January 2017 – CANCER STORY

Bile Duct Cancer: Go find a good surgeon to help you!

Kat (not real name) is a 64-year-old Indonesian lady from Aceh. Her problems started about three weeks ago when she felt dizzy and had abdominal pain. A doctor in Aceh did an USG and said there was something in her gallbladder.

Kat and her family came to a private hospital in Penang for further management. MRI of her abdomen showed:

a lesion in the region of bifurcation of the common bile duct. It measures 42.4 x 50.0 x 24.5 mm.
gallbladder was grossly distended.
Para-aortic lymph node was enlarged, measuring 52.7 x 49.0 mm.

Diagnosis: Klatskin tumour with biliary obstruction and para-aortic lymphadenopathy.

Her blood test results are as below.

Total bilirubin	286.8 H
Direct bilirubin	210.4 H
Indirect bilirubin	76.4 H
Alkaline phosphatase	505 H
ALT	108 H
AST	54 H
GGT	461 H
C Reactive protein	15.6 H
Alpha-fetoprotein	3.1
CA 15.3	14.0
CA 125	22.4
CA 19.9	786.89

The attending surgeon, Dr. B suggested that Kat undergo a procedure to install a metal stent to relieve the blockage. This procedure would cost about RM6,000.

Kat and her family came to seek our advice first before undergoing the procedure. This is rather surprising! Generally patients come to us after all medical procedures failed them. So this morning, we gave them the following advice:

Yes, should go ahead with the stenting procedure. It is better not to wait for too long because your bilirubin level is already too high (see above).
The problem associated with stenting is that blockage can occur again after a few months (and for the unlucky ones even within a few weeks).
Because of this it is wiser to use a plastic stent first instead of a metal one.
I cautioned Kat and her family that it is important that they go to a “reputable” doctor who is known to be able to do a good job. Not long ago, I had a case where the patient’s gallbladder was removed only to be told later that she had Stage 4 liver cancer! You don’t want to go to such doctor. So we have to be careful.
From the feed-back from patients, I know that Dr. A could do a good job! Kat should see him first before agreeing to let Dr. B do the procedure.
A had done an excellent job for Bak, a patient who is also from Aceh. A stent was installed for his blocked bile duct. Every 5 to 6 months, Bak had to come back to the hospital to change the plastic stent. After 4 or 5 changes, everything was okay. And the good part of this story is that this surgeon did NOT object or did not get angry when Bak refused to undergo chemotherapy. Bak told the surgeon he wanted to take herbs instead. And most important of all, today, Bak has no more problem with his cancer! Bak’s wife came back to our centre one day and told us that her husband can now live a normal, healthy life.

A few days later Kat and her family came to see us again. The stenting procedure was done by Dr. A as suggested. Kat went into the operation room at 6 pm and was out by 7 pm. The procedure cost RM 3,890. She was discharged the next day.

Note: Let me be clear that we did not receive any monetary reward for referring Kat to Dr. A or any doctor for that matter.

After all done is done, Kat and her family wanted to pay us our consultation fee! Our answer: Free-of-Charge!

Our reward this morning was to be able to see Kat to being treated well. From the facial expressions of those who came, we knew that they were very pleased. Our little advice had helped them a lot! Praise be to God!

Understanding Klatskin Tumour and It’s Treatment

Klatskin tumour is a type of cholangiocarcinoma or a tumour of the bile duct system. It occurs at the confluence of the right and left hepatic bile duct. It is named after Dr. Gerald Klatskin. See illustration below.

The tumour blocks the drainage of the bile duct giving rise to symptoms such as jaundice (yellowing of the skin), bilirubinaria (dark urine), pruritus (itchy skin) and abdominal pain besides weight loss.

What is the cause? Don’t know.

How to treat? Placement of stent to open the duct and relieve jaundice. ” Cholangiocarcinoma represents a rare malignancy. Without intervention, death due to progressive jaundice is inevitable. The goals of therapy, therefore, are resection of all disease and relief of biliary obstruction.”

