KL is a 60-year old female. She felt tired and was told that she was anemic. However, a colonoscopy done on 25 March 2014 indicated tumours in her ascending colon.

KL immediately underwent an operation. The operation cost RM 20,000. Unfortunately on the third day after the operation, KL suffered severe bleeding. The doctor told the family it was a Stage 4 cancer since it had spread to the liver.

About a month after the surgery, KL was started on chemotherapy. Each cycle of chemo cost about RM4,000. After receiving a total of 6 cycles (oxaliplatin + oral Xeloda) the oncologist stopped the treatment because it was not effective.

The oncologist offered KL two options:

1. Continue with more chemotherapy but using a combination of more expensive drugs – Avastin + Erbitux. This cost more than RM10,000 per cycle.
2. Go home. There is no more medicine!

Details Of KL’s Medical Records.

CT scan of 27 August 2014: Known case of CA ascending colon, post operation and post chemotherapy.

Impression

1. CA ascending colon with multiple lever metastases. The metastatic lesion in the left lobe of the liver is larger in size associated with progressive dilatation of the left intrahepatic bile duct.
2. A small stable nodule in the lower lobe of right lung.

Blood Test Results

Comments

KL and her family came to seek our help. She presented with loss of appetite and swelling of the abdomen and both legs. She lacked strength to walk or to stand up. The video below showed her condition that day.

This is what KL’s husband said: “What the doctor said caused us to panic. We followed what the doctor wanted us to do. Money spent but she (the patient) became weak.”

This is a tragic case. Many questions need to be asked:

1. Why was KL only told that the cancer had spread to her liver after her colon operation? Why not before the operation?
2. Would it not be prudent or even the norm of medical practice, to check if the cancer has spread to other parts of the body before any surgery is done?
3. If the cancer has spread extensively, it is sensible to go ahead with the surgery? Chemo?
4. Why was there severe bleeding 3 days after the surgery?
5. After 6 cycles of chemo, KL was told that the treatment did not work. With all the experiences (giving chemo to patients over the years), does the oncologist not realize that chemo rarely (if at all) works for patients?

Reflect on the quotations below: