Tag Archives: lung cancer

Lung Cancer: Free “Tarceva-for-life” failed

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FY is a 50-year-old Malaysian. His problem started with headache, poor appetite and weight loss. He consulted a doctor in a private Hospital A in his hometown. He was told there could be something in the brain. A CT scan was done and there was a lump in his lung. A biopsy confirmed a moderately differentiated adenocarcinoma.

FY was referred to a private Hospital B in Penang. The biopsy tissue was sent to Kuala Lumpur for further analysis. EGFR mutation was detected. In the meantime, FY underwent five times of radiation to the head (due to the headache). This treatment cost RM11,000. The oncologist suggested taking oral chemo.

FY decided to seek further treatment in another private Hospital C. The oncologist in Hospital C prescribed oral drug, Tarceva. This was the deal. Take Tarceva for ten months, thereafter it will be provided free of charge for life. Each month’s supply cost RM4,500, meaning FY will have to fork out a total of RM45,000 first before he could enjoy the free supply of Tarceva.

In all, FY took Tarceva for 11.5 months. So, he managed to enjoy free Tarceva for 1.5 months.

Medical Reports 

The progress of FY’s treatment was monitored by scanning and blood tests. 

CT scan thorax done in Hospital A, 29 August 2017.

  • a suspicious 3.4 x 2.8 x 3.3 cm lump in the lower lobe of his left lung.

CT scan of brain, neck, thorax, abdomen and pelvis done in Hospital C, 26 September 2017.

  • lesion at apical segment of left lower lobe of lung and small cavities due to primary carcinoma.
  • multiple small metastases in both lungs.
  • enhancing lesions at left parietal lobe, vermis and right cerebellum.
  • patchy sclerosis of body of T1 vertebrae suggestive of metastasis.
  • lymph node at level 4 of neck.

MRI thoraco-lumbar spine done in Hospital C, 3 October 2017.

  • abnormal signal intensity within C7,T1 and T2 vetebral bodies. Features suggestive of metastases.
  • L4/L5 disc bulge.
  • L5/S1 disc bulge. 

Whole body PET Scan done in Hospital C, 18 January 2018.

  • metabolic activity noted in the right (1.8 cm) and left sides of neck (1.9 cm) .
  • metabolic activity noted in the left base of the tongue.
  • metabolic activity left axillary lymph node (2 cm).
  • irregular metabolic active mass (3.2 cm) seen in the apical segment of the lower lobe of left lung.

Whole body PET Scan done in Hospital C, 21 August 2018.

  • metabolic activity node see in the left (1.3 cm) side of the neck.
  • metabolic activity left axillary lymph node (0.6 cm).
  • FGD-avid mass (4 cm) seen in the apical segment of the lower lobe of left lung. This is larger and has more metabolic activity compared to the previous PET CT on 18 Jan. 2018.
  • metabolic active nodule (1.9 cm) seen in the posterior segment of the upper lobe of right lung – not seen in the previous scan.
  • another metabolic active nodule (1.7 cm) seen in the posterior basal segment of the lower lobe of the left lung — not seen in the previous scan.
  • a few 2-5 mm, non metabolic active nodules seen in the right and left lungs. These are not seen in the previous scan.
  • increased metabolic activity seen in the left adrenal gland (1.4 cm).
  • metabolic active lesions seen in the spine of C7 and T1. These re larger and more metabolic active compared to the previous PET CT scan.
  • metabolic active bony lesions seen in the spine T12, left sacrum and medial wall of the left acetabulum. These are not metabolic active in the previous scan.

You don’t need to be a doctor to know that FY is getting worse, not better, after taking Tarceva.

Below is a table with values of CA125, CA15.3 and CA19.9 taken over a period of about a year while FY was taking Tarceva. The most telling results are the values of CA125. In September 2017, the value was 434. After taking Tarceva it gradually decreased to 48 and down to 15 in February. But in March 2018 (barely five months later) the CA125 started to increase and in August 2018 it was at 46.5.

Date CA 125 (0-35) CA 15.3 (0-31.3) C19.9 (0-37)
26 September 17 434 9.8 39.4
24 October 17 48 7.7 16.9
28 November 17 15 n/a n/a
27 December 17 15 n/a n/a
23 February 18 15 4.9 8.2
26 March 18 18 5.8 15.6
23 April 18 19 5.9 11.0
22 May 19 22 5.2 17.0
25 July 18 40.6 5.1 17.2
17 August 18 46.5 n/a n/a

The numbers above clearly showed that Tarceva was gradually losing its effective after five months!

In August 2018, the oncologist told FY that Tarceva was not effective anymore. He has to switch to i/v chemotherapy and radiotherapy. A cycle of chemo would cost RM12,000.

If FY does not want chemo, he can opt for another new, more expensive oral drug (probably Tagrisso which cost RM30,000 per month).

FY and his wife came to seek our help. They decided not to continue with further medical treatment – at least for the moment.

Chris: Can this new drug cure you?

FY: No, only control.

Comments

This my third case in which patients were asked to take Tarceva for ten months with the promise that at the 11th month onwards they get Tarceva without charge for life!

Do you ever wonder why patients are offered Tarceva for free, after being told to buy a ten-month- supply first?  Is it a noble, charitable intention or “smart” business deal?

Read this story: Lung Cancer: Spend RM80,000 and You Get Free Tarceva for Life

Daughter: My father has lung cancer. It is positive for EGFR. The doctor suggested taking the oral targeted therapy, Tarceva. One box, lasting one month, cost about RM8,000. After we take Tarceva for ten months, and if the medicine works, for the rest of his life the medicine will be free. But must complete the ten boxes first. That’s the deal!

Chris: You mean after spending RM80,000 they will give you Tarceva for free for life? But what happen if your father dies before the ten months?

D: I was thinking. May be my father cannot last that long. Maybe before the ten boxes, sure die one.

C: I have one patient who came and see me. She was asked to take Nexavar (for liver cancer). The deal was buy one, free one. But must pay RM20,000 first (for the first month’s supply) and next month she will get one month’s supply of Nexavar for free! But after she took the drug for a week, her health deteriorated, had to be hospitalised and she died. Already paid RM20,000, cannot claim back.

Another question that bugs me is, why free only after TEN months? Why not earlier? Why not buy one, free one like they offered for Nexavar?

