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:

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

1. 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.
2. Did you ask if the surgery was going to cure you? No, there would be no cure.
3. 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.
4. 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?

1. Why do you think an initially inoperable cancer suddenly was operated on? Was it because the stent was clogged after 3 months?
2. 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/
3. 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?
4. 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?
5. 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.