Thirty-six-year-old Lisa and her husband flew from a distant country to tell us this pathetic story.

Sometime in 2013, Lisa felt a small lump in her left breast.

• Bilateral mammography and ultrasound of both breasts on 12 April 2013 showed suspicious lesion in the left breast at 12 o’clock axis.
• Ultrasound of whole body on 13 April 2013, showed no significant abnormality.
• MRI on 16 April 2014 showed multi-focal malignancy in the left breast. The lesions noted in the right breast at 12 and 1 o’clock axis, have low suspicion of malignancy.

A FNAC biopsy indicated highly suspicious for malignancy.

Lisa underwent left breast conservation surgery with reconstruction on 22 April 2013.

Histopathology reports showed invasive ductal carcinoma, multi-focal Nottingham grade 1, left breast, regional lymph nodes showed reactive changes (0/17), pT1pNoMo.

ER / PR postive and Her-2-Nue Negative (1+) (Please take note of this statement).

Her case was discussed in tumour board and planned for External Beam Radiotherapy to left breast. Lisa received 32 radiation treatments starting from 17 October 2013. Lisa also received 6 cycles of chemotherapy using FEC — 5-FU + Epirubin + Cyclophosphamide.

Discharge medications after chemotherapy were:

1. Tab Crocin, Tab wysolone before Peg-grafeel injection
2. Peg-grafeel once — 24 hours post chemotherapy.
3. Cap Aprecap, once daily for 2 days.
4. Hafooz Cream – apply locally.
5. Ointment Thrombophobe – apply locally.
6. Tab Graniset, twice daily for 5 days.

For vomiting:

1. Tab Emeset
2. Tab Domstal

For Indigestion:

1. Tab Pantocid
2. Syp Digene

For Fever:

1. Capol / crocin

In case of loose motions:

1. Cap Imodium / Tab Lomotil one every 5 hours
2. Plenty of oral fluids
3. R.S. / electral powder

In case of constipation:

1. Syp Cremaffin

In case of pain:

1. Tab Crocin

In case of ulcers:

1. Tab Forcan for 5 days
2. Boroglycerine with Tab Dexona – crushed and mixed together to be applied in mouth, thrice a day.

After all these treatments, Lisa was started on Tamoxifen. She has to take this drug for 5 years (aya, outdated! The new guideline is 10 years!). So Lisa has been taking Tamoxifen for the past one and half years, when she came to see us.

Routine medical checkup showed Lisa was doing alright. Her CA 15.3 on 16 September 2015 was at 6.2. Ultrasound of her abdomen showed no evidence of any anomaly. Her uterus showed normal echotexture.

However, Lisa complained of tiredness. She felt irritated easily. She still has per periods but during menses she had pains and her stomach was bloated. The doctor suggested that Lisa undergo an ovarian ablation! This procedure would add 2 to 3 percent to her survival.

While her husband and family were agreeable to this surgery, Lisa was not happy and wanted to have a second opinion. So she and her husband flew to Penang to seek our advice!

Listen to her conversation that day.

 

Comments

In premenopausal women, most of the estrogen in the body is made by the ovaries. Because estrogen makes hormone-receptor-positive breast cancers grow, reducing the amount of estrogen in the body or blocking its action can help reduce the risk of hormone-receptor-positive breast cancers coming back (recurring). Ovarian shutdown with medication or surgical removal is only for premenopausal women.

There many ways to shut down the ovarian function.

There are three different ways to stop the ovaries producing oestrogen:

• surgery to remove the ovaries
• hormonal therapy to ‘shut down’ the ovaries (ovarian suppression)
• radiotherapy to stop the ovaries working.

Premenopausal women who had their ovaries removed and took Tamoxifen for 5 years after breast cancer surgery had a lower risk of the breast cancer coming back and better survival rates compared to premenopausal women who didn’t have their ovaries removed and took tamoxifen after surgery. While this is considered aggressive treatment because it puts you prematurely and permanently in menopause, it may be a good treatment option for women who don’t want to have any more biological children.

Side effects

Women whose ovaries are removed will have an early menopause straight away. The symptoms of this can start suddenly and may be more intense than the symptoms of a natural menopause.

Ovarian ablation using hormonal therapy or radiotherapy happens over a period of weeks or months and is a more gradual change.

The menopause can cause symptoms such as:

• hot flushes
• dry skin
• vaginal dryness
• lowered sex drive
• psychological effects.

