After graduating in 1967 from the Medical School of the University of Hong Kong, and after a surgical stint (including neurosurgery), Dr. Tsao pursued an oncology career as inspired by Dr. H.C. Ho, a world-renowned expert on nasopharyngeal cancer (NPC) – a prevalent cancer in Southern China – currently ~1,000 new cases/year but very rare in Caucasians. By the early 1980s, with post-graduate qualifications (DMRT and FRCR), he was rather unhappy that Hong Kong had no academic oncology department – both undergraduate teaching and Western text information on NPC were then inadequate. In the mid-1980s, with the opening of Hong Kong’s first academic Department of Clinical Oncology at The Chinese University of Hong Kong (CUHK), he soon became the first Civil Servant oncologist-turned-academic. He was also involved in setting up the Department’s research laboratory – both equipment and staffing – and he was subsequently appointed as the Director of Radiotherapy, CUHK.

NPC is a solid cancer (as opposed to leukemias or lymphomas that are very responsive to chemotherapy) that is significantly more responsive to both radiotherapy (RT) and chemotherapy than other solid cancers, e.g., lung, breast, cervix and gastro-intestinal ones. For NPC, surgery is usually performed merely for intractable local relapses. For early stages, NPC is actually curable by RT alone, except that this represents only ~10% of all NPCs. Thus, other than striving to educate the public on early cancer presentation, an intense search was made for a reliable serum tumor marker to alert early NPC developments. Although serum ferritin was markedly raised in advanced NPC, it was not specific enough. The Epstein Barr virus (EBV) DNA was more specific but too costly for routine screening for early NPCs (repeated testing in a large normal population required), Although EBV has often been regarded to be closely related to NPC development, 100% of adult Chinese are infected (the use of chopsticks for sharing food at meals blamed). Thus, causation was more likely to be multi-factorial.

As Western textbooks lacked detailed NPC inputs, e.g., of specific incidence rates, etiology, early symptoms and signs, the optimal modalities of treatments and most importantly, an accurate description of complications of treating NPC, careful documentations of all of these aspects detailed in various papers and book chapters were published. Moreover, the classical Ho’s NPC staging system had to be revised and proposed actively to international staging authorities upon the availability of cross-sectional imaging techniques (the discussion on CT versus MRI for staging utilization being most relevant). In fact, much preparatory work in the early 1980s had already involved Dr. Tsao’s venturing to computerize the manually operated Hong Kong Cancer Registry. Such computerization was mandatory for documenting the exact incidence rates of NPC (as well as other cancers). Obviously, with the majority of NPCs in advanced stages, much research had also to be performed on managing relapsed or residual NPCs. For instance, Dr. Tsao’s self-designed after-loading intracavitary irradiation device for NPC (in the mid-1980s); his stereotactic irradiation technique for locally relapsed NPCs (in the mid-1990s). Although this was soon superseded by intensity-modulated RT (IMRT) some 5 years later, it is still very useful for some peripheral hospitals without the benefit of the complex IMRT technology or infrastructures.

With NPC’s very probable relationship with the EBV, lots of related research projects were undertaken. As there were many different strains of EBVs, interpretations should not be taken at face value regarding the role of EBV as an etiology agent. Remarkably, when one of Dr. Tsao’s post-graduate students applied high-dose vitamin C at the Department’s laboratory, EBV expressions were duly suppressed. Anyway, this remarkable incidental finding had alerted Dr. Tsao to the amazing therapeutic potential of vitamin C. In fact, other micronutrients’ role on possible reduction of cancer incidence rates had also been investigated. Although Dr. Tsao has already been using high-dose vitamin C (on compassionate grounds) for several years, it's the current pandemic that rekindled his prior interest in vitamin C as a safe, affordable anti-viral agent, as described in his book. Incidentally, Dr. Tsao’s other non-oncology research was on hormone assay – radioimmunoassay (RIA) for serum thyroid hormone – indirectly relevant for metering the precise dosage of thyroid hormones required for precise replacement and/or suppression purposes for thyroid cancer patients. Subsequently, RIA has been superseded by EIA (enzyme immunoassay) and subsequently used more directly for assaying EBV parameters, in collaboration with Y.Y. Gan of the Nanyang Technological University of Singapore.

Significant milestones for Dr. Tsao’s contribution to oncology include his decisive effort to increase Hong Kong’s WHO morphine quota – despite undue concerns, ultimately, intractable cancer pain could be controlled more readily. For other aspects of end-stage cancer care, Dr. Tsao was substantial in establishing Hong Kong’s first stand-alone hospice (the Bradbury Hospice) in the late 1980s – a "teaching hospice" to train local hospice care staff. Meanwhile, upon Hong Kong’s reduced tuberculosis rates, he also assisted the Haven of Hope Sanatorium to convert an under-utilized tuberculosis ward to a new hospice care ward. In Singapore, he also volunteered to provide regular medical support to their new hospice care ward at the St. Joseph's Home of Singapore. Meanwhile, in the late 1990s, he was also appointed to chair the charitable Parkway Healthcare Foundation which eventually donated a Chair of Geriatrics to the National University of Singapore – apart from the Foundation’s very active charity work for elderly centers in Singapore. Back in Hong Kong, Dr. Tsao also conducted weekly oncology teaching sessions in Macao SAR, China, upon their first commencing RT services there (2003–2008).

