May 2019 – CANCER STORY

Patients who came to see me with cancerous lumps in their breasts will usually get this standard advice: Get the lump removed, by lumpectomy or mastectomy. No two ways about it. That has always been my position all these years. But in early 2019, I have learned something new! If you have angiosarcoma of the breast, which is indeed a rare cancer, then surgery may not be the answer. Yes, I have learned that it would be a wrong advice if I “push” you to go for surgery for this type of breast cancer.

This is the story of Lily.

Lily is a 31-year-old lady from Sabah. She came to our centre with her mother, in January 2019. Lily found a small lump under the left arm-pit a year ago. Then she found another lump in her left breast. After a scan and biopsy, Lily underwent a lumpectomy. Histopathology report confirmed a low grade angioscarcoma.

A CT scan was done in November 2018 to look for distant metastases. The cancer had spread.

There are two masses in the left breast, 2.8 x 3.8 cm and 2.0 x 2.4 cm.
Lesion in the left pectoralis muscle measuring 2.2 x 3.0 cm.
Multiple lesions in the chest wall measuring 1.3 x 1.2 cm, 1.4 x 0.9 cm.
Mass located near the ascending colon and right kidney measuring 2.6 x 3.9 cm.

The doctor suggested surgery to remove the whole left breast. In addition, the surgeon would remove the tumour in the arm, chest wall and stomach. After surgery, Lily was told she may need to undergo chemotherapy.

Atm this moment, Lily was not keen on more surgery and came to seek our help. Listen to our conversation that morning.

Lily: At first the doctor said chemotherapy is not indicated. Later he said it is possible to undergo chemotherapy after the surgery.

Chris: Did you ask if surgery and chemo are going to cure you?

L: No. The treatment may slow down the growth of the cancer or it may even make the cancer more aggressive and spread more widely.

C: Oh, it may slow down the cancer’s growth or it may make the cancer go wild?

L: Yes. And I don’t want to go for the surgery. Even if I do, the result may just be the same.

C: I believe this doctor has not seen too many of this type of cancer before.

L: Correct. The doctor told me so far there are only two such cases in the hospital. Me and another lady, X before me. This doctor performed the surgery on X. Her breast was removed. Then the cancer started to spread to all over the body — including hands and legs. Now, the doctor said he cannot operate on her anymore because there are too many tumours in the body.

C: So what did they want to do with her now?

L: They sent her home to die. The doctor told me that — she is waiting to die.

C: The doctor told you that — just go home and wait to die?

L: Ya. Actually X is a nurse in the hospital.

C: This same doctor is now asking you to go for the same surgery?

L: Ya, that is what it is.

C: He saw the results of what he did to X — then he asked X to go home and die. And now this same doctor is asking you to undergo the same surgery. I can’t understand that.

L: Because of that I am afraid.

C: I understand. I understand you. I cannot promise you anything. But what is the point of undergoing surgery and then you can’t walk, stay at home suffering and waiting to die. No point.

I prescribed Lily some herbal capsules A, C,D and M, in addition to Breast L and M + PLM teas, Lympho + SAP teas and Soft Tissue tea. About two months later, Lily came to our centre again with her monther and father. Listen to our conversation below:

Gist of our conversation that morning.

My first question to Lily was, How do you feel after taking the herbs. Do they help you in anyway. Unfortunately Lily was not able to answer this question! If the herbs do not help you, why continue to take them? You may want to find another option.
But it seems that Lily and her parents wanted to continue taking the herbs! But what for?
Her parents said, What could happen if she does not the herbs? She could be worse off?
I can understand their logic but I cannot say such a thing because it might appear that I am trying to sell our herbs
My next question to Lily. After taking the herbs, can you continue to live a normal life?
Do whatever you want to do? Yes, Lily could continue to live a normal life!
Now, what had happened to the nurse who also had breast angiosarcoma and had undergo an operation? She already died within six months as predicted by her doctor.
I told Lily and her parents. You are on our herbs and two months already. And you are still alive and doing okay. If you can live for another four months, then we “win” in this game! I know all patients who come and seek our help expect me to cure them. I am not God. I cannot cure you.

Since breast angiosarcoma is such a rare cancer, let us turn to the internet and learn more about this cancer.

Ming Yin et al. (https://bmccancer.biomedcentral.com/articles/10.1186/s12885-017-3292-7) wrote:

Breast sarcomais an extremely rare. The annual incidence of breast sarcomas was 4.48 cases per million women.
Angiosarcoma is a very aggressive malignant tumor of the vascular endothelium, characterized by rapidly proliferating and extensively infiltrating growth. It carries a poor prognosis.
Optimal care of breast angiosarcoma is poorly defined because information from previous studies is insufficient and inconsistent.