Let’s study the blood test numbers critically.  Let’s look at the bigger picture. The CA125 was at 434 in September 2017. After taking Tarceva the value dropped to 15. Bravo! Tarveca seemed to do the magic. But this euphoria did not last long. A month later, in March 2018, the CA125 started to increase. By August 2018, it was at 46.5.

By offering patients free Tarceva after ten months, seems appealing and noble at the first look; but in reality does the drug company or doctor not know that by a few more months, patients don’t need Tarceva anymore because it is not effective?

From a business point of view, it also does not make “sense” why the drug company would give Tarceva for free. Business is to make money. Just imagine what could happen if all patients get free Tarceva for life — will that not make  the drug company go bankrupt?

Let me share with you what my favourite Jewish rabbi, Harold Kushner said:

When I started to ask these questions, I became more curious. To kill the curiosity in me, I googled cost of generic Tarceva in India.

This is what I get.

  • In many countries, the brand-name Tarceva 150 mg drug costs about $18,700to 19,000 (price subject to vary) per 30 tablets. However, the mass production of generic cancer drugs versions are available for less than 15% of the retail price of the brand-name drug. Mar 22, 2018

Click this link and you get prices of generic Taceva available in India

https://dir.indiamart.com/impcat/erlotinib-tablets.html

(Exchange rate: Indian Rupee 10,000 = RM 563)

In India you can buy a month supply of generic Tarceva for less about RM563. Wow, amazing — I learned something new today!  At one time Tarceva was selling for RM 8K per month. Now the price dropped to RM5K — and that is still many times more expensive than the Indian generic.

Erlotinib   Rs 11,900, 150 mg, 30 tablets

Erclocip  Rs 7,230 for 30 tablets

Erlonat  Rs 6,000 for 30 tablets

Erlonat by NATCO,Rs 10,000 for 30 tablets

I have another question. I wonder why the Power-that-Be in developing countries do not look to India for the cheaper, generic drugs? Is that not a good way poor for poor countries to save money?

If you are skeptical about this suggestion, that is okay. Go ahead and spend your money.

But if you are poor and cannot afford to buy these expensive, American drugs, I believe my suggestion makes sense.

Take this case, FY paid for the  “expensive original” Tarceva, right? For less than a year, he already spent RM45,000. Look what happened to him?

Go to these links and read:

Generic cancer drugs that we can trust

Access to cancer medicines in India

India to supply generic cancer drug to US 

India approves generic cancer drug

Dying to Survive: Indian generic medicines have a tale to tell

Terminally ill dad saves more than $200k bringing in cancer drugs from India

 

 

 

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Alimta for lung-liver-lymph nodes-bone cancer: Buy two, free two. If you make it to 12 cycles, free for life!

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A young couple came to me on behalf of his father. The young man sounded very disorientated. I could not figure what he was saying in his soft voice. Luckily he brought along his wife who could present their father’s case clearly and logically.

Ono (not real name) is a 64-year-old. He lives in an Indonesia town about seven-hour-bus ride to Kuching, Sarawak.

Ono’s problem started about four to five years ago when he had abdominal problems. He consulted a doctor in a private hospital in Kuching. According to the doctor there was stone in his gallbladder. He was told not to worry and was sent home.

About two to three years later, Ono suffered a mild stroke. He was given medication and was okay after that.

In July 2018, Ono had severe abdominal pain with cold sweat. According to the daughter-in-law this was not due to gastritis or wind in the stomach.

In mid September 2018, Ono went to a private hospital in Kuching. An USG showed his gallbladder had pus and there was infection of the liver.

Ono underwent an operation to remove his gallbladder. A pathology report indicated a perforated gallbladder with malignant glands. It was a moderately differentiated adenocarcinoma.

Blood test on 10 September 2018, showed elevated liver function enzymes.

Alkaline phosphatase 133 H (30-120)
GGT 152 H (0-50)
AST 34 (0-45)
ALT 44 (0-55)

CT scan on 27 September 2018 indicated the following:

  • metastatic liver nodules.
  • metastatic paraortic lymph nodes.
  • right upper lobe lung mass (2.3 x 3 cm), likely tumour, metastasis.
  • small left lower lobe nodule, likely metastasis.
  • right hilar and mediastinal lymph nodes.

Biopsy report dated 29 September 2018 confirmed:

  • right upper lung lobe mass — moderately differentiated adenocarcinoma.
  • subcarinal lymph node — no malignancy. Another report C2354-18 on the same date, subcarinal lymph node aspirate: few atypical cells that are suspicious for carcinoma.

MRI on 2 October indicated:

  • T4 pathological facture causing compression on the thecal sac and spinal cord.
  • T2 – T7 and S1 – S2 metastatic vertebral lesions.
  • mild L4/5 posterior disc bulge.

EGFR PCR 6 October 2018: None of the mutations were detected.

11 October 2018: Tumour cells do not demonstrate a staining reaction to ALK-1.

Blood test on 13 October 2018 showed the following:

Alkaline phosphatase 114 (30-120)
GGT 137 H (0-50)
AST 32 (0-45)
ALT 65  H (0-55)
CEA 69.3 H (0-5)

Ono was referred to the oncologist for follow up. He underwent one cycle of chemotherapy using Alimata, dosage 690 mg. The total cost per cycle is RM8,500. Ono was told that he might need to go for four to six cycles.

Was Ono better after the first shot of chemo? According to the son, he had less pain but he is still in great pain. The pain was in the chest. It was more severe at night than daytime. Ono’s son said he had to massage his father’s legs throughout the whole night to make him comfortable. In fact that was the reason why he was so disorientated when he came to see us due to lack of sleep. Ono had no energy and need to lie down all the time. His breathing was difficult.

I had to be up front with Ono’s children. I said, I cannot cure your father. Actually I told them to go home and continue with the chemo if they want to. Either way, the  outcome would not be different. Ono’s children was very disappointed. They wanted to try the herbs.

Comment 

At CA Care I learn many things each day. Today’s lesson is something I did not know before until I encounter Ono’s case.

The total cost of one cycle of chemo (Alimta and Carboplatin) is RM8,520.70. Of this total

  • Alimta 500 mg cost RM4,600
  • Alimta 100 mg cost RM2,560
  • Kemocarb – carboplatin 450 mg cost RM151.50

So the total cost of the chemo-drugs is RM7,311.50. The remaining RM1,209.20 is the cost of hospital care inclusive of RM500 oncologist’s fee.

