Ask a Medical Oncologist: Dr Robert Lim from Icon Cancer Centre Singapore

Ask a Doctor ForumCategory: OncologyAsk a Medical Oncologist: Dr Robert Lim from Icon Cancer Centre Singapore
Robert Lim - Oncology (Cancer) - Mount Elizabeth Novena HospitalDr Robert Lim asked 2 years ago
I am Dr Robert Lim, Medical Oncologist practicing at Icon Cancer Centre- Singapore. Ask Me Anything! I am a specialist in medical oncology at Icon Cancer Centre. I am a graduate of both the University of St Andrews and the University of Edinburgh where I obtained my medical degree (MBChB). I then moved to New York where I completed my postgraduate training in Internal Medicine followed by Haematology and Medical Oncology at The New York Hospital – Cornell University Medical College and Memorial Sloan Kettering Cancer Center. In addition to my American Board certifications in Internal Medicine, Medical Oncology, and Haematology, I am also a Fellow of the Royal College of Physicians in Edinburgh. After returning to Singapore in 1998, I developed a special clinical interest in biliary tract cancer, colorectal cancer, esophageal cancer, gastric cancer, liver cancer, and pancreatic cancer and accepts referrals for all cancer types. Besides my skills in clinical care, I co-authored several pivotal major studies in colon cancer and pancreatic cancer that have influenced clinical practice. From 2005 to 2011, I was the Head of the Department of Haematology-Oncology at the National University Cancer Institute, Singapore (NCIS). In particular, the focus on developing new drug treatments and enhancing the understanding of the unique problem for Asians with cancer has helped many patients and their families. I have been a member of the Specialist Training Committee in Medical Oncology, instrumental in training many doctors both in internal medicine and oncology, providing invaluable mentorship and guidance. Amongst my many varied responsibilities, I have served as an Associate Director of NCIS and is a previous council member of Dover Park Hospice, chairing their medical professional audit committee. Learn more about me here: I am excited to be here to share and discuss about Cancer with everyone. I will be actively answering questions. If you have any questions about biliary tract cancer, colorectal cancer, esophageal cancer, gastric cancer, liver cancer, and pancreatic cancer, feel free to ask me! === Want to ask a question? Submit your question at the bottom of this page. Don’t forget to include your name and email address to get notified when the doctor answers your question.
19 Answers
Hock Lye answered 2 years ago

My father has stage 3B colorectal cancer. Is chemotherapy combined with radiation therapy still effective at this stage? His disease was found when it was already advanced. I need your opinion, Doctor. Thank you

Dr Robert Lim replied 2 years ago

For stage 3B colon cancer, chemotherapy alone is the standard treatment administered. If the cancer originated in the rectum, radiotherapy is often included as part of the planned treatment before or after surgery, along with chemotherapy. The aim of the chemotherapy for stage 3 colorectal cancer is to treat the potential microscopic disease that might be there and this has been shown to reduce the chances of relapse and improve overall survival.

Loretta Tay answered 2 years ago

I am undergoing chemotherapy prior to surgery for my pancreatic cancer. Would I still need to undergo more chemo after the surgery?

Dr Robert Lim replied 2 years ago

Chemotherapy prior to surgery is called neoadjuvant chemotherapy. If you are receiving it for pancreatic cancer before surgery, and surgery is performed after that, it is likely that chemotherapy will be continued after the surgery. Chemotherapy after such surgery has been shown to improve the odds of recurrence

Eunice Chan answered 2 years ago

My husband’s stomach cancer has spread to his liver. Do you think chemotherapy is still effective at this stage? Is there any treatment we should add to his treatment plan?

Dr Robert Lim replied 2 years ago

Gastric cancer that has spread to the liver is in the 4th stage. Unfortunately, treatment aims are to control the cancer and prolong survival. Most recently, the addition of immunotherapy to chemotherapy has been shown to improve control and survival for patients.

Danny Leong answered 2 years ago

I was just diagnosed with stage 2 non-small cell lung cancer. How do I know if it is chemotherapy or immunotherapy that works best on me?

