety and body image concerns.

“Adolescents and young adults are ‘supposed’ to be at the peak of their physical health, going through major life milestones such as finishing school, going to university, starting work or a family. To manage all of these while coping with a cancer diagnosis can be devastating,” Dr Poon said. 

“Re-integration back into society or school can be a challenge, too, because they often need to take a hiatus from what they are doing to focus on treatment.”

Ms Fong was on hospitalisation leave for about 10 months.

Now that the cancer is in remission, she is looking forward to many new beginnings this year.

She recently visited her family living in Malaysia after border controls were lifted. Next month, she will start a new career in the banking industry. 

In September, she will tie the knot with her fiance.

Ms Fong said that she went for a gynaecological check-up recently and scans showed that her remaining ovary “seems normal”.

“I hope to have a kid. I’ve always wanted to start a family,” she said.

Ms Fong encouraged young people battling cancer to persevere and surround themselves with supportive people.

“Even though you can’t see the light at the end of the tunnel while going through treatment, just hold on. Believe that once you go through this toughest part of your journey, everything will go upwards from then on,” she said.

“Some people may feel it’s taboo to tell others they have cancer but I feel it’s important to have a lot of support when you’re going through it.

“I think one of the reasons why I was so positive (despite having severe treatment side effects) was because of my friends and loved ones’ support.”

To register for the webinar on Zoom happening from 1pm to 4.30pm on April 30 and featuring young cancer survivors with sharing on fertility preservation, log in here.

Related topics

cancer chemotherapy fertility body image nccs Health

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