There are two interesting points to highlight after studying the detailed medical bills.

 Alimta Special Offer

From the above, for every two cycles of Alimta, Ono will get the next two cycles free of charge. So it is like buy two, free two. And the offer gets even more attractive after that. If Ono could make it to a total of 12 cycles of Alimta, he will receive free Alimta for life!

One point that bothers me is this, does the offer: buy two free two and after 12 cycles you get free for life, really makes business sense? Like the Malay saying, ada udang disebalik batu? (is there a prawn behind the rock?). I am sure you are smart enough to come to your own conclusion.

Why not use generic Alimta from India?

Ono paid a total of RM7,160 for Alimta. Just for curiosity, what would this generic drug cost in India?

In India you have a choice between the expensive and cheap generic Alimta.

  • Eli Lily or US brand cost Rs 91,343 for 600 mg injection (or RM5,175 as opposed to Kuching which cost RM 7,160)
  • The generic Alimta cost one-fourth the price, Rs 23,990 to Rs 24,000 (or RM1,359).

Indeed if the Power-that-Be in the developing countries is wise, why don’t they opt for the cheaper generic drug from India?

But you may say, the Indian stuff does not work. The American one is better. Really?

Take a look below. In addition to Alimta, Ono also received carboplatin. The oncologist in Kuching did not use the American stuff. He used generic carboplatin from India called Kemocarb. Ono paid only RM151.50 for this generic carboplatin. Great doc., you tried to save money for your patient. That’s the way to go!

 

 

 

 

 

 

Lung Cancer Part 1: Free Tarceva for Life — A Crashed Dream

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GG is a 59-year old Malaysian lady. About four years ago (June 2014) she had a bit of cough. She consulted a GP who  said there might me something in her lung. GG was asked to consult a lung specialist in Hospital A in Penang.

A CT scan on 5 June 2014 indicated mild fibrosis in both lungs. There was a 1.6 cm nodule in the right lower lobe, likely benign in nature. Minimal atelectasis (collapse or closure of a lung resulting in reduced or absent gas exchange) in the right lung base. Conclusion: Features are suggestive of infective process, such as tuberculosis.

GG was sent home without any medication.

Unfortunately, GG did not get any better in spite of returning to see her doctor again and again.

Her tongue became crooked. GG went for acupuncture. Great! Her headache went away and her tongue became straight again. The acupuncture treatment was for about two months. She received two treatments per week. Each treatment cost RM 8.00.

Unfortunately again, GG’s problems did not go away. In September 2017, she developed severe headaches and could not stand the pain. She started to cough, especially at night. GG went to consult a neurologist in Hospital B. A scan showed nothing in her brain but there was a 2.6 x 2 x 2.5 cm mass in the left upper lobe of the lung. There was also a 2 x 1.6 x 2 cm mass in the right lower lobe.

There was partial collapse of her T3 vertebra. There were lytic and sclerotic lesion seen in the right 6th rib and the left 10th rib.

A core needle biopsy of the lung mass was done. The result confirmed cancer — an invasive moderately differentiated adenocarcinoma.

GG went for a second opinion in Hospital C. A PET scan was done followed by a biopsy again.

The PET scan results suggested primary lung cancer with metastasis to the perihilar node and multiple bony metastasis involving the spine, pelvic bones, bilateral ribs, right skull base, left scapula and left humerus.

A tissue specimen sent to Kuala Lumpur for further analysis indicated positive for EGFR gene mutation.

GG was started on oral drug Tarceva in October 2017. And she had been taking this drug until now. GG had to pay RM5000 plus per month for this medication. In addition she received monthly Zometa injection for her bone. This cost about RM1500 per month.

Chris: Did you ask the oncologist if these treatment can cure you?

GG: No, cannot cure. Can control only.

C: How long do you need to be on the medication?

GG: Take Tarceva until I die.

When GG came to see us, she was already on Tarceva for 13 months.

The oncologist offered an interesting deal. GG has to buy Tarceva for 10 months. After that she will be given free Tarceva for life. In other words, spend $50 to 60K on Tarceva first and then you get whatever Tarceva you need for life.

For the past three months GG received free Tarceva but had to spend about RM300 per visit on hospital expenses.

Unfortunately, about two weeks before she came to CA Care, GG had to be hospitalised for ten days. This cost her RM21,000.

All in all, up to this point in time, GG said she had already spent RM100,000 for her medical treatments. Never mind, insurance pay!

C: Why do you come and see us. Why don’t you continue taking the Tarceva. After all it is for free now!

GG: The oncologist said Tarceva is not effective anymore! I need to change to another more expensive drug. And this time I need to pay for that drug. It will probably cost RM10,000 per month and I cannot afford that.

C:Did you suffer any side effects while on Tarceva?

GG: Initially there was a bit of hair loss. My skin was dry and there was a bit of itchiness. After about seven months on Tarceva and Zometa, I started to have more serious problems.

  • Double vision. If I close one eye, it is okay. With two eyes opened it is havoc.
  • Cannot stand the bright light with my eyes opened.
  • Both ears with ringing sound.
  • Legs no strength.
  • Severe muscle pull at the neck.

C: Did you have such problems before taking Tarceva?

GG: No such problem.

 

 

Indeed when GG came to see us she was really in a bad shape. She could not sit up for long and needed to lie down. Her son pushed her around in a wheel chair.

I asked GG to leave behind her stack of medical reports and CDs of the scan. I need to do some “homework” to understand what had happened.

One month after commencing Tarceva, GG had a CT scan. Did the tumours in her lung disappear? As shown by the scan below, there was no magic.

One year after consuming Tarceva, CT scan showed GG’s condition did not get any better either. Study the images (above and below) and see for yourself that the tumours in the lungs did not go away.

GG had been a RM1,500-Zometa-injection every month. Her bones did not get any better either. MRI in September 2018 showed severe compression fracture of body of T3 vertebra and sclerotic lesions in bodies of T2, T3, T4, T5, T6, T7 and T11 vertebrae.

Every month, GG did blood test and her CEA, CA 153 and CA 19.9 were monitored. The results (as in tables below) were disappointing.

