Sarcoma is a form of cancer that originates from mesenchymal cells, the same stem cell that can differentiate to become soft tissues like muscle, cartilage, tendon, bone and fat. Because of this, and unlike other types of organ-specific cancer, sarcoma can occur in any soft tissue in any part of the body and in most bones, says Dr. Grace Moshi, director and founder of Sarah-Grace Sarcoma Organisation Singapore (SGSOSG), a cancer survivor, and a well-regarded medical practitioner.
Clinical observation shows that its occurrence peaks during times of rapid positive growth, such as among children aged three to five years old, and among teenagers who are 16 to about 18 years old. During those periods the cancer tends to affect the long bones, she continues. Sarcoma also seems to be associated with phases of negative growth, such as menopause. Nevertheless, it is rare in adults, accounting for about 1 per cent of adult cancers, but about 20 per cent of all childhood cancers.
“Sarcoma can occur anywhere in the body; it is often hidden deep in the tissues and tends to show vague symptoms that by the time it is diagnosed, often when a person is feeling pain, it is in advanced stage,” Dr. Moshi explains. In children, it occurs around the same time that they are experiencing bone pain from growth and may thus be misdiagnosed.
“These are the reasons why we want to raise awareness in the community and even among GPs. The wisdom is that any lump that's larger than a golf ball needs to be checked out – through MRI, X-ray or CT scan. If there are vague symptoms with a lump, although it doesn't mean it’s necessarily sarcoma, it's worthwhile to checking it out.”
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In 2010, Dr. Moshi founded the Sarah-Grace Sarcoma Foundation (SGSF) in Australia to advocate for increased research into new and better treatment for sarcomas. SGSF also launched a health campaign component, Kick Sarcoma, which raises sarcoma awareness. “We go to sporting teams and schools to tell the children that if they have any discomforts, lumps or bumps that are not sports-related injuries to have them checked out. We don't tell them it's sarcoma but make them aware that getting themselves checked out is worthwhile.” They also distribute bright green shoe laces to children to call attention to their activity.
SGSOSG, meanwhile, has been working as a foreign organization in Singapore. With its registration as a charity organization this year, Dr. Moshi plans a more robust and varied awareness campaign, along with initiatives that will tap on what SGSF has built. To date, SGSOSG has identified youth ambassadors, one of whom is a young Danish student at an American school here in Singapore. “She’s an amputee who has qualified to join the Danish paralympic team; she will be doing a big ‘swimathon’, and we'll be there to help raise awareness for sarcoma.”
Both SGSF and SGSOSG reach out to communities of affected kids through Kick Sarcoma, “especially if they're amputees”, Dr. Moshi underscores. “Sometimes, kids are not very nice to each other, so we talk to them about sarcoma, and why a person had to lose a leg. We provide psychosocial support to affected children, and we mentor them with other sarcoma survivors.” In Australia, the patron of the organization is an amputee and paralympic swimmer. “We put them in touch with other survivors who have gone through the journey, and support them through community events.” The organization, she highlights, is fully run by volunteers. “Nobody gets paid.”
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Sarcomas, Dr. Moshi emphasizes, usually have very bad prognosis. About 50 per cent of people die within five years of diagnosis mostly because of the delay in diagnosis, she says. The poor prognosis and the presence of many subtypes that may affect different parts of the body further complicate treatment as no single chemotherapy works for all of them.
“We established, through the main Foundation, a sarcoma research program at the John Curtin School of Medical Research in Australia,” Dr. Moshi says. It's a good research school with five Nobel Prize winners including the current Vice Chancellor, she adds. “And as a registered charity in Singapore, we formed a collaboration with KK Women's and Children's Hospital last year.” The research groups from the two institutes are working together on compounds that have been discovered through the research program to treat sarcoma. The compounds will be tried on Asian cell lines in Singapore. “We also worked with VIVA Foundation for Children with Cancer to set up this collaborative research.”
In Singapore, SGSF is funding a locally developed immunotherapy that primes the patients’ own immune system to fight the cancer if it recurs after surgery. It is also setting up funds to bring the latest or unavailable chemotherapy to children. “Surgery is the mainstay of treatment,” Dr. Moshi says, “chemotherapy does not necessarily work in all types of sarcoma, except in some osteosarcomas.”
Dr. Moshi is passionate sarcoma drug research. “Drug development is a bit archaic; it takes one researcher years of work just on one thing every single day to get somewhere, and because of that, a lot of the drug companies have started taking over drug development. I’m not saying this just to criticize drug companies,” she clarifies.
“I'm pro-artificial intelligence. Today, we've got these high-throughput drug development platforms, which can test thousands of drugs at thousands of concentrations. So, it's taken research from going five years per research to six months or seven months. These are university-initiated programs that put research back to the intellectual space where it should belong. I think that's the right way to go.”
In the near future, Dr. Moshi plans to raise more funds in Singapore. “We will be eligible to apply for IPC (Institutions of Public Character) next year. We're hoping to reach the required KPIs in order to get an IPC status, which will put us in a much better position to do a lot more fundraising.”
Dr. Moshi hopes to collaborate with a lot of companies that may want to extend help them as part of their corporate social responsibility (CSR). But she draws the line at accepting funding from drug companies. “We don't want any bias in our research, that’s why we stay away from drug companies.”