Liver Cancer: Surgery and Chemo Did Not Cure Him

Surgeon told him three years too late that nine out of ten patients whom he operated on died anyway

KB (H467) is a 57-year-old male. In 2006, he suffered back pains. CT scan of the abdomen on 23 June 2006 indicated: “a hypervascular lesion in the right lobe of liver in Segment 6/7 measuring 3.5 x 5.2 x 4.5 cm. This has ill-defined margins. Features suggestive of an underlying hepatoma.”  In short, KB had liver cancer and without hesitation and in haste due to fear, he underwent liver surgery in a private hospital in Penang. This cost him RM35,000.

As a follow-up treatment, KB underwent seven times of  chemoembolisation. Each treatment cost RM5,000. The first five treatments were well tolerated but the last two caused severe side effects. It was a difficult experience and KB said he was “half dead”.

About three years later, KB felt a lump in his abdomen. CT scan on 23 June 2009 report is a follows:

“There is a previous segment 6/7 and 7/8 wedge liver resections. There are multiple foci of lipiodol uptake in the liver post chemoembolisation in keeping with multicentric hepatomas.  These range from 2 – 20 mm in size. There are several recurrent hypervascular foci noted scattered in the subdiaphragmatic region of the right lobe of liver ranging from 5-15 mm. Absent gallbladder (previous cholecystectomy). No evidence of abdominal lymphadenopathy.”

Another CT scan was done on 4 September 2009. The imaging report appeared exactly the same as the one written on 23 June 2009 with the following exception:

“There are several hypodense foci in the right subdiaphragmatic region ranging from 2-15 mm. Impression: several  hypodense lesions scattered in the subduaphragmatic region of the right lobe of liver, ? generating nodules, ? early hepatomas.

MRI was also done on 3 October 2009. The report appeared exactly the same as the CT scan reports of 23 June and 4 September 2010, with the following exception:

“There are multiple irregularly enhancing nodules scattered in both lobes of the liver with clustering in the right subdiaphragmatic regions ranging from 3- 20 mm. These are suspicious of multicentric hepatomas.”

It was a real disappointing result for KB and his family. At that time he was still undergoing chemoembolisation. KB complained to the surgeon that the treatment was making him sick. The surgeon said this: “Out of ten patients I operated on, nine died.” KB and his family were also told that KB was already lucky that he is still alive. “Most of others patients have all died. If you do not wish to continue with the chemo, you would be waiting to die.”

Listen to our video conversation below.

The son told us: But he only told us this fact three years after the operation. The surgeon should have told us before he did the operation.  Disappointed KB decided to see another doctor in Ipoh. A total body CT scan was done on 10 August 2010. The report is a follows:

“There are multiple hypodense lesions seen within the liver affecting nearly the entire parenchyma, with clustering seen in the subdiaphagramatic region. This is suggestive of multicentric hepatoma. The area of involvement is worse than that seen in previous scans.

In the private hospital in Ipoh, KB received three i/v chemo treatments. Unfortunately the treatment was not effective.  The family was told about CA Care and KB and his family came to see us on 26 November 2010.  Take a look as his blood test results.

  4 Oct 10 15 Oct 10 4 Nov 10 19 Nov 10
Direct bilirubin 7.3 6.7 5.9 7.4
SGOT/AST 116 103 112 132
SGPT/ALT 66 49 55 74
GGT 882 723 649 790
Alkaline phosphatase 179 157 138 179
Alpha-fetoprotein 2480 2419 3185 3208

Comments:

This is indeed a sad story. Talking to KB and members of his family that night, made me realized how vulnerable we all are. KB trusted the expert to cure him. He was willing to spend so much money to find the cure for his liver cancer. He did not doubt about what he was doing  – for that matter he probably took it for granted that he would get his cure. Like most people believe, after the operation the cancer is gone.

Then came the bombshell three years too late. He was told that nine out of ten patients who underwent liver surgery died anyway! I asked him: “Before you had the surgery, did you ever ask the doctor if surgery would cure you?” The answer was NO. Well, most patients never ask such a question. They took for granted that surgery would be the “magic tool”. His wife said: “We were ignorant”. KB said: “I was in fear.”

Dr. Hamilton, a neurosurgeon, in his book: The scalpel and the soul, wrote: “As doctors, we generally don’t tell outright lies. We just don’t speak the truth fully.”