Prognosis: Intrahepatic bile duct cancer: 5-year survival — Localized 15% Regional 6% Distant 2%

Extrahepatic bile duct cancer: 5-year survival — Localized 30% Regional 24% Distant 2%

Swollen face, palm and foot gone after three days on herbs

MS is a 68-year-old man. About four years ago, he had colon cancer. He underwent an operation but did not undergo follow-up chemotherapy. He went on vegetarian diet. His cancer did not go away.

CT scan done on 1 August 2016, showed large mass in his right lung measuring 10 x 7.4 x 10.0 cm in size. It invaded the mediastinum. There were also multiple smaller lesions in the right and left lungs, measuring up to 2.4 cm.

MS did not receive any more medical treatment and opted for supplements. He took Transfer Factor, Probiotics, Tea4Life, etc.

MS became breathless. X-ray done on 29 August 2016, showed a 12.0 x 9.0 cm mass with pleural effusion (fluid in the lung) as below.

Ultrasound guided drainage of the lung fluid was done. Blood test showed the following results.

Platelets count	522
CEA	900.7
CA 125	148
CA 19.9	193.07

MS stayed at home and took whatever supplements, but these did not help him. On 3 January 2017, a son of MS came to seek our help.

I was told that MS had difficulty breathing and his face, hands and legs were swollen. He was not able to lie down flat when sleeping.

This was what I told his son: This is a serious case and there is no cure. Let us try to tackle the problem slowly. First is to try and resolve this swelling and also get rid of the fluid in his lungs.

MS was prescribed Lung 1, Lung 2 teas plus Lung Phlegm. In addition he was given Upper Edema tea.

Wonderful results: Listen to what his son told us.

Swelling of the face, hand and feet were gone after taking the herbs for three days!
He had more strength.
He urinated a lot.
He coughed out a lot of phlegm (effect of the Lung Phlegm tea).

Comment: We often tell people that we are not magicians and we cannot do magic. But sometimes that in this special case, magic did happen. It is beyond our expectation even though we have seen such results happened many times before! Praise God for this wonderful blessing.

Metastatic Breast Cancer: Problems after taking Nasi Kebuli / Biryani rice!

In my earlier posting, I have written the story of Yan, a 36-year-old Indonesian lady who had breast cancer. She underwent a mastectomy. The cancer had spread to various lymph nodes and possibly to the bones (?).

Yan was asked to undergo follow-up treatments — chemotherapy, radiotherapy and hormonal therapy. The total cost would come to about RM 200,000 — something any ordinary 36-year-Indonesian could ill afford.

https://cancercaremalaysia.com/2016/05/18/surgery-and-chemotherapy-did-not-cure-their-breast-cancer-equally-a-big-mistake/

When Yan came to seek our help she was feeling miserable. She had backache which came on and off. Due to the pain, she could not sleep. She had stomach wind which caused nausea and sometime vomiting.

To our surprise, after taking the Pain Tea for a day, Yan said she felt well — no more pain. We felt so happy for her. Yan was doing well with our herbs.

Eight months later, Yan’s husband came to seek our help again. He came with a list of his wife’s problems.

Chris: Did she take care of her diet?

Husband: Yes.

C: She was well for so many months, then what happened?

H: In early December 2016, she started to have stomach discomfort. Here is a list of her complaints.

Nausea and vomiting, at that time she sweated a lot.
Pain on the right side of the abdomen, where the liver is.
Backache.
Fatigue.
Liver area felt bloated or full.
Black stools.
Tea-coloured urine in early morning but was clear for the rest of the day.
Pain that radiated to the back.
Most serious problem is pain in the liver area that radiated to the back.
No swelling of abdomen, hand or leg.

C: Before December, she had no problem. Now, tell me what did she ate in early December?

H: She ate “nasi kebuli” and that started the problems.

C: What rice is that?

H: Something like nasi briani.

C: That could be the problem. There was one lady patient of mine. She ate nasi biyani in the late afternoon. At 6 p.m. she was in severe pain and landed in the hospital. The doctor wanted to chemo her, thinking that the cancer had spread aggressively. Her husband called me. I told him to refuse chemo but just flush her stomach! She was in the hospital for almost a week and was well again (without any chemo!). So I know that such food is a “no, no”. Let me ask you again, BEFORE she ate nasi kebuli was she okay?

H: She was okay before that.

C: So, what did you do when she had the problems?

H: We went to see an internist and did an USG.

