DL is a 47 year-old-male. Sometime in September 2010, he had uncomfortable feelings in his stomach. He went to see a GP who thought it was a food poisoning or gastric problem. He was told not to worry about it as the problem would just go away in a day or two.  Unfortunately it was not to be. The problem persisted and in early February 2011, DL felt there was lots of air/gas in his stomach.  In the early morning of 8 February 2011, DL went to see the same GP again. This time the doctor took his blood sample for analysis. An ultrasound was also done.

The blood test results of 8 February 2011 showed ESR = 40 (high), GGT 67 (high) while the cancer markers were all within normal range; CEA = 0.7, CA19.9 = 7.7, and Total PSA = 0.5.

Ultrasound of the abdomen showed “thickened loop of bowel, suggestive of colorectal malignancy”. He was advised to undergo a colonoscopy and CT scan of the abdomen.  A follow up CT scan confirmed thickening in the colorectal region.

On 10 February 2011, a colonoscopy was performed. There was a caecal polyp, and ulcerated growths in the transverse and sigmoid colon.

Biopsy report confirmed the following:

1. Caecal polyp:  tubule-villous adenoma with high grade dysplasia, along with suspicious foci of infiltration.
2. Transverse colon: malignant transformation of a tubule-villous adenomatous polyp with foci of infiltration.
3. Sigmoid colon: malignant tubule-villous adenoma with foci of infiltration. Grade 2 adenocarcinoma with infiltration.

DL was referred to the government hospital for surgery.  A second colonoscopy was done at the government hospital and on 1 March 2011, DL underwent an operation to remove the cancer. According to the pathology report, the descending colon, part of ileum of appendix, caecum, ascending colon and descending colon and mesocolon were resected.  Histology indicated:

1. Mycinous adenocarcinoma, well differentiated, pT3NoMx
2. Tubular adenoma with invasive adenocarcinoma at caecum, well differentiated.
3. Intramucosal adenocarcinoma (at caecum) forming small polyp.
4. Inferior mesenteric lymph node: no malignancy.

DL was in the hospital for seven days.  He was told that it was a Stage 2 cancer. DL was subsequently referred to an oncologist in the same government hospital. The oncologist offered chemotherapy and this is what DL was told:

“With chemotherapy, the chance of recurrence would be 17 percent, without chemotherapy the chance of recurrence would be 20 percent.” DL would have to undergo thirty cycles of chemotherapy.

Listen to what DL told us when he came to CA Care on 15 July 2011.

Comments

DL was indeed lucky to have met an honest oncologist who told him the “reality” of what chemo is all about.

• In exchange for thirty cycles of chemotherapy, DL would stand to cut recurrence rate by 3 percent.
• An equally important   point not said but implied is that even with chemotherapy there is no certainty that DL would remain cancer free. There is a 17 percent chance of recurrence.

So in dealing with cancer, no one will know with certainty its ultimate outcome.  Patients need to be honestly told the odds against them. The cards must be laid out openly on the table. Patients must be the ones to make the decision since this involves their life.

It is most unfair for those in the know to tell only the “good things” about chemo treatment, downplaying the many “bad things.” Patients are sometime “threatened” and “pushed” or “cheered” into taking a path that they are reluctant to take. We salute DL’s oncologist for being honest with DL. Even more so, when he told DL that should DL decids to do chemotherapy in the future, he is welcome to come back to receive the treatment. Many patients tell us, “If we defy our doctors, we will not be able to go back to the hospital again.”  This fear is real and has “cowed” patients into following what their doctors want them to do.