Dr Robert Lim replied 2 years ago

For stage II NSCLC, adjuvant treatment after surgery is typically recommended. This may either be chemotherapy or if a specific EGFR mutation is found, targeted therapy with Osimertinib may be considered. Immunotherapy as an adjuvant treatment after surgery for NSCLC has not been established as a standard of care at this time.

Jun long answered 2 years ago

Is chemotherapy a good substitution for a liver transplant in the case of advanced liver cancer? My father in law was advised to have a transplant, but we want to pursue non-surgical treatment first if possible.

Dr Robert Lim replied 2 years ago

If a patient has advanced liver cancer and is judged to be suitable for a transplant, that would offer the best chance of a cure. Selection of advanced liver cancer cases for transplant is important. If the tumor is too advanced, transplant is not associated with good outcomes. Chemotherapy is not particularly helpful for liver cancer. If the disease is limited to the liver, there may be options of liver-directed treatments (e.g. chemoembolization, radioembolization, radiofrequency ablation for smaller lesions). Immunotherapy is now utilized for advanced cases, as is targeted therapy. In these situations, such treatments are typically aiming to control the cancer and prolong survival.

Adam answered 2 years ago

My father is under treatment for his stage 4 lung cancer. He takes Pembrolizumab. Does this particular drug still aim for remission at his stage?

Dr Robert Lim replied 2 years ago

Treatment of stage IV lung cancer has aims of controlling the cancer and prolonging survival. If he has had a prolonged and durable response, there might be consideration to stop the treatment to observe the cancer situation.

Hong Zheng answered 2 years ago

My grandfather has been taking immunotherapy drugs for a year and five months now to treat his stage 3 lung cancer. The treatment will be stopped in seven months. Would you suggest we switch to palliative care thereafter?

Dr Robert Lim replied 2 years ago

If he has been on this treatment for over a year, it would imply that his cancer is well controlled. The trial that established that immunotherapy for stage III lung cancer is beneficial administered the immunotherapy (Durvalumab) for 1 year and then stopped. If he is well and his cancer is in remission, observation alone after stopping is appropriate. If his cancer should latterly relapse, further treatment with immunotherapy and/or chemotherapy could be considered so long as he is judged to be suitable to receive the treatment.

Jerrell answered 2 years ago

My immunotherapy treatment has been leading to hypothyroidism problems for me. Is this a sign for me to search for other treatment options? Should I take care of my thyroid issue first before continuing my cancer treatment? I am a stage 2 lung cancer patient

Dr Robert Lim replied 2 years ago

Thyroid disorders are one of the most common side effects of immunotherapy and should be relatively simple and easy to address with treatments. If it can be addressed this way, there is less reason to have to switch treatment especially if it is working well. It is interesting to hear that you are receiving this treatment as a stage 2 lung cancer patient. If you have had surgery to determine that it is stage 2, the usual treatment would either be chemotherapy or targeted therapy for the EGFR mutation if the latter was found. If you did not have surgery, then the treatment aims are not for cure but for control. For a stage 2 lung cancer that has not been removed surgically, the common options would be radiotherapy with chemotherapy, targeted therapy if a specific mutation is found and lastly also immunotherapy if judged to be indicated.

Xing Zhi answered 2 years ago

Is post-surgery immunotherapy a good treatment option for stage 2 liver cancer? If a patient is treated with immunotherapy, does he need any other treatment?

Dr Robert Lim replied 2 years ago

There is currently no evidence that any treatment for liver cancer after surgery is associated with lower chances of recurrence or improved survival. The standard of care would be surgery alone

Waiwan answered 2 years ago

What is the best treatment option for relapsed stage 3 pancreatic cancer that was previously treated with surgery?Do you think chemotherapy is palliative at his stage?

Dr Robert Lim replied 2 years ago

Relapsed pancreatic cancer unfortunately means that it is incurable, therefore similar to stage IV. Chemotherapy is the main treatment used for this situation with aims of controlling disease and prolonging survival. Testing for microsatellite instability MSI (for the possibility of immunotherapy) and BRCA mutations (for the possible use of PARP inhibitor drugs) can be considered too, though the odds of a MSI-high tumor or BRCA positive tumor are not that high. Treatment aims are palliative.

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