C: Okay, now I understand. According to the USG, there are some tumours in her liver. Meaning that cancer had spread. So when she ate oily food, she will end up with such problems — feeling bloated, etc.

Comments

This is one sad experience which can be expected of most cancer patients. After they are well, they forget what we teach them about food. They start to eat what they like and they end up with problems like this!

Healing cancer is about changing human attitude! Which is really hard to do!

I am curious what nasi kebuli is. So here is the information from the internet (https://en.wikipedia.org/wiki/Nasi_kebuli).

Nasi kebuli is made by cooking rice soaked in goat meat broth with milk or coconut milk instead of water. The goat meat is later cooked and mixed with sauteed spice mixture in ghee oil. The spice mixture is made from ground garlic, shallot, ginger, black epper, clove, coriander, caraway, cardamom, cinnamon, nutmeg and ghee. Then the goat meat and spices are boiled together with half cooked rice in milk until completely cooked.

Nasi kebuli is usually served with asinan nanas (pineapple in spicy and sour sauce) or sometimes also topped with sambal goreng hati (cow liver in spicy sambal sauce) and sprinkled with raisins.

Nasi kebuli was influenced by Arab culture and its origin can be traced to Middle eastern cuisine, especially Yemeni Arabian influence (Mandi rice), and also Indian cuisine influence (Biryani rice). Nasi kebuli also popular in cities with significant Arab descendants, such as Jakarta, Surabaya, Surakarta and Gresik.

It goes without having to say much that if cancer patients eat this kind of food, they are just inviting problems. So to stay healthy and well is your choice!

Breast Cancer Part 2: Go for chemotherapy

I am aware that when SN,40-year-old lady, came to see us it was because she did not want to go for chemotherapy. She had a mastectomy but decided to go for Gerson Therapy and taking a whole lot of supplements as follow-up treatment. Unfortunately, she failed miserably. Within a few months, the aggressive cancer came back as in the picture below. The cancer had spread to the lymph nodes, hence the swelling at her collar bone.

Facing this severe (and dangerous) problem, what can be a sensible thing to do? Stick to your failed “dogma and belief”? Or do you look for “other ways” to solve your problem?

Many patients came to us with a belief that I would not ask them to see their doctors — to go for surgery or chemo them. Wrong! Let me be clear — we at CA Care are not anti-doctors.

We want you to get the best and make you well. It does not matter if it is the Western or Eastern ways. Go for what works for you. This is not a religion — teaching you, if you do this or do that you go to hell or heaven.

But before you embark on any treatment protocol, here are a few things you need to be aware of.

Why do you seek treatment? Because you want to be cured, right?

Unfortunately in the world of cancer treatment, cure is very elusive no matter what you do! I have seen enough over the past 20 years to know the game. In addition to my own experience, read what others say about breast cancer treatment.

So when SN came with her problem, I explained (as in the video below) the big problem facing her.

Do not be misled that by taking our herbs, we can cure her! No way. The only sensible thing to do is try both the medical way and the traditional way. What choice have we? And by doing that, let us hope for the best outcome.

The rationale of going for chemo is to try to shrink the tumours, even if it is just a temporary reprieve. At the same time, SN should take the herbs and take care of her diet properly.

Doctors often tell their patients not to take herbs while on chemotherapy for fear of harmful interactions. There is no basis for such fear. Through my years of experience I know that patient who take herbs while undergoing chemotherapy fared better! Since their doctors are against such practice, and to make their oncologists happy, patients do not tell their doctors that they are on herbs! So, there is no chance for doctors to learn something new that they don’t teach in medical school.

Listen to what Dr. Russell Blaylock said:

You may wish to ask me, what do I expect out of this “adventure”. I must admit I don’t know. As said earlier, I am just hoping that chemotherapy would shrink the tumours a bit and this would make it “easier” for the herbs and diet change to help her. I am asking SN to try 3 or 4 shots of chemo only. I am also aware that chemo can kill. Over the years, I also know that patients ended up dead after one or a few shots of chemo. So that is the “gamble” we have to take.

Read what these doctors say about chemotherapy.

If the patient don’t die because of chemo, I am also aware that chemo can SPREAD and make the cancer MORE AGGRESSIVE besides causing much damage to the body.

