AS (S-357) is a 65-year-old Indonesian. He came to seek our help on 14 April 2013 after having undergone a failed liver surgery in Singapore.
His problem started in late December 2011 when AS felt gastric-like pain in the stomach. An ultrasound at a hospital in his hometown indicated a possibility of gallbladder infection.
Not satisfied, AS went to Jakarta and on 31 December 2011 underwent a cholecystectomy (surgery to remove gallbladder). During the operation, the surgeon also did a liver biopsy for suspicious liver lesions.
In February 2012, AS went to the National Cancer Centre in Singapore for a second opinion. The histology slides from the early surgery and liver biopsy were reviewed. The liver biopsy showed poorly differentiated tumour.
A whole body PET / CT on 2 February 2012 revealed left hepatic lobe mass, measuring 3.2 x 2.6 cm (picture below).
On 25 April 2012, AS had another CT scan. The report indicated interval increase in size of the dominant heterogenous hepatic mass from previous 2.9 x 2.6 cm to currently 0.3 x 3.5 cm. No other new focal hepatic lesion seen. (Note: this report stated a different tumour size compared to the earlier report. A mistake somewhere?).
On 3 May 2012, AS underwent a hemihepatectomy – i.e. a surgery to remove one-half or a lobe of the liver. The tumour was at the left lobe of his liver. AS was discharged on 9 May 2012. The procedure cost S$28,000.
Liver histology indicated a hepatocellular carcinoma (HCC or liver cancer), 4 cm, Edmondson Grade 3 with 3 satellite nodules. Resection margins were clear. Vascular invasion was present. The 2 diaphragmatic nodules were metastatic HCC. Gallbladder shows chronic cholecystitis with no malignancy seen within.
About three months later, 16 August 2012, AS went back to Singapore for review. A repeat CT of abdomen and pelvis showed NO evidence of recurrent HCC or focal liver lesion.
Unfortunately this euphoria did not last long. Six months later (i.e. about 9 months after the surgery) another PET /CT scan on 11 March 2013, revealed a new recurrent hetergenous hypodense mass in the liver at the resected margin measuring 8.0 x 4.8 cm (picture below).
On 22 March 2013, AS underwent TACE (transarterial chemo embolization) for his recurrent liver tumour. Unfortunately this procedure failed. The interventional radiologist was unable to access the tumour feeding vessel. So TACE could not be completed and the chemo drug not delivered. In spite of the failure, AS had to pay S$5,000 for the procedure.
AS was discharged on 25 March 2013 and was referred to an oncologist for chemotherapy. AS decided to give up further medical treatment and came to seek our help on 14 April 2013.
While talking to AS, his wife and son I posed this question: Why don’t you want to go for chemotherapy? After all AS had willingly undergone surgery and TACE – why chicken out now?
The wife replied, We are scared!
AS replied: The doctor did not show any responsibility.
My reply: What do you expect from the surgeon? What more do you want him to do? His job is to cut you. And has cut you and there is nothing more that he can do. He has done his job. Now, he is passing you to the oncologist because he is a surgeon and not an oncologist!
From his reply I fully understand how AS felt – being let down by the surgeon. He was totally disappointed. He came to the surgeon in Singapore believing that he was in the safe hands of the expert. He was willing to pay S$28,000 for the surgery but he did not get what he had bargained for. Now, he was passed on to another doctor – where is the responsibility then?
Let me tell you – AS is not the only one who felt let down or cheated. There are many, many others who come to us with a similar story. I am reminded of one really pathetic case. A man from Pontianak was pushed into undergoing surgery for his liver cancer (see A great failure and let down ) He was told that his condition was serious and surgery must be done immediately. The wife said: The surgeon even hugged me and assured me – Don’t worry, he (my husband) would be well and alright. Oh, it was so sweet of him. Unfortunately after the surgery, the cancer recurred. The patient and his wife tried to seek clarification from the surgeon. They were snubbed. The surgeon did not even want to talk to them. The wife was full of tears when she related this story.
Yes, I fully understand how patients feel after a medical failure.
I told AS and his family that his is a big problem and I am not sure if I could help him. I can only do my best. AS was prescribed Capsule A, B, C and D. In addition he has to take LL-tea, Liver 1 and 2 teas. We sent him for a blood test. The results as of 15 April 2013 showed his alpha-fetoprotein = 1,064.0 and total bilirubin = 25.0. Other liver function enzymes were within normal range.
Question You Should Ask: Can surgery cure me?
I always pose this question whenever a patient comes to see me, Before you undergo surgery, chemotherapy or radiotherapy, did you ever ask the doctor if the treatment he is giving you is going to cure you? You will be surprised most cancer patients don’t ask such question. They take it for granted that they will be cured!
AS told me. I did not ask that question. I only asked, What is the best way out for me! I told him, That’s the wrong question to ask! If you go to a barber, he will tell you the best option for your head is to cut your hair. If you ask a hammer what all of us look like in this world, the answer would invariably be, You all are nails meant to knocked down! You go to a surgeon he would most likely say, Operate. That’s his best option for you. Ask the oncologist, he would invariably say, Go for chemo! You have missed the point here. Is the procedure suggested going to cure you? This ought to be the main concern.
By asking the wrong question, you get an answer that brings you elsewhere – perhaps where you don’t want to go. So, my advice to all patients, Ask this all important question – can your treatment cure me? Don’t be afraid, ask.
After you get the answer then use your commonsense to evaluate what the doctor tells you. Does it make sense? Do you believe in the statistics or percentage or whatever claim the doctor gave you? If this is not what you are looking for, go elsewhere. Look for another path.
Likewise, when you come to CA Care and tell me that you want me to cure you of your cancer I would tell you this, Go elsewhere – I don’t have the magic bullet and I cannot cure you! In my many years helping cancer patients I don’t really see any so-called cure for cancer. Cure means the disease goes away and never come back. Generally, the cancer recurs after some years. My auntie died of metastatic cervical cancer after an apparent cure, 13 years later! Where is the cure?
In the case of AS, surgery did not cure him! After 9 months, the tumour grew back and this time it grew more than twice its original size. Where is the cure?
The next question you probably need to ask is about your diet. This question will give you some idea about the kind of doctor you are dealing with! His answer shows his perception about health in general. And more important whether he is well read or not. Today the medical literature is replete with information about diet in spite of how important it is in helping cancer patients. If he says you can eat whatever you like – I am sorry, I am not sure if this is the kind of doctor you should go to! I am fully aware that diet in cancer is a big, sore point between medical doctors and alternative medicine practitioners. Suffice for me to quote what two doctors said about diet (below). Think hard about what your doctor tells you about diet and come to your own conclusion. If you are not convinced that he is right, how do you expect him to be able to solve the bigger problem of treating your cancer?