SS is a 71-year-old male. Three years ago, in 2012, his urine contained traces of blood. A checkup in a private hospital showed:

• Normal meatus (urinary meatus is the opening or hole at which urine comes out of the urethra) and urethra (theurethra  is a tube that connects the urinary bladder to the urinary meatus for the flow of fluids from the body. In male  the urethra travels through the penis, and carries semen as well as urine).
• Mildly enlarged prostate, measures 5.5 x 4.0 x 3.8 cm.
• Both kidneys are well visualised and shows a normal echo pattern with no focal lesion within it. No renal stones seen and there is no evidence of any hydronephrosis.
• Creatinine level was elevated, at 156.8 (normal 63.6–110.5).
• Fatty liver change.

SS was prescribed some medications. The bleeding stopped and he was well for two years.

One day in late 2014,  SS had pains when he turned his body from the right to the left. USG on 9 October 2014 showed:

• Fatty liver change. No focal liver lesion.
• A cyst with wall calcifications on the upper pole of the right kidney measuring 8 x 7 mm.
• There is a lobulated hypoechoic lesion in the upper two thirds of the left kidney measuring 7.0 x 6.8 x 6.2 cm.
• No hydronephrosis seen.

A CT scan, done on 16 October 2014, showed the following:

• Small cyst in the upper pole of the right kidney measuring 5 xc 5 mm in size. No mass or focal lesion noted.
• An irrregularly enhancing mass infiltrating almost the whole of the left kidney sparing the power pole measuring 7.8 x 6.2 x 10.3 cm.
• Enlarged lymph nodes noted medially measuring 2.5 x 3.0 x 3.0 cm and 1.8 x 1.6 x 1.0 cm.
• Subcentimeter paracaval and para-aortic lymph nodes.

SS underwent surgery to remove his left kidney. The histopathology report dated 21 October 2014 indicated:

• Grade 3 transitional cell carcinoma of the renal pelvis, T4N2Mx, Stage 4.
• Two (2/10) hilar lymph nodes contain deposits of metastatic transitional cell carcinoma.
• Free of metastatic tumour deposits.

The operation was a success (later you would want to ask if this is really true?) and everything was alright. SS was asked to go for chemo, he refused. Routine check up three months later showed everything was perfect. Another routine three-month check up on 22 January 2015 also showed perfect result.

Six months after surgery, 2 June 2015, X-ray showed an oval nodule in the left mid zone of the lung, measuring 13 x 12 mm. This nodule was not seen in the previous chest radiograph on 22 January 2015. An underlying metastatic deposit is considered.

CT scan of the thorax on 4 June 2015 showed:

• A nodule in the apical segment of the left lower lobe measuring 15 x 12 x 13 mm.
• Another smaller nodule is noted in the lingular segment of the left upper lobe measuring 5 x 5 x 5 mm.
• These are suspicious of metastatic deposits.

SS was asked to go for chemotherapy. He went to consult an oncologist. Listen to this video.

You want me to do chemo, but I only have one kidney left. How does that affect me?

No problem. We shall use the drugs, carboplatin + Gemzar.

Can you cure me?

No cure. There is no cure for cancer! We shall go for 3 cycles first and see what happen.

Each cycle of chemo is going to cost RM 5,000.

After the chemo (and this is not a cure) how long do I have?

I am not God

I know that you are not God.

Probably you have six months to a year! I can’t say, all depends on yourself!

(Depend on luck? Fong shui? If this being the case, where is the so called “science” in oncology then?)