Harry (not his real name) felt breathless sometime in May 2021. An examination by the doctor in a private hospital indicated three of the heart blood vessels were blocked. In June 2021, Harry underwent coronary angioplasty – i.e., a procedure using a tiny balloon catheter that is inserted in a blocked blood vessel to help widen it and improve blood flow to the heart.

While in the hospital Harry also suffered altered bowel habits and rectal bleeding. A colonoscopy was done and showed transverse colon (hepatic flexture) tumour and hemorrhoid.

Harry underwent a right hemicolectomy and omentectomy on 28 June 2022.

The histology report confirmed:

• mucinous adenocarcinoma of colon with tubulo-villous adenoma at its edges.
• Invasion of mesocolic fat, pT3 tumour.
• Three of 8 lymph nodes are involved by metastatic tumour, pN1.
• One microscopic focus of serrated  adenoma found at the tip of appendix.

Comment:  The  combination of mucinous adeonocarcinoma, tumour in the right colon and presence of serrated adenoma in the appendix is uncommon.

Stage 3B – T3N1M0

Harry was told to undergo chemotherapy in the same hospital where he had surgery. However, he was not happy with what he had gone through in that hospital and decided to take a break and ask around for various  opinions. Two months later, he decided to go for chemotherapy at  another hospital.

Before starting chemotherapy a PET scan was done. The PET scan report dated 9 September 2021 showed:

• A focus tracer accumulation seen anterior to the third part of the duodenum (0.8 x 1.0 x 0.9 cm). This FDG avid lymph node likely represents metastasis.
• Patchy ground glass opacity seen in the left lower lobe of the lung.
• There is no evidence of metastasis to the brain, nodes,  neck, thorax, mediastinum, pelvis, thyroid, lung, stomach, liver, pancreas, spleen, adrenals and bones.

Harry underwent 8 cycles of chemotherapy.

He did not suffer any severe side effect except a little numbness of his hands.

The chemo treatments was completed in April 2020. A PET scan done on 7 April 2022 indicated:

• Comparing with the scan done on 9 September 2021, the present scan indicate complete metabolic response to the treatment. Problem solved!
• Patchy ground glass opacity seen in the left lower lobe of the lung is unchanged in appreance.
• No evidence of FDG avid lesion seen in any other parts of the body.

Six months later, Harry did another PET scan. PET scan report dated 13 October 2022 showed:

• Patchy ground glass/consolidative opacity seen  in the left lower lobe of the lung was grown larger.
• New patchy nodular opacity seen in the anterior segment of the right upper lobe.

Harry was told to undergo another 8 cycles of chemotherapy using the regimen – TS 1, Irinotel + Avastin. The estimated cost of this second round of chemo would be about RM 66K as outlined  below (a note given to by the hospital).

Harry declined to undergo further chemotherapy.

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

Harry: I have done that before and it did not work!

C: When you did the first round of 8 cycles of chemo, did you ever ask the doctor if the treatment is going to cure you?

H: No. I did not know anything. I just followed what I was told to do.

C: In all, including  your heart operation, how much have you spent?

H: Roughly about RM200,000.

Comment

One big lesson we can learn from this case is that surgery and chemo did not cure Harry’s Stage 3B colon cancer.

After the completion of chemotherapy, Harry had a PET scan which showed everything was clear – no more cancer! So the treatment was effective. But that was just a …. (put in any word you like)!

About 6 months later, another PET scan showed that the cancer had recurred. Harry was asked to do more chemo.

Ask these questions:

1. What is the use of doing a PET scan when the result is so short-lived. A “success” had turned into a “disappointment” within 6 months.

2. Harry was asked to go for another round of 8 cycles of chemo which is going to cost him another RM 66K at least. Is that going to be a good investment for him?