Part 2: Cervical Cancer: Look Up To God For Guidance
WD (S-536) is a 39-year-old lady from Indonesia. Sometime in May 2013, she had a routine Pap smear and was told that everything was alright. Three months later, she had bleeding after sex. In November 2013, she did another Pap smear. Again WD was told there was nothing wrong! Unfortunately, the bleeding did not go away.
In February 2014, WD came to a private hospital in Penang for further check up. The gynaecologist did a biopsy and the result indicated an invasive non-keratinising moderately differentiated squamous cell carcinoma, large cell variety. It was a Stage 2A cervical cancer.
A CT done on 14 February 2014 (below) indicated cervical carcinoma with no evidence of local infiltration or distant metastasis.
According to the gynaecologist, surgery was not indicated and there was nothing he could offer her. WD was then referred to an oncologist. WD was told she had to undergo 25 to 28 times of radiation treatment and 5 cycles of chemotherapy. Chemotherapy would cost RM 2,500 per cycle while the total cost for radiotherapy would be RM7,500.
WD came to seek our help on 20 February 2014. The following are excerpts of our conversation that day.
Chris: You have been asked to go for chemo and radiation. Did you ask if these treatments are going to cure you?
WD: Seventy percent cure. The oncologist said, “if you want 100 percent then go to God.” (Pointing up) ha, ha.
C: Did you ask about the side effects?
WD: I shall have menopause. Apart from that there would be no other problems. I would be given “good” medicine that does not cause vomiting or hair loss.
C: It looks like the treatment is not going to cause you any problem then.
WD: Yes, but yesterday after talking to the oncologist, I saw patients in the waiting room. Some of them had difficulties and had to be fed. So I told my husband I do not want to be like that.
C: You were told you would be okay, but what you saw in the waiting room was a different picture!
WD: There is another reason why I did not want to go for chemo. Before they did the CT scan for me, they gave me an injection (contrast agent). Look at my hand now – blue black and it has been like this for already a week.
I was not able to eat for 2 days after the CT scan. I had non-stop diarrhoea.
My friend had breast cancer and she went for chemo in Singapore. After 2 years the cancer spread to all over her body. She just died a few months ago.
WD is a sweet, upbeat lady with a positive attitude. It is indeed sad that she ended up with cancer at 39. When she came to ask for help, I was dumbfounded – wanting to offer her another option but not knowing what the outcome could be. Either way, there is no right or wrong answer. Let me explain my dilemma.
I started to read Chapter 3 – Invasive Cervical Cancer of the book, Clinical Gynecologic Oncology by Philip Disaia and William Creasman.
- The cause of cervical cancer is unknown but its development seems related to multiple insults and injuries sustained by the cervix. Squamous cell carcinoma of the cervix is virtually nonexistent in a celibate population.
- Currently, greater attention is being paid to the human papillomavirus (HPV) infection of the cervix as a link to etiology.
- Some 85 to 90 percent of cervical cancers are squamous cell and the majority of the remaining 10 percent are adenocarcinomas.
- The earlier tumors are detected and treated, the better the chances of cure.
How best to treat the patient?
- The choice of treatment demands clinical judgment …the choice lies between surgery and radiotherapy.
- In most institutions the initial method of treatment for locally advanced disease is radiotherapy, both intracavitary (cesium or radium) and external x-ray therapy.
- Of 2,000 patients treated with radiotherapy at MD Anderson Hospital. Fletcher reports the following 5-year cure rates:
Stage 1 – 91.5%
Stage 2a – 83.5%
Sage 2b – 66.5%
Stage 3a – 45.0%
Stage 3b – 36.0%
Stage 4 – 14.0%
- Currie reported the results of 552 radical operations for cancer of the cervix.
Stage 1 – 86.3%
Stage 2a – 75.0%
Sage 2b – 58.9%
Other stages – 34.1%
- In general, in early stages, comparable survival rates result from both treatment techniques – surgery or radiation.
- Among the disadvantages of radiation therapy:
One must consider the permanent injury to the tissues of the normal organ bed of the neoplasm and the possibility of second malignancies developing in this bed.
Many lesions were not radiosensitive and some patients had metastatic disease in regional lymph nodes that were alleged to be radioresistant.
- Among the disadvantages of radical surgery:
Postoperative bladder dysfunction.
Formation of ureteral fistulae and lymphocysts, pelvic infection and hemorrhage.
Various regimens have been used. Most of the regimens have been platinum-based combinations, often including bleomycin and vincristine.
Dramatic reductions in the size of the neoplasm have been documented after as little as 3 courses or 3 weeks of therapy.
IT HAS YET TO BE LEARNED WHETHER THIS TECHNIQUE EVENTUATES IN BETTER SURVIVALS OR IS YET ANOTHER TECHNIQUE THAT DEMONSTRATES GOOD RESPONSE BUT OFFERS NO IMPROVED OUTCOME.
The oncologist told WD she has a 70 percent chance of cure if she was to go for chemo and radiation therapy. What is said is consistent with medical literature … for Stage 2A the 5-year cure rate is 75 to 83 percent. Very impressive statistics indeed except that these figures are based on the results of what others did in other parts of the world. What about the results in Penang hospitals? What is this oncologist’s personal experience? Is it the same? Many cases has he treated and at what success rate?