In September 2017 when GG started seeing her doctors in Hospital B, her CEA was only 11.7. Then GG started to take Tarceva  prescribed by an oncologist in Hospital C. The CEA increased to 58.6. Over the months, even with Tarceva, the value fluctuated. It August 2018 (after almost a year on Tarceva) it was 42.5. In September 2018, it was 14.8 (Table below).

The rise and fall of CA 15.3 and CA 19.9 showed similar trend. Look at the big picture.

GG started off with CA15.3 = 35.5 and a year later it was 98.

For CA 19.9, it was at 120.4 in September 2017 and it was at 178.9 in September 2018.

You don’t need to be a doctor to know that the treatment did not work. GG needs to try her luck elsewhere. If she continues with the medical treatment, she was told that she needs a new, more expensive drug. This time she has to pay for the drug. Her dream of enjoying free Tarceva for life turns out to be just a “crashed dream” or an illusion.

 

Lung Cancer Patient from Selat Panjang — still alive and healthy?

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I once asked an Indonesian patient who came to see me. Do you know where Selat Panjang is? He shook his head — No. 

Well, I don’t expect him to know — the Indonesian archipelago has 18,307 islands!

But I am glad to say that over the years taking care of cancer patients, my geography about Indonesia has improved a notch! I know where Selat Panjang is — because I have patients who come from that Riau islands.

Let’s watch this video first.

Comments

When patients come here for the first time, I normally ask a few general questions, such as Where are you from? Who ask you to come here? 

Here are some lessons we can learn from my conversation with this lady (let us call her Alice) from Selat Panjang that morning. 

Where are you from? 

From her hometown, Selat Panjang, Alice had to take a three-hour plus ferry ride to Batam. From Batam, it  was another two-hour plus ferry ride to Johor. From Johor she took a ten-hour bus ride to Penang. Unfortunately, Alice got off  at the wrong place! This was her first time in Penang — a real daring adventure!

Over the years, I learned that some other patients need to travel for one or two days just to reach Penang. They had to take a train or bus for hours to the airport and then fly to Penang. Some patients had to change planes one or two times to get to Penang.

I really feel sorry for people like Alice who has to travel so far and so long just to come and seek our help.

So, those of you who live nearby, consider yourself lucky or blessed. You need not have to suffer such “ordeal” to come and consult us. I used to joke with some patients. Some patients just have to drive across the Penang Bridge to come and see us and that they consider “very far away”!  To others, taking one- or two-hour plane ride is considered “far”? Think about Alice and others like her! 

Who ask you to come and see us? 

Alice came because someone in Selat Panjang told her about us.

About three years ago, a lady came to seek our help on behalf of her father who had lung cancer. The father was bed-ridden and was unable to move his bowels and urinate. This lady brought back some herbs for her father. He was also told to take care of his diet. Within two weeks he got better. It has been three years now and he is still alive and healthy.

Can you believe this story? To be honest, I don’t. More often than not, people tend to exaggerate their “success”!

So I took some time trying to get more details from Alice. Did you really meet this patient? Yes. Alice met and talked to the patient himself. This patient made a photocopy of our name card and gave it to Alice. Up to this day, Alice said the man still takes care of his diet. I asked Alice if he is he really alive and healthy? Yes, he puts on weight and is not a skinny, half dead person! Really still alive? Yes.

If you ask me if a bed-ridden, lung cancer patient would survive that long my answer would probably be no way. The condition of Alice’s father is almost the same as this man, both of them have lung cancer and are bed-ridden.

One important lesson I learned about helping patients is the need to share.

When we started our cancer centre in Penang, the first thing I did was to knock down the wall of our consultation room to make it an open space. I see patients in this open hall. Why? From the very beginning I believe that we are all in here together — you and me, and many other patients who come to CA Care for help. There is nothing to “hide” from each other — let us learn to share and help each other.

When I first started CA Care in 1995, I knew nothing about cancer. I did not even know the difference between radiotherapy and chemotherapy let alone know what herbs to prescribe for various cancers. With time I read a lot and learned from the experiences of patients who came and shared their experiences.  My patients taught me how to heal them! I in turn shared those experiences to help others. As I said, we all are in here TOGETHER. And this how CA Care grows.

I am glad to learn that this lung cancer patient in Selat Panjang decided to share his healing experience with others who need help. It is noble of him to help his fellow islanders!

Over the years, I must say that 99.9 percent of the patients are very co-operative. They are willing to share their success stories. It is because of this willingness to share that makes CA Care what it is today. However, over the years, I have also come across some “rotten apples” who don’t want to share. They even ask me to delete their stories posted in the website. So be it, I respect their wishes.  Luckily, such rotten apples are rare, otherwise I would have closed CA Care years ago! 

Why are you here? 

Alice came with a strong feeling that we could help her father. Her father has lung cancer that has spread to his bones. Because of that he is bed ridden. According to the oncologist, without chemo her father would die within six months.

I was upfront with Alice and I did not want to play god in this game. I told Alice I would not be able to cure her father. I would not be able to repeat the success that happened to the patient who introduced her to us. Remember what happen to others, need not happen to you. What happen to you need not necessarily happen to others. In cancer, your healing or failure is uniquely yours.

I also ask Alice to ignore the oncologist’s prognosis. To me, telling patients that they have six or a few months to live if unethical.  When patient asks me how long he/she has, my answer is, Don’t worry we shall do our best to help you. Read what Professor Jerome Groopman, a well known oncologist at Harvard Medical School wrote:

I am also aware that one of the sales tactics, to push more treatment to patients, is to instill fear into them. Make patients helpless and you can pull them by their noses — tell them to jump into a pit, they would willingly do it. I would not want to do that.

Alice has come all the way to seek help. She deserved to receive the best from us as honestly as we can provide. After spending some hours with Alice, I asked her to relax, go back to her hotel first and call her family in Selat Panjang to explain what it takes to embark on this healing journey. It is not easy. If her father is not willing to follow our advice, it is better not to take our herbs. No, we do not wish to putting any fear into the family by rattling out meaningless statistics or create a do-or-die situation.  Be calm and think properly.

Healing needs a strong sense of commitment. Nobody can help you except you yourself. I am glad that Alice understood this. She took time to talk to her father and family. The next day she came back and said she wanted to try our therapy. For the rest that follows, I pray that God will guide and bless the patient.

