SINGAPORE - It is harder to recognise former Singapore Idol contestant Daphne Khoo, 26, these days with her chic pixie cut.
The third runner-up in the first season of singing contest Singapore Idol in 2004 and former lead singer of indie band West Grand Boulevard had long locks that the audience came to know her by.
She snipped them off in June last year in preparation for chemotherapy.
That was also the year she had a most stressful experience battling wave after wave of debilitating illnesses.
The 26-year-old was diagnosed with a form of ovarian cancer so rare that it affects perhaps one Singaporean a year.
Yet, she does not pity herself, telling Mind Your Body: "I see the illnesses as part and parcel of life. When life knocks you down, you just roll with the punches."
The petite music student takes a light-hearted approach to her hiatus from school, joking that the cancer was a welcome break after four rigorous semesters at the Berklee College of Music in Boston in the United States.
But while she looks on the bright side, she will not easily forget how she discovered her cancer. After a morning gym session in March last year, she had an outbreak of hives from her neck to her ankles.
Her eyes swelled up "like golf balls", so her Korean roommate whisked her off to the emergency department at Brigham and Women's Hospital nearby, where she was given antihistamines intravenously for close to eight hours.
Though her symptoms were alleviated, Miss Khoo decided to consult an allergist.
When skin prick tests yielded no conclusive results, she underwent a full-body check-up, which included a Pap smear of her cervix.
10cm growth in left ovary
It was during this physical examination that a nurse raised the alarm about Miss Khoo's bloated abdomen, which Miss Khoo said she had had since she was 18.
Back then, she had asked her mother to feel her abdomen, but there did not seem to be an abnormal mass.
Unknown to them then, it was abnormal for a woman to have swelling of the abdomen without weight gain in other places.
Miss Khoo said: "We just never thought it could be cancer as I felt no pain there."
After a pelvic ultrasound scan, she was told there was a 10cm growth in her left ovary which had to be surgically removed.
She still held up well when told by a nurse over the phone that it might be cancerous, but broke down when she was asked if any of her family members were with her.
She had lived alone in the US for the last two years for her studies, and the bad news could not have come at a worse time. Her parents, both 60 years old, and 30-year-old elder sister were then on vacation.
Miss Khoo first called her younger sister, a 25-year-old marketing executive, and then called her parents.
Her retiree father cut short his golf vacation in Atlanta and was by her side three days later. Her mother, a treasury manager in her own firm, steeled herself on her flight back to Singapore from Japan.
Mrs Denise Khoo said: "I had no mood to enjoy being in business class. I just kept praying for Daphne."
Mrs Khoo had herself been diagnosed with early stage breast cancer at the age of 49 and had had surgery, chemotherapy and radiation therapy.
So it pained her to know that her daughter was faced with a similar ordeal.
Rare form of ovarian cancer
Miss Khoo had surgery on May 17 last year at Brigham and Women's Hospital while her parents and then-boyfriend waited anxiously outside the operating theatre during the four-hour procedure.
The surgeon told them he removed her left ovary and left fallopian tube, together with the tumour which was, in fact, 13cm in diameter.
A few days later, they learnt, to their relief, her cancer had not spread to other areas of the pelvis.
However, it had spread to the tissue lining her peritoneal cavity or abdomen.
Miss Khoo had a rare type of germ cell cancer, known as dysgerminoma. The Singapore Cancer Registry noted that there were nine such cases in a decade, from 1998 to 2007.
A spokesman from the Ministry of Health said there was just one case between 2008 and 2010. Of every 100 cases of ovarian cancer, only about five are cases of germ cell cancer, said Dr Tay Eng Hseon, medical director of the Thomson Women Cancer Centre.
Germ cells are cells in the ovaries or testes that go on to form eggs or sperms. Most germ cell tumours are not cancerous, though the testicular cancer suffered by disgraced cyclist Lance Armstrong was a form of germ cell cancer.
The other, more common, types of ovarian tumours are those of the epithelium (tissue covering the ovaries) and sex cords (structures that develop into ovarian follicles where immature eggs grow).
Dr Tay said dysgerminoma can grow rapidly, from being impalpable to a large tumour in the span of a few months.
The typical symptom, therefore, is a fast-enlarging abdominal mass associated with pain. The cancer tends to strike women between 15 and 25 years old.
Dr Tay said this cancer was highly fatal until the late 1970s, when the platinum group of chemotherapy drugs was introduced.
The disease is highly sensitive to this class of drugs, to the point that almost no one will die from it now. The exception is a small group of patients with an even rarer and highly aggressive form of germ cell cancer which is still difficult to treat, Dr Tay said.
Obstructed bowels
A few days after her surgery, Miss Khoo was racked with such pain she could hardly lay still. She was constipated and vomiting bile.
She had fallen prey to an uncommon complication of abdominal surgery. Adhesions, or internal scar tissue, forming as part of the healing process, were creating blocks in her bowels.
The obstruction prevented her intestines from functioning properly.
Back at the hospital, Miss Khoo had a tube passed through her nose, down the oesophagus, and into the stomach to remove the contents that had accumulated since the bowel obstruction.
She said: "It felt like someone was stabbing me in the throat. It took everything in me to stay calm during the insertion."
Five days later on her mother's birthday on May 29, Miss Khoo finally had the tube removed. By that time, her intestinal obstruction had somehow resolved on its own. She was able to move her bowels.
The problem recurred a week later but, fortunately, the obstruction cleared on its own. Then there was also the trauma of losing her hair, for which Miss Khoo had been mentally prepared by her mother.
Two weeks before she began chemotherapy at the Memorial Sloan-Kettering Cancer Centre in New York, she had her chest-length hair cut in an avant-garde style with a bob on one side and the other shaved bald.
She said with a grin: "I felt it was a fun way of preparing myself for hair loss. I wanted to do it in style."
She also had her eggs retrieved and frozen to preserve fertility.
Don't brush off complaints
That was the positive part. After three cycles of chemotherapy that lasted nine weeks, Miss Khoo lost 7kg to weigh 45kg, though her body mass index (a measure of body fat based on weight and height) showed that this was still normal for her 1.52m frame.
The food lover tried to stimulate her appetite by viewing pictures of food, and tried to swallow the soup her mother cooked lovingly for her but nothing helped.
She joked that the upside to chemotherapy drugs was that they helped to clear her eczema and gave her baby-smooth skin.
She has since gone back to college, where she is completing her final semester to graduate in May. She has also switched her major from songwriting to professional music.
The past year has been hard for her as she loathes being dependent on others for her needs and kept indoors mostly.
When asked what she missed most during her illness, she said it was her hearty appetite, before adding softly: "I also appreciated my mum more."
Mrs Khoo said parents should take note.
"When young girls say they feel bloated, don't brush it off as nothing. Bring them for ultrasound scans because this could save lives."
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