In the early 1980s, Dr. Tsao had a first-hand knowledge in the then milestone flow cytometry technology development for typing lymphocyte subsets, when implemented by S. Dische of the Mount Vernon Hospital, Northwood, England. Indeed, among all the various immunology parameters of NPC, lymphocyte subsets parameters were most interesting and warranted all those detailed discussions as published in late 1980s. In the late 2000s, another milestone was published by L. Galluzzi et al on the phenomenon of immunologic cell death (ICD). Disappointingly, we have all missed it for many decades mainly because we nearly always use immunodeficient mice for most oncology investigations (to ensure that no rejection of implanted tumors would ever occur); this, however, would miss the ICD phenomenon that could have been induced (had immunocompetent mice been used). Currently, Dr. Tsao believes ICD is not only potent but also safer than most other oncology modalities of treatment, e.g., high-dose chemotherapy. Importantly, as there are all these “mysteries” surrounding ICD, considerable introductory texts to simplify the issue are very appropriate.

Over the years, Dr. Tsao has published ~50 peer-reviewed papers in indexed medical journals, let alone several chapters in a few books. Recently, Dr. Tsao has gradually realized that the tumor microenvironment (TME) is actually closely related to the makeshift tumor vasculature as induced by cancers for their own survival and growth. Yet, the usual (or deliberate) lack of oxygen and excessive acidity would enable the TME to be the worst culprit for cancer relapse and resistance. Unfortunately, as the TME has many "plan Bs" and "plan Cs", probably, an "umbrella cover" strategy is mandatory, as introduced in Dr. Tsao’s recent publications (especially in his new book, "Bridging the Gap: in This Era of Cancer Immunotherapy"). Dr. Tsao believes cancer control may well be enhanced if the ICD phenomenon is activated and robust innate immunity is induced. Naturally, all of these rather complex phenomena require considerable thought and endless deliberation efforts. This is what Dr. Tsao has been doing. Hopefully, his publications will serve as readable summaries of the current thinking.

Shiu Y. Tsao, FRCR Past Director of Radiotherapy, the Chinese University of Hong Kong

After graduating in 1967 from the Medical School of the University of Hong Kong, and after a surgical stint (including neurosurgery), Dr. Tsao pursued an oncology career as inspired by Dr. H.C. Ho, a world-renowned expert on nasopharyngeal cancer (NPC) – a prevalent cancer in Southern China – currently ~1,000 new cases/year but very rare in Caucasians. By the early 1980s, with post-graduate qualifications (DMRT and FRCR), he was rather unhappy that Hong Kong had no academic oncology department – both undergraduate teaching and Western text information on NPC were then inadequate. In the mid-1980s, with the opening of Hong Kong’s first academic Department of Clinical Oncology at The Chinese University of Hong Kong (CUHK), he soon became the first Civil Servant oncologist-turned-academic. He was also involved in setting up the Department’s research laboratory – both equipment and staffing – and he was subsequently appointed as the Director of Radiotherapy, CUHK.

NPC is a solid cancer (as opposed to leukemias or lymphomas that are very responsive to chemotherapy) that is significantly more responsive to both radiotherapy (RT) and chemotherapy than other solid cancers, e.g., lung, breast, cervix and gastro-intestinal ones. For NPC, surgery is usually performed merely for intractable local relapses. For early stages, NPC is actually curable by RT alone, except that this represents only ~10% of all NPCs. Thus, other than striving to educate the public on early cancer presentation, an intense search was made for a reliable serum tumor marker to alert early NPC developments. Although serum ferritin was markedly raised in advanced NPC, it was not specific enough. The Epstein Barr virus (EBV) DNA was more specific but too costly for routine screening for early NPCs (repeated testing in a large normal population required), Although EBV has often been regarded to be closely related to NPC development, 100% of adult Chinese are infected (the use of chopsticks for sharing food at meals blamed). Thus, causation was more likely to be multi-factorial.

As Western textbooks lacked detailed NPC inputs, e.g., of specific incidence rates, etiology, early symptoms and signs, the optimal modalities of treatments and most importantly, an accurate description of complications of treating NPC, careful documentations of all of these aspects detailed in various papers and book chapters were published. Moreover, the classical Ho’s NPC staging system had to be revised and proposed actively to international staging authorities upon the availability of cross-sectional imaging techniques (the discussion on CT versus MRI for staging utilization being most relevant). In fact, much preparatory work in the early 1980s had already involved Dr. Tsao’s venturing to computerize the manually operated Hong Kong Cancer Registry. Such computerization was mandatory for documenting the exact incidence rates of NPC (as well as other cancers). Obviously, with the majority of NPCs in advanced stages, much research had also to be performed on managing relapsed or residual NPCs. For instance, Dr. Tsao’s self-designed after-loading intracavitary irradiation device for NPC (in the mid-1980s); his stereotactic irradiation technique for locally relapsed NPCs (in the mid-1990s). Although this was soon superseded by intensity-modulated RT (IMRT) some 5 years later, it is still very useful for some peripheral hospitals without the benefit of the complex IMRT technology or infrastructures.