 

Lung Cancer: After Surgery, Chemo and Radiation, the cancer spread to his healthy lung

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CK is a 62-year-old male from Kuala Lumpur. He and his wife came to see us with copies of his medical reports neatly filed in a folder. This is a very pleasant couple who is now helpless and directionless. This is what happened.

1)  20 December 2015: Had food poisoning after taking expired red wine. 

2)  21 December 2015: Consulted a GP who discovered “cracking sound” in his left lung.

3) 22 December 2015: CT scan of chest showed a 3.2 x 5 cm mass in the left lung.

4)  2 January 2016: A CT-guided biopsy confirmed a bronchoalveolar adenocarcinoma.

CK was referred to a cardio-thoracic surgeon in a “heart hospital.”

5)  14 January 2016: PET scan confirmed carcinoma of the left lung with no associated locoregional or distant metastasis.

6)  23 January 2016: Admitted to the “heart hospital” for lower lobe lobectomy, i.e. surgery to remove a quarter of the lung.

The surgery was a “success” and histopathology report showed:

  1. a) Aortic wall adventitia was infiltrated by tumour.
  2. b) One pulmonary lymph node showed tumour metastasis.
  3. c) lower lobe of left lung — invasive adenocarcinoma with predominant bronchoalveolar and papillary pattern.

7)  February to June 2016: Underwent 4 cycles of chemotherapy and 20 sessions of radiotherapy.

Things seemed to be okay after all these treatments but CK had chest pains, coughs and fever. He was prescribed “strong” antibiotics.

8) 30 March 2017 — after slightly more than a year.

Follow up CT scan showed multiple nodules and patchy opacities in the upper and lower lobes of right lung.

Radiologist suggested: Differential diagnosis: lung metastases and pneumonia. Suggest close follow up CT lung after a course of antibiotics.

CK went back to his surgeon about this new development. The surgeon was pretty sure that the spots were not cancer related.

9)  1 June 2016:  CT scan of chest. The radiologists wrote the following:

CT on 23 March and 30 March 2017 were reviewed. The current CT is about 2-3 months after  the previous CTs. The current CT showed the following:

  1. a) The ground glass opacities in the right upper and lower lobes of the lung appears more dense and larger.
  2. b) Newer small nodular lesions are seen in the right upper and lower lobes.

Based on the above observations, the radiologist was of the opinion that this new development was a metastasis or recurrence. However, ground glass opacities may  be due to drug induced lung changes and infection.

The changes in the left upper lobe (note: left lower lobe was removed) are suggestive of non-neoplastic process and fibrosis. If DXT (radiotherapy) was given, these could be due to that treatment.

10) 18 September 2017: Went back to the same GP again (as in 2). “Cracking sound” at the lower part of my good lung.

Cancer marker in December 2016 was 16. In July 2017,it was 173.

CK and his wife decided not to go back to his doctors again. Because it will just be repeating the same procedures all over again — another biopsy and more chemo.

Total cost of treatment = RM130,000 of personal savings.

Comments 

I had my first lesson about lung cancer some 22 years ago. The second patient of CA Care is VJ. He had lung cancer and had one side of his lung removed and underwent treatments at the “cancer hospital.” I was at the hospital and saw him suffer and eventually died.. Surgery did not cure lung cancer. Treatments received in the cancer hospital also did not cure lung cancer.

My second lesson about lung cancer came a few years later when the mother of my student underwent radiotherapy for her lung cancer. Yes, I encouraged her to go for the treatment. After completion of her treatment she died. Lesson number two, radiation does not cure lung cancer. To understand why, just go to the market and buy a piece of lung. Bring home and place the lung over fire and see what happen! The lung hardened — and is this not why the patient cannot breath?

Over the years, I have seen this story being repeated over and over again. In the case of CK, it is another one of those cases I have come across over the years.

Can herbs cure CK’s cancer? No. Can we help him? May be. CK’s problem recurred less than 2 years after treatment. After spending RM 130,000 he got nothing out of it.

Perhaps some people would want  to tell you that if you don’t go for treatment, you would die sooner. Nope — I don’t believe so. Over the years, I have patients who led a much better life if they do nothing.

Perhaps you may want to read some of the articles I have written earlier:

  1. He Died Of Lung Cancer — Treated by the Best Oncologist in One of the Best Hospitals in the World

2. Medically Given Up Lung Cancer: She died after 5 years on CA Care Therapy

3. Lung Cancer: Six to 12 Months to Live. Must do chemo, that’s the only way. With herbs still alive after 2 years!

4. Lung Cancer: Given Honest Answers Patient May Run Away from Chemotherapy

5. Two Billion Rupiah, Chemo And Surgery Failed. Oncologist said, “More chemo, you just have to trust me!”

6. Lung Cancer: Chemo Experiments That Failed and Failed

7. Lung Cancer Success Stories

My advice to CK.

Don’t give up hope yet. We shall do our best. If you can sleep, can eat, can move around and have you no pain, don’t ask for more. To that CK and his wife totally agreed. In fact that was what they hope for when they came to seek our help … “to have quality life.”

 

 

 

May God bless you.

Cancer of the pancreas-liver-lung: Surgery and chemo failed. She came to CA Care

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Mei (not real name) is 53-year-old lady who flew to Penang with her husband from Australia. They were desperately in need of help. According to her doctors, Mei would not live long — it is a month to month case and Mei would probably not survive to celebrate Christmas 2017 (5 more months!).

Mei’s problem started in March 2016, when she had problem swallowing food or even water. Both her hands and legs itch. Her GP did a blood test and found her liver function enzymes were elevated. This could be due to obstructive jaundice. She was then referred to a specialist.

CT and MRI showed tumour in the head of the pancreas. In early April 2016, Mei underwent a Whipples resection in which part of the pancreas, intestine, bile duct, gallbladder, omentum and 8 lymph nodes were removed.

After the surgery, Mei received 6 cycles of chemotherapy. 

Chris: Did you ask if the chemo was going to cure you? There  is no clear cut answer to this question. According to Mei, she was given the impression that everything would be okay after completing the chemo.

Did you suffer from the chemo? Yes. Listen to our conversation. It was 5 months of hell.

 

 

Unfortunately too, after the fifth chemo, Mei was told that the cancer had spread to her liver. There were “innumerable foci throughout all segments of the liver.” Mei was also told that there was a spot in her lung.