Katrina N. Glazebrook et al. https://www.ajronline.org/doi/full/10.2214/AJR.07.2909) wrote:

Primary angiosarcoma of the breast occurs in young women and usually present as palpable masses that may be growing rapidly.
Secondary angiosarcoma occurs most frequently after breast conservation therapy with radiation therapy. The average latency period is 5–6 years. There are two types of secondary angiosarcoma: lymphedema-associated cutaneous angiosarcoma and postirradiationangiosarcoma.
Both of these types of angiosarcomas may present with bruiselike skin discoloration.
Patients with secondary angiosarcomas present with red plaques or nodules or with areas of skin discoloration.
Surgical resection with mastectomy is the usual treatment for both forms of angiosarcoma.
With increasing use of breast conservation therapy for breast cancer, reports of post irradiation angiosarcoma have increased.

Suresh Jaywantrao Bhosale et al. https://www.sciencedirect.com/science/article/pii/S2210261213000369) wrote:

Primary angiosarcoma has a poor prognosis, even after complete resection.
Surgery is the mainstay of treatment with a limited rolefor chemotherapy and radiotherapy.
Angiosarcoma usually presents as a palpable mass, but 17% of cases may present with a bluish discolouration or bruising of the overlying skin.
The frequency of this rare tumouris 0.04% of primary breast tumours and approximately 8% of breast sarcomas.
Angiosarcoma may present as a painless often discrete palpable mass that grows rapidly.Some patients complain of a painful mass with tenderness. Approximately 2% of patients may present with diffuse enlargement of the breast. However, a bluish red discolouration of the overlying skin may be there.
Nippleretraction, discharge, or axillary node enlargement are generally absent.
As angiosarcomas of the breast are very rare, there is no established standard treatment. Mastectomyis the mainstay of treatment. Although some individuals seem to benefit from chemotherapy, it is of minimal benefit for patients with disseminated disease.

Pam Stephan (https://www.verywellhealth.com/angiosarcoma-of-the-breast-430619) wrote:

To understand breast angiosarcomas, it’s helpful to first distinguish between carcinomas and sarcomas. Most breast cancers that people are familiar with are carcinomas—cancers that begin in epithelial cells, such as those that line the ducts or lobules of the breast. Sarcomas, in contrast, are derived from myoepithelial cells, cells that make up connective tissues such as bones, muscles, and blood and lymphatic vessels. The term “angio” means blood, and angiosarcomas are tumors that begin in blood or lymph vessels. Angiosarcomas may occur anywhere in the body, and the majority of these tumors occur in regions other than the breast.
Primary angiosarcoma diagnosed in a person who has never had breast cancer may feel like a thickened area of the breast or an ill-defined lump. In some cases, the nearby skin may turn blue or reddish and appear to have a rash or to be bruised.
Secondary angiosarcomaoften presents with an area of redness or a bluish appearance of the breast. There may also be swelling or a mass in the breast. These lumps, unlike many breast cancers, are often painful.
Angiosarcomas are less likely to spread to lymph nodes than more common breast cancers, but tend to spread rapidly to distant regions of the body. Sites of metastasis may include the lungs, liver, bones, skin, other breast, brain, or ovaries.
These tumors have a high rate of recurrence, and may recur locally in the breast or in distant regions of the body.
Breast angiosarcomas do not often respond to chemotherapy. Radiation does not appear to have any survival benefit for people with primary angiosarcoma, and is associated with poorer survival in people with secondary angiosarcoma.

Omar Ashour and TarannumFasih (http://www.acanceresearch.com/cancer-research/radiation-induced-angiosarcoma-of-the-breast-case-series–review-at-a-single-breast-screening-institution-and-review-of-the-litera.php?aid=9396) wrote:

Breast conserving surgery with radiotherapy has replaced mastectomy as the standard care for earlystage breast cancerin the last few decades. Angiosarcoma arising in the irradiated breast after breast conserving therapy is being reported in the literature with increasing frequency. As more women undergo breast conserving therapy, the incidence can be expected to increase.
The risks of developing angiosarcoma of the breast have been attributed to multiple risk factors; this includes trauma, radiation, lymphoedema, and breast implants.
There is no established standard treatment that is evidence based. Mastectomy however is the mainstay of treatment.
Although some individuals seem to benefit from chemotherapy, it is of minimal benefit for patients with disseminated disease.