These symptoms can vary from being mild to severe. This can be difficult for women to cope with, especially when they’re already dealing with breast cancer and its treatments.

Deciding to have your ovaries shut down with medicine or surgically removed requires a lot of careful thought and discussion.

Source: http://www.breastcancer.org/treatment/hormonal/ovary_removal

http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Breast/Treatingbreastcancer/Hormonaltherapies/Ovarianablation.aspx

Our advice to Lisa is simple: Follow what your heart says! Others around you — may have all the best of intentions — but they may NOT understand the trauma that you have gone through and would need to go through gain. At the end of it all, the consequences of such treatment will only be borne by you, and one else.

Think carefully, by undergoing ovarian ablation Lisa stands to benefit only 2 to 3 percent in terms of added survival time! Note, survival does not mean cure. Is the added survival worth it or is it just an added misery?

Professor Gershom Zajicek, of The Hebrew University of Jerusalem, Israel, wrote about a seemingly healthy lady, once diagnosed with cancer, would be given a CANCER mask to wear. And with that mask on you are expect to take on your new role – act and behave like a cancer victim. Never mind even if you are healthier than you grandmother!

Professor Zajicek said:

• Yesterday, a woman felt healthy. Today, she discovers a small lump in her breast. Suddenly she becomes ill, realizing that she carries an evil disease. The lump is her death sentence. In reality, she is healthy. The lump does not pose an immediate threat to her. Nevertheless she panicked. It is not cancer that causes her misery, but society and doctors that promote this fatalistic perception.
• Now this woman is alarmed and rushes to her doctor the next day. She undergoes a mammography and biopsy and is told she has cancer. The doctor tells her that she is very ill. Her world turns upside down.
• Before detecting the swelling, this woman is otherwise a healthy person not until she is given the cancer mask to wear. Her doctor is now preoccupied with her cancer mask. Fear is generated. Everything needs to be done quickly and urgently to fight and save her life from this evil disease – the tumour! So this woman has to act, to conform to the roles of the mask that she wears. She now acquires a new disease called the mind-cancer. From then on she sinks into the abyss of misery, believing that she will die rather soon.
• Ask these questions: Before the discovery of the lump, and before consulting her doctor – what was her life like? She was as fit as a fiddle, wasn’t she? The sudden change of fortune befalls her just because she had discovered a lump in her breast. What is the real cause of her misery? The lump in her breast or the perception of evilbeing spun by society and the medical establishment?

(Read more: https://cancercaremalaysia.com/2012/05/18/new-thinking-about-cancer-and-its-treatment/)

When Lisa felt a lump in her breast, she went through a series of traumatic experiences. She rushed to the doctors and underwent:

1. Ultrasound
2. Mammogram
3. MRI
4. Biopsy
5. Surgery to remove the breast lump
6. Reconstructive surgery
7. Chemotherapy
8. Radiotherapy
9. Tamoxifen
10. After all these, the game was not over yet. She was asked to remove her healthy ovaries.

From the above, it looks like the SOP for cancer was strictly adhered to.  Do you think all these are necessary? Can’t we skip a step or two?

All the imaging machines in the hospital were put to use — ultrasound, mammogram and MRI before a biopsy was ordered.

Then came the treatments — everything was thrown in. And many kinds of medications were prescribed to take care of the side effects — vomiting, indigestion, fever, loose stools, constipation , pain and ulcers! Indeed, Lisa was really sick!

But after all these treatments. was Lisa guaranteed of a cure? No one can be sure! 

Again, read what Professor Gershom Zajicek wrote:

• Modern medicine fails to cure cancer. Medicine is in a conceptual deadlock … the basic tenets of cancer treatment are false.
• After being diagnosed with cancer your mission is to train yourself to live with cancer in peace and harmony. The message your body is giving you is that your life needs to take a new course, with a new mission. It does not matter whether you were cured by surgery or not.
•  Start a new life which is devoted to tilt the balance between cancer and your body in your favor.
• You may turn to your doctor for advice on alternative approaches.  He may just look at you, laugh and say:  Who tell you all this nonsense? Don’t believe in such unscientific and unproven baloney!  For medicine it is inconceivable that other ways are better than their cut, burn and poison approaches.
• You will have to trot this difficult path on your own. Medicine ignores its limitations and views what are being said by alternative healers as nonsensical.