So, here it is. If you don’t ask you get no answer. There is a Malay saying: Segan bertanya, sesat jalan (Shy to ask, you lose your way).

This is what I always tell patients. Before you do anything – be it surgery, chemotherapy, radiotherapy or even taking drugs – ask the doctor first of the possible and expected outcome. Why the rush to get things done? Ask if what he is going to do or giving you is going to cure you or not. Then evaluate his answer or response. What he says, how he says it and how he addresses your concern (including his body language) will tell you where you are heading for.

I was a bit baffled that night. I asked KB and his family – what made the surgeon say that damaging “confession” – nine out of ten patients whom he operated on died. In what context or under what circumstance did he say such a thing? I got this answer. KB was unhappy because the chemo was “killing” him and he complained to the surgeon about it. He was reluctant to go on further with the chemo – in spite of having received seven “shots” already. In an effort to make KB comply with his instruction, perhaps “threatening” KB with a possible death would do the trick?

But then why come out with such damaging statement? One is tempted to speculate that this “truth” has been lying buried in his heart all these days of his professional life but he could not share this truth with his patients. But once a while, things have to “explode” and be let out. Unfortunately for KB, this truth is revealed three years too late. What if KB was told that he had only a 10 percent chance of survival before he underwent the surgery? Would he go ahead with the surgery?

Why must doctors adopt the attitude that “we just don’t speak the truth fully”?

At CA Care we lay out our cards on the table – clearly and fully. When KB came to see us, I have made it clear that I would not be able to cure him at all. But I promise to do my best to help him – the way that I know how. I told him to keep to the good diet. Cancer patients cannot eat anything they like. I am aware that most patients are disappointed and they never come back again after hearing my “lecture.” That is okay – it is better to be honest and become unpopular with patients than misleading them.  The wise words of Rabbi Harold Kushner came to mind. In this world we have a choice on how we conduct our affairs:  “There is the morality of cleverness and wit, in which success means getting the better of the other person by means of a slick business deal or a clever answer. Then there is the morality of righteousness, in which the highest good is thoughtfulness toward others. The worst sin is hurting another person.”

In his book, Never to be lied to again, Dr. David Lieberman wrote:

  • In an ideal society there would be no need for lies. But we live in a world of deception. And whether you want to play or not, you’re in the game.
  • And there’s one undeniable truth about lying – everybody does it.
  • Some of these lies can be “subtle that they can be easily missed unless you pay close attention”. Others may be glaringly obvious. In some instances, you’ll be looking for lies of omission – what’s missing that should be there.

Dr. Lieberman offered numerous tips in his book on how to detect lies and deception. Here are some examples:

  • Body language – the truth can be always silently observed. No or little direct eye contact is a classic sign of deception. Feeling guilty a lier does not want to look you in the eyes. Liers tend to be less expressive with his hands or arms. Arm movements and gestures seem stiff and almost mechanical – not natural.
  • Someone who is lying rarely points a finger, either at others or straight up in the air. Finger pointing indicates conviction and authority.
  • Watch out for the good old Freudian slip or slip of the tongue.  This is a subconscious leak when a person’s misspoken words reflect and reveal his true feelings, thought or intentions.
  • He doesn’t want to respond to a question. He may imply an answer but never answers  it directly.
  • When asked a question, he depersonalizes his answer by offering his belief on the subject instead of answering directly.

Here are something we can do and need to be aware of:

  • When you’re desperate, you’ll be apt to do what you never should do – make a decision out of fear.
  • Just because you’re told that something is the latest, best, hottest or biggest seller does not make it right for you.
  • A white lab coat does not make anyone an expert.
  • Evaluate a person’s integrity based upon what is being presented not what is promised.
  • Often we don’t stop and ask ourselves, “Does this make sense?” A dash of common sense can go a long, long way.
  • We certainly can’t stop people from trying to lie to us, but we can keep them from being successful.

Read the following related posts:

A Great Failure and Let Down

Surgery for Liver Cancer: Eighty Percent Success?

Liver Cancer: He Died After a RM 10,000 Open-Close Surgery

The Doctor Said: “No More Hope” After a 60-Million-Rupiah Operation for Bile Duct Cancer

Healing of Metastatic Liver Cancer

 

 

 


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