Ria is a 53-year-old lady from Jakarta. About four years ago she was diagnosed with breast cancer and had a right mastectomy at a private hospital in Penang. Since she did not bring the medical report of her surgery, I was not able to tell you how serious her breast cancer was. Anyway, Rias was asked to undergo follow-up treatments — chemotherapy and radiotherapy. She refused. She was not on any medication either.

Ria was okay after the surgery and did not bother to come back for any check-up after that. About three months ago (i.e. about four years after her mastectomy), Ria became breathless. She was admitted to a hospital in Jakarta and was told there was fluid in her lungs. The doctor wanted her to undergo chemotherapy. She refused.

Ria came back to the same private hospital in Penang where she had her surgery. She was referred to the lung specialist. A CT was done and showed the following:

There is a 5.5 x 5.1 x 3.5 cm mass in the manubrium sterni with an extension of the mass into the prevascular space of the mediastinum.
There is moderate to large right pleural effusion (fluid in the lung).
Collapse-consolidation of right lower lobe.
Right and left main pulmonary arteries and their lobar branches are consistent with pulmonary embolism (PE).

Ria’s right leg was swollen and USG confirmed it was due to extensive deep vein thrombosis (DVT) of the right common femoral, superficial femoral and popliteal veins.

The lung specialist was not able to offer Ria any help and referred her to the oncologist instead. Ria was told to undergo 6 cycles of chemotherapy with Taxol and Epirubicin. She refused chemo.

From the pictures above, her breast cancer must have spread to her lungs, bone and liver. In addition she suffered DVT of the right leg. The doctor wanted Ria to be admitted into the hospital right away, to treat her DVT. She also refused.

Ria came to seek our help instead.

What can I do with such a case? Listen to our conversation that morning.

Three Weeks After Taking the Herbs

Ria came back to see us again. She was full of energy and was happy. Her swollen leg was almost (70 percent) healed. Before the herbs her right leg was “hot”, hard and painful. After taking the herbs, it was back to normal.

When Ria first came three weeks ago, I did not believe that I could do anything to help her. This was because I had a bad experience with DVT before. When we first started CA Care twenty plus years ago, I remember of a young man, an engineer, who had cancer and underwent chemotherapy. He developed DVT (deep vein thrombosis) in his thigh. His wife came to our house well after mid-night asking for help. I could do nothing for him. He immediately underwent an operation for his DVT and died.

I told Ria. “I am really surprised. When you first came three weeks ago, I did not write anything about your case history. See the blank page. This is because I thought your condition was so serious that you could die anytime. I did not expect you to live. I am glad that you are well now. God really loves you!”

Then jokingly I told Ria. Now that you are okay, why don’t you go for chemotherapy for your recurrent breast lumps. Ria replied, “Itu racun — that is poison”! What a surprising answer. Ria is not an educated lady. She makes kue — local cakes — to sell in Jakarta market. But she know what chemo is!

From the internet, I gather some information about DVT.

Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Most deep vein clots occur in the lower leg or thigh.
Deep vein thrombosis can cause leg pain or swelling with red or discolored skin on the leg. There is a feeling of warmth in the affected leg. This is what Ria said she had.
Deep vein thrombosis can be very serious because blood clots in your veins can break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism). And that is exactly what the CT scan showed Ria had: Right and left main pulmonary arteries and their lobar branches are consistent with pulmonary embolism (PE).
A deep vein thrombosis canbreak loose and cause a serious problem in the lung, called a pulmonary embolism, or a heart attack or stroke.
A pulmonary embolism can be life-threatening. Signs and symptoms of a pulmonary embolism include: sudden shortness of breath, chest pain or discomfort that worsens when you take a deep breath or when you cough, feeling lightheaded or dizzy, or fainting, rapid pulse and coughing up blood

Can DVT kill you?

Yes, you can die of a deep vein thrombosis. If a pulmonary embolism(PE) occurs, the prognosis can be more severe.
If the clotis big or the artery is clogged by many smaller clots, a pulmonary embolism can be fatal. About 25% of people who have a PE will die suddenly.
In the US, every five minutes someone dies from a blood clot or deep vein thrombosis. Each year between 100,000-180,000 Americans die as the result of pulmonary embolism.

Month: May 2019

Angiosarcoma of the Breast — When surgery may not be the answer!

Breast Cancer recurred four years after surgery. DVT of right leg. Herbs helped her!