Mei had to undergo more chemo. Mei received 4 more cycles of chemo. On two occasions she had to be hospitalized due to breathing difficulties. She decided to give up chemotherapy.

The oncologist and Mei’s husband came to a compromise — Mei would go on a “drug holiday” for 2 months and then resume chemo again. When the 2 months were up, Mei told the oncologist she would not want to continue with her chemotherapy any more. The oncologist said he hoped Mei could make it to December.

Comments

Many people have written about chemotherapy and its devastating effects on patients. Reflect on these quotations.

 

For more go to Part 2.

 

Lung Cancer: Spend RM80,000 and You Get Free Tarceva for Life

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Sam (not real name) is 63 years old. Sometime in June 2016, he had pain in his right arm. An X-ray was done and the doctor said it could be due to muscle problem. He was asked to go for physiotherapy. It did not help.

In January 2017, his right arm was swollen and his condition became more serious. He consulted an orthopedic doctor. There was nothing wrong!

Sam was admitted into a private hospital on 11 February 2017 for further examination.

MRI on 12 February 2017 showed a 3.1 x 2.3 cm mass at the distal humerus (bone in the upper arm) involving the triceps muscle. Incidentally, the doctor also found a suspicious 4.4 x 5.2 cm lesion in the lower zone of his right lung.

A CT scan done the next day, 13 February 2017, confirmed the presence of an irregular 4.3 x 4.38 x 3.96 cm mass in his lung. There were also multiple enlarged lymph nodes in the pretracheal and carina. The largest being 2.69 x 1.77 x 1.9 cm and 3.48 x 2.91 x 1.61 cm respectively.

In short, the cancer had spread. But the question is: Spread from the lung to the bone, or from the bone to the lung? A biopsy of the bone showed negative for malignancy. A biopsy of the lung showed positive for cancer.

The total cost of the 4-day-stay in the hospital for the above procedures cost RM 12,595.90.

So what comes next? What to do. The doctor suggested the following options:

  1. Chemotherapy.
  2. Immunotherapy.
  3. Target therapy — taking of oral chemo-drug if it is positive for EGFR.
  4. Bisphosphonate, a drug that slows down or prevent bone damage. Depending on the type of drug given, this is to be taken either once a day, once a week (on the same day of the week), or once a month (on the same day of the month).

Listen to our conversation this morning!

Gist of our conversation.

Daughter: My father has lung cancer. It is positive for EGFR. The doctor suggested taking the oral targeted therapy, Tarceva. One box, lasting one month, cost about RM8,000. After we take Tarceva for 10 months, and if the medicine works, for the rest of his life the medicine will be free. But must complete the ten boxes first. That’s the deal!

Chris: You mean after spending RM80,000 they will give you Tarceva for free for life? But what happen if your father dies before the ten months?

D: I was thinking. May be my father cannot last that long. Maybe before the ten boxes, sure die one.

C: I have one patient who came and see me. She was asked to take Nevaxar (for liver cancer). The deal was buy one, free one. But must pay RM20,000 first (for the first month’s supply) and next month she will get one month’s supply of Nexavar for free! But after she took the drug for a week, her health deteriorated, had to be hopitalised and she died. Already paid RM20,000, cannot claim back.

So back to you, Tarceva is a good deal. Why don’t you want to take the drug? Can take the drug for life and no need to pay.

D: (Shaking her head) No, don’t want.

C: Did you ask if Tarceva can cure or not?

D: It will control the cancer cells, so that they never spread.

C: But cannot cure?

D: That’s what I asked him (doctor). The tumour is going to be there.

C: That means, cannot cure la because the tumour is still there.

D:  In about 5 percent of patients, the tumour shrink.
C: What happen to the 95 percent, tumour never shrink?

D; Under control.

C: I tell you. For some people the tumour was totally gone after taking the drug. But a few months later, the tumour came back again. And this time it was twice the size.

Did the doctor tell you about the side effects of Tarceva?

D: Ya, I asked. Diarrhoea, only that.

C: Only that?

D: Ya, mild one only.

C: You believe him or not?

D: May be not.

C: I tell you. Don’t just listen to me only. I can bluff you. Go back and read more. Read what others say.

D: I prefer natural medicine.

C: I shall do my best to help you. I shall give you herbal teas for his lung, lymph nodes and bone. The herbs are bitter — awful taste. Can or not?

Know that I cannot cure your cancer. But take herbs and see if they can help you or not. If you take the herbs for a month, I am going to ask you if you feel better or not. If you don’t feel better, then no need to come and see me anymore. If you feel better, continue taking the herbs.

When can you stop taking the herbs? I really don’t know. But if you are feeling better, why stop it? Because I know there is no cure for cancer.

In America, most people with stage 4 lung cancer die within a year. But, I am not saying you are going to die soon. Go home and read the stories (in the website).

Of course, all of us have to die. So don’t worry about death. What is important is, don’t die suffering. Want to die also cannot, want to live also cannot. That’s terrible.

So, I shall try to help you. If it’s good, continue. If no good, don’t continue. Go home, take care of yourself and take care of your diet.

Comments

They say knowledge is power. This is true! To me, with cancer, ignorance kills!

I am glad that Sam’s daughter is smart! She asked questions. And she “processed” the answers given!

In this world today, we read about “fake news”, “fake information”, “cybertrooper”, etc.. So please be on guard and beware.

As I was writing this story, one lady came to ask for help. She was also given Tarceva for her lung cancer. For about one month plus, Tarceva seemed good for her. Then she started to suffer side effects. After seven months the side effects were unbearable and she gave up Tarceva totally. No, she did not hit the 10-month-mark! The irony is, this lady is a medical staff of a hospital. She should know better!

Listen to her story.

Google “side effects of Tarceva” and you get this. No, it is more than just mild diarrhoea!

Side effects of Tarceva include:

  • Acid or sour stomach
  • belching
  • blemishes on the skin
  • bloated or full feeling
  • bone pain
  • burning, dry, or itching eyes
  • diarrhea (mild)
  • difficulty with moving
  • dizziness
  • dry eyes
  • dry skin
  • excess air or gas in the stomach or intestines
  • excessive tearing
  • fear
  • feeling sad or empty
  • feeling unusually cold
  • hair loss
  • headache
  • heartburn
  • indigestion
  • irritability
  • itching skin
  • joint pain
  • loss of interest or pleasure
  • nervousness
  • passing gas
  • pimples
  • rash, mild
  • redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
  • shivering
  • stomach discomfort, upset, or pain
  • swelling
  • swelling or inflammation of the mouth
  • swollen joints
  • thinning of the hair
  • tiredness
  • trouble or inability to sleep
  • trouble with concentrating
  • weight loss
  • loosening of the fingernails
  • redness or soreness around the fingernails.

