Lung Cancer: Why do a biopsy when you don’t want to go for chemotherapy?

SK (S123) is a 59-year-old lady from Indonesia. On 11 November 2011 she came to a private hospital in Penang for a general wellness check-up.  She did not have any symptoms. She was given a “booklet” containing the data of her health screening and was told by the doctor that she was healthy – no problems. The following are some of the information for us to study carefully.

  • The chest X-ray report showed both lungs are clear.
  • Ultrasound of abdomen indicated fatty liver.
  • Blood test results are as follows:


ESR 42     High
Platelet 102   Low
Free T4 (ng/dl) 1.5    High
Free T4 (pmol/L) 19.3  High
Alanine transaminase 52      High
GGT 31
AST 37      High
Alkaline phosphatase 136

SK went home to Jakarta feeling satisfied and happy after being given a clean bill of health by the doctor. However, about three months later, SK developed fevers and breathing difficulties. She consulted a lung specialist in Jakarta and was hospitalized. There was fluid in her lungs. Pleural tapping was done. Four liters of fluid were tapped out of her lungs during the 5 days in the hospital. The doctor suggested a biopsy to be followed by chemotherapy or take an oral chemo-drug, Tarceva. SK refused. She was afraid of the side effects. The total cost for this hospital stay came to about 30 million Indonesian rupiahs.

SK came to a private hospital in Kuala Lumpur for a second opinion.  She was hospitalized for a week where a  CT scan and biopsy were performed. During that time too, another 700 ml of fluid was tapped out of her lungs. The report of the biopsy of her lung dated 28 February 2012 indicated a moderately differentiated adenocarcinoma.

SK refused chemotherapy.  The doctor gave up and she was asked to go home. The total medical expenses in Kuala Lumpur came to RM 10,500.

On 28 February 2012 we received this e-mail.
Dear Mr. Chris,

My name is S. The doctor in Jakarta said my aunty has lung cancer stage 4. At the moment, we are in Kuala Lumpur (hospital). The result of biopsy will come out on Thursday or Friday, but the doctor said it’s seems advanced cancer. We would like to seek your help. Can we come to Penang without result or should we wait for the result? Your prompt reply will be highly appreciated

Thank you, best regards.

Reply:  Wait for the results and bring all the medical reports. No need to hurry. Come on Friday if you can, or Sunday night. See my website:


Over the years, I have noticed a peculiarity about cancer patients, especially those from Indonesia.  They come to hospitals in Malaysia for a second opinion after being told that they have cancer by doctors in their home country. They undergo all the test, scans, biopsy, etc. Again they are told they have cancer. They refused treatment and pack their bags and go home. I cannot understand such behavior. If you do not want to do follow up treatment why do you proceed to do the biopsy? SK spent RM 10,500 and then she decided to go home without any treatment. Actually, even the CT scans done in Jakarta were indicative enough of her lung cancer. Why go the extra step and then quit half way? As I have said earlier, this happens very often!

Health or wellness screening is another phenomenon. Do you see the flaw of going for such check-up?  I wonder how helpful is such a screening procedure?  SK was told her health was in perfect condition in November 2011 after the check up. I, however, would disagree with that.   Her ESR was high, plantlet count was low and two of her liver enzymes were elevated. Her health was not perfect. There was something wrong somewhere? But the doctor said she was in perfect health! Can you believe that? What the doctor said might not be correct!

Three months later SK’s lungs were filled with fluid. The irony was three months earlier an X-ray showed her lungs were clear. How could that be? Are we to say that within three months from “nowhere” her lungs have grown so many tumours? Another question is  –  what could have caused her lung cancer? Could it be a metastasis from somewhere? I was curious and tried to find out more. SK told me that some eight years ago she had an operation to remove a 10-cm fibroid. I wondered aloud. Could that be cancerous, and she was not told about it? And now the lung cancer is actually a metastasis?  SK had been having coughs on and off for many years. Is this not an early sign of metastasis? My aunty also had chronic coughs for two years before a CT showed that her cervical cancer had metastatised extensively to her lungs. Unfortunately, SK is not educated and could not read much – she did not have any clue of what was happening to her.