Cancer of Rectum-Liver: Stage 4 – Part 1: Surgery followed by 8 times of chemo can cure you!

Jas is a 54-year-old Indonesian lady. Her daughter came to seek our help. Jas’s problem started in mid-2016 when she had bleeding. She could not tell where it came from — through the vagina or rectum. Anyway, she consulted a gynaecologist who told her that her uterus was “dirty” and needed “cleaning up” (whatever that means!).

One day in October 2016, while a home, Jas was unable to stand up. She still had bleeding then. The doctor said she suffered from vertigo.

Fast forward to March 2017, Jas consulted another gynaecologist in Medan and was told that besides the “dirty” uterus there was a mass in her anus.

Jas came to a private hospital. in Penang. A blood test on 4 April 2017 indicated CEA = 247.03, CA19.9= 72.2, ESR = 57.

Jas underwent an operation. Histopathology confirmed the following:

  • Moderately differentiated adenocarcinoma of rectum with metastases in pericolic lymph nodes (11/11) and segment 4a of liver.
  • T3N2Mx, Stage 4.
  • Non-neoplastic liver shows features of chronic hepatitis.

The cost of the operation was RM 60,000.

Jas was told to take a rest for 3 weeks after the surgery and then come back for chemotherapy. The drug to be used was Oxaliplatin + Xeloda (oral) or Oxaliplatin + TS-One (oral). Each cycle would cost RM 7,000.

Jas needed to receive 8 cycles of chemo plus radiation after that.

Chris: Before the operation, did you ask the doctor if he can cure you?

Daughter: The doctor said you have to operate and then followed by 8 cycles of chemotherapy and radiotherapy. You will be cured.

Son-in-law: The doctor said it depends on chemotherapy. 

Jas eventually underwent one cycle of chemotherapy. She had the treatment in another hospital. Why?

The chemo treatment in another hospital using the same drugs: Oxaliplatin + TS-One cost only RM 3,500 (half the price of the other hospital where she had her surgery!).

Chris: Did you ask the oncologist if chemotherapy would cure you?

Daughter: The doctor was not sure. 

C: Did you not tell him that the doctor in another hospital said it can be cured after surgery and chemotherapy?

D: I told him. He did not respond and kept quiet. 

C: Did your mother suffer any side effects of the chemo?

D: She had difficulty sleeping, had sores in her mouth, felt nauseous and vomited. She did not vomit if she did not take TS-One. She felt very tired and very uncomfortable. No, my mother is not going for the second chemo. She does not want anymore chemo.

 

Comments

Can we all learn something from this sad story?

  1. Right from the start something did not seem to be right — being told about “dirty uterus”. What was that? After further consultations, Jas was told there was a big tumour near her anus. How could that be?

2.. Jas came to Penang and underwent an operation. She did the right thing! After surgery, she was told to take a rest for about 3 weeks and then proceed with chemotherapy. Chemotherapy — there is no need to rush to do that. Now, let us ask two important basic questions.

  1. Before undergoing any treatment, I always tell patients to ask their doctors — Can the surgery (chemo or radiation) cure me? This is a legitimate question to ask and don’t be afraid to ask!
  1. Yes, Jas asked that question. Can surgery cure me? Jas got this answer. After surgery, you need to go for 8 cycles of chemo (plus radiation) and you will be cured. 
  1. Is that an honest, truthful answer? It sound like undergoing surgery by itself is not enough to cure you. You need chemo and radiation as well to be cured.
  1. Or, by giving such vague answer, was the surgeon trying to pass the buck to the oncologist?
  1. What if chemo / radiation do not cure?

Let me relate what happened to one patient who did surgery in that same hospital A. His surgeon said he needed to cut off a part of his liver immediately, otherwise he would die soon. A few months after the surgery, the cancer came back again. The patient and his wife confronted the surgeon and was given this answer, I have already done my job. I have removed the tumour in your liver. He walked away refusing to see the couple again.

  1. Jas went to Hospital B. She asked the oncologist if chemotherapy would cure her. The oncologist said, NOT SURE ! When told that the doctor in Hospital A said after 8 chemo Jas will be cured, this oncologist kept quiet! Take note, people of the same tribe takes care of each other, right?
  1. Take note also that this is a stage 4 cancer — from the rectum the cancer has spread to her liver. Can surgery and chemo cure such cancer?
  1. Lesson two: Before undergoing any treatment ask how much it cost – that is if money is important to you! Using the same drugs, each cycle of chemotherapy in Hospital A cost RM 7,000 but in Hospital B it was only RM3,500 (half the price!).Treatment for cancer is extremely lucrative!

 

 

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