The oncologist also said that if you want a 100 percent cure rate, you have to turn to God! Oncologist can only cure 70 percent! The oncologist did not tell WD what happened to the 30 percent who did not make it. And more relevant still, is which group WB belongs to … the 70 percent success or 30 percent failed group? Nobody can answer that. WD may just belong to the failed group like these cases below.
I started to wonder about the stand taken by the gynaecologist. After the biopsy he sent WD to the oncologist. This is just a Stage 2A cancer yet he did NOT consider surgery beneficial? Why? Medical literature says surgery is as effective as radiotherapy for early stage cervical cancer. Why did he not suggest surgery? Is it because he knows from experience that surgery does not work? My guess is not a “wild guess.” Melissa had only Stage 1B cervical cancer and had surgery at this very same hospital. She followed up with chemo and radiotherapy and it turned out to be a great disaster.
As I am writing this story, there is another case of cervical cancer. This is a 62-year-old lady. She was diagnosed with Stage 1B cervical cancer and had undergone a radical surgery. Unfortunately the pathology report after surgery showed the cancer had spread to her pelvic nodes, right ovary, myometrium and endometrium. Ask this question: in this case, is this RM15,000-surgery really beneficial for the patient. It does not appear to be so — perhaps just a futile effort. The daughter asked the doctor, “Can surgery cure her?” The answer given was, “Not sure but it is better to have it removed.” Based on the above statistics, surgery for Stage 1 cervical cancer had a 86 percent chance of cure. Do you believe that?
Let me share with you some of the cases I came across over the years.
BH underwent radiotherapy. She was told that there was a eighty-nine percent chance that she would be cured. BH had 25 sessions of external beam radiation and 3 sessions of brachytherapy (i.e. internal radiation). In addition BH received 2 cycles of chemotherapy. BH said she was well after the treatment. She came back for a check up on 25 November 2011 and was told everything was alright. She “believed” she was cured. However, barely four months later, 15 February 2012, a CT scan showed the cancer had spread to the lymph nodes and lungs.
Amy (not real name) was a 39 year old lady from Indonesia. Amy came to a private hospital in Penang for further investigation. Physical examination showed presence of a huge mass arising from the. The doctor indicated it was a cervical adenocarcinoma, Stage 2B. Amy underwent 25 sessions of radiotherapy and at the same time received 5 cycles of chemotherapy. The drug used was cisplatin given at weekly interval. Amy also underwent 2 sessions of brachytherapy (internal radiotherapy). The treatment did not cure her at all – within 6 months the cancer had gone wild!
Mother, an Indonesian, was 64 years old. She was diagnosed with cancer of the cervix, Stage 2A in December 2000. She underwent 26 times of radiation and 6 cycles of chemotherapy. The cancer recurred after a year. She had radiotherapy again for 11 times. Her health deteriorated and she was in severe pain. Mother died 1 year and 8 months after being diagnosed with cervical cancer.
Melisa was a 44-year old female. She underwent a hysterectomy for her cancer of the cervix, Stage 1b. After the operation, she underwent 25 times of radiation treatments and one time of brachytherapy (internal therapy). Melisa ended up having to go in and out of the hospital due to pains, fevers and temperatures. Later, a scan showed there was pus in her abdomen and the cancer had spread to the lungs and liver. Melisa ended up in a hospital in Singapore – in search for a cure. The doctor at first suggested that she undergo surgery to remove the infected parts. Melisa questioned how surgery could help her when her entire liver and lungs were infected with cancer? She declined surgery but went ahead with chemotherapy. The first shot of chemotherapy was tolerable but the second and third shots were real bad. She preferred to die rather than complete the treatments.
Jonathan Chamberlain’s wife, Bernadette, was diagnosed with cervical cancer in 1993. She had surgery, radiation and chemotherapy and was dead exactly a year later. There is no doubt that she died as much from the treatment as from the cancer itself. Looking back, Chamberlain feels that the biggest mistake they have ever made was to do what the doctors advised because Bernadette could not have died sooner if they had done nothing.
In his book: Cancer Recovery Guide, pg. 28, Jonathan Chamberlain wrote: When my wife Bernadette learned that despite all the surgery, radiation and chemotherapy her tumour had returned, she was informed that she had three months to live. She was told this on 17 January. She died on 16 April. Three months exactly.
In our conversation (Jonathan-Chris, in Penang), Jonathan said: From my own experience with my wife, we were in awe of the doctors …. We were in awe of our ignorance. We assumed that the doctors were best … I realized that was the biggest mistake I have ever made – to do what the doctors advise. You learn the hard way. She (wife) suffered from chemotherapy and it killed her. She died not just from cancer. She died from cancer plus chemotherapy. She died within one year because she did everything that the doctor advised her.
Based on the above experience, it is hard for me to “encourage” anyone to do what their oncologists want them to do. To all patients I have this to say: Do what you think is right for you. But to WD, I told her: Turn to your God for guidance (read our next article).
Let me end by quoting Professor B.M. Hegde, an internationally recognised cardiologist (in his book, What Doctors Don’t Get to Study in Medical School):
- Doctors start believing in all that they are told and what they get to read. Most of what comes out in the plethora of biomedical journals is fake and doctored, but it is difficult to convince the readers about it (pg.3).
- Most of what come out in medical literature is not the truth. Medical literature is doctored, tutored and “sexed up” by the powers-that-be before being allowed to be published (pg.274).