Source: https://www.drugs.com/sfx/tarceva-side-effects.html

More about the side effects of Tarceva:

Meaningless Shrinking of Tumor While on Tarceva https://cancercaremalaysia.com/2012/04/26/meaningless-shrinking-of-tumor-while-on-tarceva-treatment/ 

Meaningless Decline of CA 15.3 and Tumour Shrinkage Following Treatment With Iressa and Tarceva https://cancercaremalaysia.com/2012/04/26/meaningless-decline-of-ca-15-3-and-tumour-shrinkage-following-treatment-with-iressa-and-tarceva/ 

 

Update: Daughter wrote to say father died on 7 October 2017

Swollen face, palm and foot gone after three days on herbs

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lotus-3

 

MS is a 68-year-old man. About four years ago, he had colon cancer. He underwent an operation but did not undergo follow-up chemotherapy. He went on vegetarian diet. His cancer did not go away.

CT scan done on 1 August 2016, showed large mass in his right lung measuring 10 x 7.4 x 10.0 cm in size. It invaded the mediastinum. There were also multiple smaller lesions in the right and left lungs, measuring up to 2.4 cm.

MS did not receive any more medical treatment and opted for supplements. He took Transfer Factor, Probiotics, Tea4Life, etc.

MS became breathless.  X-ray done on 29 August 2016, showed a 12.0 x 9.0 cm mass with pleural effusion (fluid in the lung) as below.

tham-lung-xray

Ultrasound guided drainage of the lung fluid was done. Blood test showed the following results.

Platelets count 522
CEA 900.7
CA 125 148
CA 19.9 193.07

 

MS stayed at home and took whatever supplements, but these did not help him. On 3 January 2017, a son of MS came to seek our help.

I was told that MS had difficulty breathing and his face, hands and legs were swollen. He was not able to lie down flat when sleeping.

This was what I told his son: This is a serious case and there is no cure. Let us try to tackle the problem slowly. First is to try and resolve this swelling and also get rid of the fluid in his lungs.

MS was prescribed Lung 1, Lung 2 teas plus Lung Phlegm. In addition he was given Upper Edema tea.

Wonderful results: Listen to what his son told us.

 

 

  1. Swelling of the face, hand and feet were gone after taking the herbs for three days!
  2. He had more strength.
  3. He urinated a lot.
  4. He coughed out a lot of phlegm (effect of the Lung Phlegm tea).

Comment:  We often tell people that we are not magicians and we cannot do magic. But sometimes that in this special case, magic did happen. It is beyond our expectation even though we have seen such results happened many times before!  Praise God for this wonderful blessing.

 

He Died Of Lung Cancer — Treated by the Best Oncologist in One of the Best Hospitals in the World

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It was 3 a.m. when I finished reading the last page of this 224-page-New York Time #1 Bestseller.

When breath becomes air

The Author: Dr. Paul Kalanithi was an outstanding neurosurgeon with very impressive academic credentials. He graduated from Stanford University with a BA and MA in English literature and a BA in human biology. He earned an MPhil in history and philosophy of science and medicine from the University of Cambridge. Later, he went to Yale School of Medicine where he graduated with a cum laude. Paul then returned to Stanford to complete his residency training in neurosurgery.

To Paul, being a neurosurgeon is a noble calling. You can’t see it as a job, because if it’s a job, it’s one of the worst jobs there is.

Unfortunately, fate has it that Paul did not end up being a full-fledged neurosurgeon. Well into his six-year-residency  he was diagnosed with stage 4 metastatic lung cancer. Less than two years (22 months) after the diagnosis he died — just when he was ready to graduate.

I read this book with a heavy heart — sad that such a brilliant and caring doctor like Paul had to leave so soon.  Lucy — Paul’s wife wrote, When I see the hospital where Paul lived and died as a physician and a patient, I understand that had he lived, he would have made great contributions as a neurosurgeon and neuroscientist. He would have helped countless patients and their families.

Such is the sad, cruel reality about life. Lucy wrote, What happened to Paul was tragic, but he was not a tragedy. True indeed. I always believe for anything that happens, there must be a reason if only we look at the bigger picture.

Salute the Neurosurgeon!

Paul did well in life — he studied literature, history and philosophy before doing medicine. With such academic background he was well prepared to become a caring doctor — a cut above others. Here are some quotations of what Paul wrote in his book:

  • As a resident, my highest ideal was not saving lives — everyone dies eventually — but guiding a patient or family to an understanding of death or illness. Where there’s no place for the scalpel, words are the surgeon’s only tool.
  • Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients.
  • Like my own patients, I had to face my mortality and try to understand what made my life worth living. With limited time, Paul wrote this book. He did not get to finish it.

Prognosis and Statistics

As a neurosurgery resident Paul had operated on brain cancer. After surgery it is the standard practice to send patients for follow up chemo and/or radiation. Here doctors often talk about prognosis with their patients and family members.

This is something Paul wanted us to know. He wrote, By this point, I had learned a couple of basic rules. First, detailed statistics are for research halls, not hospital rooms … Second, it is important to be accurate, but you must always leave some room for hope — Median survival is eleven months or You have 95 percent chance of being dead in two years — I come to believe that it is irresponsible to be more precise than you can be accurate. Those apocryphal doctors who gave specific numbers (The doctor told me I had six months to live): Who were they, I wondered, and who taught them statistics?

Limitation of Science

  • Although I had been raised in a devout Christian family …I, like most scientific types, came to believe in the possibility of material conception of reality, an ultimately scientific worldview that would grant a complete metaphysics, minus outmoded concepts like souls, God, and bearded white men in robes.
  • Scientific methodology is the product of human hands and thus cannot reach some permanent truth. We build scientific theories to organize and manipulate the world, to reduce phenomena into manageable units.
  • Science is based on reproducibility and manufactured objectivity.
  • Science … its inablity to grasp the most central aspects of human life: hope, fear, love, hate, beauty, honor, weakness, striving, suffering, virtue.
  • Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete. 