With NPC’s very probable relationship with the EBV, lots of related research projects were undertaken. As there were many different strains of EBVs, interpretations should not be taken at face value regarding the role of EBV as an etiology agent. Remarkably, when one of Dr. Tsao’s post-graduate students applied high-dose vitamin C at the Department’s laboratory, EBV expressions were duly suppressed. Anyway, this remarkable incidental finding had alerted Dr. Tsao to the amazing therapeutic potential of vitamin C. In fact, other micronutrients’ role on possible reduction of cancer incidence rates had also been investigated. Although Dr. Tsao has already been using high-dose vitamin C (on compassionate grounds) for several years, it's the current pandemic that rekindled his prior interest in vitamin C as a safe, affordable anti-viral agent, as described in his book. Incidentally, Dr. Tsao’s other non-oncology research was on hormone assay – radioimmunoassay (RIA) for serum thyroid hormone – indirectly relevant for metering the precise dosage of thyroid hormones required for precise replacement and/or suppression purposes for thyroid cancer patients. Subsequently, RIA has been superseded by EIA (enzyme immunoassay) and subsequently used more directly for assaying EBV parameters, in collaboration with Y.Y. Gan of the Nanyang Technological University of Singapore.

Significant milestones for Dr. Tsao’s contribution to oncology include his decisive effort to increase Hong Kong’s WHO morphine quota – despite undue concerns, ultimately, intractable cancer pain could be controlled more readily. For other aspects of end-stage cancer care, Dr. Tsao was substantial in establishing Hong Kong’s first stand-alone hospice (the Bradbury Hospice) in the late 1980s – a "teaching hospice" to train local hospice care staff. Meanwhile, upon Hong Kong’s reduced tuberculosis rates, he also assisted the Haven of Hope Sanatorium to convert an under-utilized tuberculosis ward to a new hospice care ward. In Singapore, he also volunteered to provide regular medical support to their new hospice care ward at the St. Joseph's Home of Singapore. Meanwhile, in the late 1990s, he was also appointed to chair the charitable Parkway Healthcare Foundation which eventually donated a Chair of Geriatrics to the National University of Singapore – apart from the Foundation’s very active charity work for elderly centers in Singapore. Back in Hong Kong, Dr. Tsao also conducted weekly oncology teaching sessions in Macao SAR, China, upon their first commencing RT services there (2003–2008).

In the early 1980s, Dr. Tsao had a first-hand knowledge in the then milestone flow cytometry technology development for typing lymphocyte subsets, when implemented by S. Dische of the Mount Vernon Hospital, Northwood, England. Indeed, among all the various immunology parameters of NPC, lymphocyte subsets parameters were most interesting and warranted all those detailed discussions as published in late 1980s. In the late 2000s, another milestone was published by L. Galluzzi et al on the phenomenon of immunologic cell death (ICD). Disappointingly, we have all missed it for many decades mainly because we nearly always use immunodeficient mice for most oncology investigations (to ensure that no rejection of implanted tumors would ever occur); this, however, would miss the ICD phenomenon that could have been induced (had immunocompetent mice been used). Currently, Dr. Tsao believes ICD is not only potent but also safer than most other oncology modalities of treatment, e.g., high-dose chemotherapy. Importantly, as there are all these “mysteries” surrounding ICD, considerable introductory texts to simplify the issue are very appropriate.

Over the years, Dr. Tsao has published ~50 peer-reviewed papers in indexed medical journals, let alone several chapters in a few books. Recently, Dr. Tsao has gradually realized that the tumor microenvironment (TME) is actually closely related to the makeshift tumor vasculature as induced by cancers for their own survival and growth. Yet, the usual (or deliberate) lack of oxygen and excessive acidity would enable the TME to be the worst culprit for cancer relapse and resistance. Unfortunately, as the TME has many "plan Bs" and "plan Cs", probably, an "umbrella cover" strategy is mandatory, as introduced in Dr. Tsao’s recent publications (especially in his new book, "Bridging the Gap: in This Era of Cancer Immunotherapy"). Dr. Tsao believes cancer control may well be enhanced if the ICD phenomenon is activated and robust innate immunity is induced. Naturally, all of these rather complex phenomena require considerable thought and endless deliberation efforts. This is what Dr. Tsao has been doing. Hopefully, his publications will serve as readable summaries of the current thinking.

Showing the single result

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