If these are the risks, why on earth you, Chris Teo, asked SN to go for chemotherapy? That’s the only way I know how to help SN with her problem. I am mindful of the advice of Dr. Jerome Groopman below.

I am glad that with the above explanation, SN agreed to try chemotherapy (not the full 6 or 8 cycles though!). I shall report the outcome of this effort in Part 3 of this story later.

Breast Cancer Part 1: Cancer Recurred Soon After Surgery, Gerson Therapy and Supplements

SN is a 40-year-old lady. Her problem started at the end of March 2016 when she found out that her right breast was swollen with rashes of the surface. There was also a lump in her right arm pit. A biopsy pn 29 March 2016 showed invasive ductal carcinoma.

At the time of this diagnosis, SN was breast feeding her baby. She did not immediately undergo any medical treatment, not until a few months later when her breast turned hard.

She started on an intensive Gerson Therapy in April 2016 based on the manual and Gerson Online Course. The therapy consisted of juicing, supplements and coffee/castor oil enema. She adopted a no salt, no oil (except flaxseed oil) diet.

SN was supposed to take 13 glasses of juices a day but she could only manage to take 8 glasses. She was supposed to do 5 times of coffee enema per day but she managed to do only 4 times a day.

She took the following:

Gerson supplements

Acidol persin
Potassium compound solution
Lugol, half strength drop
Niacin 50 mg
Thyroid 2 grains
Pancreatin
B-12 tablet
Dessicated liver
CoQ10
Selenium
Milk thistle
Inf-Zyme Forte (digestive enzyme)
Colostrum
Vitamin C 1000 mg
Flaxseed oil

Other supplements

Coconut oil
Wheat germ oil
Regulatpro Bio
Wheat grass powder
Chollera powder
Chlorophyll powder
Super blend wild berry by EzyProtein
Natural raw food by Juvo
Vitamin D 800IU
Spirulina
Garlic pill
Probiotic powder

Spices / Herbs (dried)

Oregano leaves
Thyme leaves
Dill leaves
Tumeric powder
Cayenne pepper powder
Ginger powder
Garlic powder

All these went on for about one and a half month. It was a disaster after that! She ended up with a bloated stomach, vomiting and bad gastritis. Then she started to bleed for 2 weeks and had to be admitted into a hospital. In July, August and September, SN went in and out of the hospital for 5 times.

An endoscopy/colonoscopy was carried out. Nothing was found and the doctor said her intestine was just “too” clean.

USG of her right breast was done in May 2016 and showed multiple lesions, suspicious of malignancy.

At 1.30 o’clock, 3-6 cm from nipple: a well-defined nodule with microcalcifications, 4.5 x 4.7 x 3.2 cm.
At 1.00 o’clock, 6 cm from nipple: lobulated solid lesion, 2.3 cm in diameter.
At 1.00 o’clock, 2 cm from nipple: deep seated nodule, measuring 1.8 x 1.2 cm.
At 1.00 o’clock, 8 cm from nipple: 3 tiny nodules.
At 1.30 o’clock, 6 cm from nipple: 9 x 6 x 9 mm nodule.
At 1.30 o’clock, 10 cm from nipple: 8,2 x 6 mm nodule.
At 11.00 o’clock, 4 cm from nipple: microlobulated nodule 2.2 x 3.8 cm.
At 10.30 o’clock, 5 cm from nipple: 2 nodules, measuring 8 x 8.8 x 10 mm and 17 x 11 x 13 mm.
At least 8 enlarged right axillary nodes, largest measuring 5.2 x 5.2 x 2.5 cm.
3 infraclavicular nodes measuring 11, 6.8 and 2 mm.\
No focal solid or cystic lesions in left breast.
No left axillary, left supraclavicular or infraclavicular abnormality.

On 2 June 2016, SN underwent a right mastectomy. Histopathology report confirmed an invasive ductal carcinoma with residual chest wall lesion. It was triple negative breast cancer — estrogen receptor negative, progestrone receptor negative and Cerb-B2 negative.

Her operation cost RM 33,000 (cover by health insurance!).

SN was asked to undergo follow-up chemotherapy. She refused.

Chris: Why did you not want to go for chemotherapy?

SN: I know of persons who had cancer and went to chemo. They all died. One was a breast cancer lady, about 50 + years old. After surgery she had chemo and was on an oral drug. Six years later the cancer came back and she died within a year. The second case was my Aunty. Also 50 + years old. It was tongue cancer and two-third of her tongue was removed. She had no chemo but underwent 30 sessions of radiotherapy. The cancer came back. She went for an “oxygen bath” in Hungary. She died within a year.

My grandma was 80 + years old. She had ovarian cancer. She underwent a hysterectomy, but no chemo. She died within 2 years.

C: I understand the phobia you have.

SN came to see us in October 2016. The cancer had recurred.

Mastectomy did not cure her cancer. Gerson Therapy and all kinds of supplements did not cure her cancer. I told SN, My herbs would not cure your cancer as well. It is indeed a very, very difficult case to handle. I suggest that you try chemotherapy!

Part 2: Go for chemotherapy!

Part 3: Did chemo helped her?

Carcinoid Tumour of the Intestine: Surgery not indicated, chemo would not cure! Three weeks to live. But still alive after 9 months!

CH is 50-year-old male. He had chronic constipation with pain for about 6 months but did nothing about it.

Eventually he landed in a hospital and was told he had two tumours. One at the anorectal junction, 4.4 cm in length and 1.7 cm thick. There was also a mass at the mid sigmoid colon, measuring 1.5 x 2.7 cm.

CT scan also showed:

Multiple non-enhancing lesions in both lobes of the liver which measure up to 4.5 x 3.9 x 5.0 cm.
Numerous tiny well-defined nodules seen in both lung fields.
No lymphadenopathy.
No bony lesion.

A biopsy was done and the histopathology report indicated a neuroendorine tumour, most likely a high grade carcinoid.

(Note: Neuroendocrine tumors (NETs) are RARE neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. Many are benign, while some are malignant. They most commonly occur in the intestine, where they are often called carcinoid tumors, but they are also found in the pancreas, lung and the rest of the body).

CH consulted 4 doctors and all of them said he needed chemotherapy. A doctor in a private hospital said CH had only 3 weeks to live. So CH immediately underwent chemotherapy, initially for 3 cycles (to do 6 cycles).

While undergoing chemotherapy, a friend of CH came to seek our help. CH was unable to travel then. We prescribed some basic herbs and did not expect CH to live long enough to be able to come and see us.

To our surprise, a week later CH and his friend drove from Kuala Lumpur to our centre.

Video 1: Surgery not indicated, chemo would not cure. After one week on herbs, he felt better!

During his first visit, CH said he had better appetite and there was less pain after taking the herbs. He had more energy. Also there was less blood in his stools.

The tumour is still inside and could not be removed. CH had to do chemo but this would not cure him!

CH was told to continue with 3 more cycles of chemo. But this time it would be at a government cancer hospital. The government oncologist told CH that he had 2 months to live!

I told CH not to worry too much. All of us will have to die one day. What is important is, take the herbs and you feel better. Don’t get worse — stomach bloated, pain here and pain there — then that would be miserable. Remember everyone of us has to die. What is important is to die well.

Video 2: After 3 cycles of chemo and a month on herbs, his health improved. But I want a cure!

A month later, CH came to see us again. This time another friend drove him here. CH said he felt better and had very much less pain (scale of 9/10 reduced to 2/10). He only took the Pain Tea and did not have to resort to all kinds of pain medications by the doctor.

There was less blood in his tools and he passed out jelly-like substance together with some blood.

Chris: Now that you are getting better, do you think you are going to die now?

CH: Not so soon.

Chris: I would wondering why doctors are not curious enough to know why you don’t die yet?

Chris: Now that you are better, what else do you want?

CH: I am hoping you can cure me.

Chris: No la … how can that be?

Video 3: After 6 cycles of chemo and 5 months on herbs, he looked like a normal healthy person!

On this glorious morning of late December 2016, CH and his wife came to see us. I could not recognise CH because he was not bald anymore. He presented as a healthy person. CH said this time he drove from KL to Penang by himself. In fact, these days he felt so good and he had been driving around without any problem.

A good achievement indeed for a man who was supposed to die within 3 weeks!

CH said he had completed 6 cycles of chemotherapy at the end of September 2016. There was no medication from his oncologist and the next follow up will be in February 2017.

In late October 2016 CT scan showed that:

Previous multiple small lung nodules — some show stable size, regression and disappearance of lesion.
There are multiple subcentimeter mediastinal lymph nodes. All appear unchanged.
Increasing in size and numbers of multiple liver lesions. The largest in segment 8, measures 7.6 x 7.4 cm. This indicates worsening of liver metastasis.
Slightly increased size of the lower rectal mass causing narrowing of the rectal canal, measures 4.5 cm in length (previously 4.4 cm).
Sclerotic lesions at the neck of left femur, right transverse process of L3 and T6 vertebral body.

Comments

There are many lessons we can learn from this case.

I received many emails from people who wrote on behalf of their friends. My answer has always been — No use. No need to try to be a “hero” trying to “save” someone else if that person or his/her family members can’t even come and see us. What can I do on line? In this case, CH’s sent a friend all the way from KL. It was not possible to me to send him home empty handed. So, I did prescribed CH some basic herbs.

I am glad that when CH got well after a week, he took it upon himself to come to Penang and talked to us. That is the spirit we want! Show that you are interested to help yourself first before others can help you. Sitting in front of a computer and expecting good things to happen is asking too much.

CH had a rare type of cancer. According to the oncologist, even chemo would not cure him. On top of that CH was told by the oncologist of a private hospital that he had only 3 weeks to live. Do you ever wonder why the oncologist needs to say such thing? Is he playing god? Or is this a way to “frighten patients to death” so that they would not want to think for themselves anymore but to submit to his recommended chemo treatment immediately? No time for second opinion anymore. Don’t waste time, you are dying! Right?

Read what Dr. Groopman said:

I fully agree with this learned professor. No mortal can decide how long you life. That’s God’s prerogative. So it is indeed foolish for anyone to believe what they are being told i.e., when they would die.

I am fully aware that talking to patients about his/her death is not a nice topic to bring up, especially when they sit in front of you looking or feeling “half dead.” Some even consider it a taboo.

But, if you really want to help yourself and find healing, I believe it is important that you are made aware of the reality of the situation. Face the problem squarely! There is no point being in denial. I hope by talking openly about death, you realize that everyone has to die, not only you! No matter how much you want to deny it or fear it, there is no escape. So why can’t we accept it as a natural process of life without any fear. If we have to “go” let us go in peace. That’s my message to our patients. Perhaps with acceptance like this, healing comes more easily.

There is one important aspect of healing which some patients forget, that is, to cultivate a sense of gratitude. Accept things the way it comes to you and always be grateful for what you are and what you have. If you can eat, can sleep, can move around without pain — what else do you want?

Yes, everyone who comes to us want a cure! CH was hoping for us to cure him too, in spite of being told that chemo would not cure him and he had only few weeks or months to live.

While we don’t want you to lose hope — you should aspire to get the best by doing your best — we also want to remind you that you may end up being “cheated” or taken for a ride if someone promises you that he can cure your cancer! So beware.

We are indeed glad to see CH doing fine up to this point — at least he can now live a normal, healthy life in spite of having many “bombs” embedded inside him. This is what we mean when we tell patients, Learn to live with your cancer. You don’t have to wage a war against the cancer inside you!

Up to this point, we see CH’s healing as a grace and a blessing. Accept it that way and you can be more at peace with life.

Often patients are told that when they are undergoing chemotherapy, they should NOT take any herbs or supplements. Then they can eat whatever they like! There is no truth in such dogma!

In this case, CH did well indeed. He did chemo and took herbs at the same time, while taking care of his diet. Is that not wonderful? Is that not safe enough — no harm comes out of this combination?

Is the Power-that-Be not curious or interested enough to know why CH is still alive and doing well? Oh, no we don’t want to know! It does not interest us a bit. Is that what it is?

Bile Duct Cancer: When MORE = WORSE

AM is a 48-year-old lady. About nine months ago she passed out tea-coloured urine. Her body was itchy. A blood test was done and her doctor said it was not good. She was referred to a private hospital near her hometown. From there she was referred to another private hospital in Kuala Lumpur.

A CT scan on 11 March 2016, showed:

A gross intra hepatic biliary tree dilation secondary to obstruction at the proximal common bile duct due to suspected cholagiocarcinoma.
No focal liver lesion.

AM had a blood clot in her neck. was treated with Clexane (an blood thinning injection to stop blood clots forming within the blood vessels). A biliary stent was inserted to help relieve the blockage.

A scan on her brain and head showed no evidence of abnormality.

Her problem was diagnosed as inoperable cholangiocarcinoma and right IJV (internal jugular vein) thrombosis. That is to say AM had a bile duct cancer that should not be operated on.

A follow-up CT scan done about a month later, 25 April 2016 showed:

An increase in size of known cholangioncarcinoma.
Enlarged spleen.
Uterine fibroids.
Multiple tiny pulmonary nodules, bilaterally.

A CT scan done on 27 July 2016 showed the following:

Biliary stent in situ … stable in appearance.
Main and right hepatic arteries demonstrate normal enhancement.
Spleen is enlarged.
Uterine fibroids.
No focal bony lesion.
Multiple pulmonary nodules stable in numbers and sizes.

From this follow-up scans, it appeared that AM condition was stable — did not deteriorate. However, after 3 months, the stent was clogged. Although AM’s cancer was initially regarded as inoperable, in August 2016, the doctor decided to operate on AM.

Pathology report indicated that many lymph nodes were infected with cancer.

Two months after surgery, AM had fluid in the abdomen. She did not feel good and had to undergo another surgery to “clean” up her abdomen.

AM was referred to a government hospital for chemotherapy. Her 6 cycles of chemo was due to start in mid-December 2016. A week before commencing her chemo, AM and her family came to seek our advice.

My advice then was to go ahead with her chemo. But AM was reluctant to undergo chemotherapy. I told her to go back and think about it properly and come back to see me again if she needed our help.

AM came back a few days later and said she decided to try our therapy first and would not go for chemotherapy for the moment.

Her blood test results done on 14 December 2016 are as follows:

ESR	50 H
RBC	3.6 L
Haemoglobin	10.7 L
Platelet count	122 L
WBC	3.8 L
Alkaline phosphatase	403 H
SGOT/AST	67 H
SGPT/ALT	57 H
GGT	198 H
Alpha fetoprotein	Less than 1.3
CA 19.9	11,500.5 H
CEA	2.2

During our conversation, I asked AM a few important questions.

In all, for the stenting and 2 follow up surgeries, how much did you have to pay? According to her husband, the total medical cost in this private hospital came to about RM 120,000.
Did you ask if the surgery was going to cure you? No, there would be no cure.
Were you okay before the bile duct surgery when you only had the stent? Yes, okay except that the stent was clogged after 3 months.
What was your condition like after the surgery? My condition deteriorated. I was better off before the surgery.

Comments

What can we learn from this case?

Why do you think an initially inoperable cancer suddenly was operated on? Was it because the stent was clogged after 3 months?
If clogging of the stent was the main reason, would a change of a new stent not help solve the problem? I recalled a case of a patient who had to change his “plastic” stent every 6 months (and he did it for about 6 times). He underwent our therapy and refused chemotherapy. Eventually the cancer disappeared and he is well up to this day. Read more here: https://cancercaremalaysia.com/2011/11/04/pancreatic-cancer-severe-itch-disappeared-and-health-improved-after-herbs-and-the-e-therapy/
AM started off with a normal liver. After the surgery, she was worse off. Her CA 19.9 was 11,000 plus and her liver function parameters were all high. Before the operation, her condition was not like that. What if she were to just change her clogged stent again and again and not do the surgery? Did surgery spread her cancer?
There is another story which was posted in this blog not too long ago, Gallbladder Stone to Stage 4 Liver Cancer: How is that possible? Would you like this to happen to your mother? This patient had surgery to remove her “so called gallbladder stone.” Surgery did not solve her problem. Later it turned out to be a stage 4 liver cancer. The patient died. How could it be?
However, many of us have the impression that the more we do, the greater are the chances that we get a cure! Doing less or nothing is never an option! But often, with cancer, it is the other way round, the more we do may mean the worse we become, as in this case.