Stage 4 Lung Cancer

  • At age thirty-six, I had reached the mountaintop; I could see the Promised Land …. then a few weeks later I began having bouts of severe chest pain … my weight began dropping … from 175 to 145 pounds. I developed persistent cough. Little doubt remained.
  • In May 2013, it was confirmed that Paul had a stage 4 non-small cell EGFR-positive lung cancer. At that time he was in his sixth year of residency — one more year to
  • The irony was that Paul had never smoked.

The World’s Best Oncologist

  • The search was on — to find who was the best lung cancer oncologist (USA). Houston and New York had major cancer cancers …The replies came back quickly and more or less unanimously: Emma (also in Stanford) not only was one of the best — a world-renowned oncologist who served as the lung cancer expert on one of the major national cancer advisory boards — but she was also known to be compassionate, someone who knew when to push and when to hold back.
  • On many occasions when consulting Emma, it was clear that this compassionate oncologist did not “dictate things” to her patient. I could hear Emma’s voice again: You have to figure out what’s most important to you.
  • Emma once told Paul: I’m totally happy for us to make your medical plan together; obviously, you’re a doctor, you know what you’re talking about, and it’s your life.
  • At their initial consultation, Paul wanted to discuss the prognosis — possibly how much time left. Emma evaded the question and said, We’re not discussing that.
  • Two months in, Emma remained vague about any prognostication, and every statistics I cited she rebuffed with a reminder to focus on my values.

Temporary Response

Paul had an EGFR-positive tumour. No intravenous chemotherapy was indicated for the moment. He was put on an oral targeted drug called Tarceva.

His cancer responded to the treatment — My lungs, speckled with innumerable tumours before, were clear except for a one-centimetre nodule in the right upper lobe … there had been a clear, dramatic reduction in tumour burden.

Paul regained strength and he returned to work in late 2013, completing his seventh year of residency.

Relapse — Chemotherapy: Too many cooks spoil the broth?

In spring of 2014, the cancer relapsed. The only option left was chemotherapy.  This was what happened after one of his chemo sessions.

  • I began to deteriorate, my diarrhea rapidly worsening … my kidneys began to fail. My mouth became so dry I would not speak or swallow … my serum sodium had reached a near-fatal level. Part of my soft palate and pharynx died from dehydration and peeled out of my mouth … I was transferred to the ICU. I was in pain …. a pantheon of specialists was brought together to help: medical intensivists, nephrologists, gastroenterologists, endocrinologists, infectious disease specialists, neurosurgeons, general oncologists, thoracic oncologists, otolaryngologist …. 
  • I was acutely aware that with this many voices, cacophony (unpleasant mixture of loud sounds) In medicine, this is known as the WICOS problem: Who Is the Captain Of the Ship? The nephrologists disagreed with the ICU doctors, who disagreed with the endocrinologists, who disagreed with the oncologists, who disagreed with the gastroenterologists. I felt the responsibility of my care… tried to corral all the doctors to keep the facts and interpretations straight.

It is hard to tell laymen, like you and me, to take charge of your own health and treatment when you are in the hospital surrounded by all those experts. But yet, that should be the way it should be!

Chemotherapy took a heavy toll on Paul. He wrote: Withered, I could see my bones against my skin, a living X-ray. At home, simply holding my head up was tiring. Lifting a glass of water required both hands. Reading was out of question.

Chemo Failed – He Died

  • Treatment wasn’t an option — not until I regained some strength.
  • Emma, I said, what’s the next step?
  • Get stronger, That’s it.
  • But when the cancer recurs … I mean, the probabilities …. I paused. First-line therapy (Tarceva) had failed. Second-line therapy (chemo) had nearly killed me. Third-line therapy, if I could even get there, made few promises.
  • You have five good years left, she (Emma) said. She pronounced it, but without authoritative tone of an oracle, without any confidence of a true believer. She said it, instead, like a plea… Doctors, it turns out, need hope, too.

Paul did not live to write the closing chapter of his book. It was left to his wife, Lucy, to document his last hours on earth in the Epilogue. Paul died, two months short of two years (on Monday, 9 March  2015) after his diagnosis. He was 37 years old.

  • In the Epilogue Lucy said, Writing this book was a chance for this courageous … (Paul) to teach us to face death with integrity.

To us who is still living, I also say, Let us learn to embrace death with courage and understanding.

Lessons from Paul’s Experience

As I read this book, I learned many things. And I kept thinking and asking. Let me share my thoughts with you.

Family of Doctors

Paul came from a family of doctors. His father, brother, uncle, wife  are all doctors. Paul was not any ordinary doctor. He was trained in one of the best medical schools in the country. When he had cancer, he had the best oncologist in the world to treat him. Few of us would not have that privilege and opportunity. Perhaps we don’t need the best when it comes to cancer? What difference would that make?

Modern medicine had contributed very much to lighten human sufferings. Let no one doubt about that. But when it comes to cancer and its treatment, perhaps we need to take a step backward, pause and explore more.

43 Wrong-battle-wrong-weapons

48-We-fought-ca-Cancer-won

Yes, many people wrote about the need to rethink the war on cancer, but there are many others who would strongly defend the status quo. Why change? Why look for something else when the present ways serve the Cancer Industry so well?

When my wife and I started CA Care in 1995, to help cancer patients, I knew absolutely nothing about cancer and its treatment. No, I did not go to medical school. I relied on my Ph.D. and my research experience on plants to do what is right for those helpless and hopeless patients. After 20 years of dealing with cancer patients, I can say this to all and sundry. As far as cancer treatment is concerned, there  are other options than just chemo and radiation. Perhaps by taking the non-conventional path, you could live longer, with less suffering and not having to deplete your life’s saving to pay for the medical bills.

I have written numerous studies in these two comic books.

Title-Page-600

Available at http://bookoncancer.com/productDetail.php?P_Id=75

In Lung Cancer – What Now?  I have documented 12 cases of lung cancers – nine of which are about patients who failed to find the cure that they wanted, in spite of spending hundreds of thousands of ringgit on their medical treatments.

Meaningless shrinkage of tumour by Iressa

1 2

Meaningless shrinkage of tumour by Tarceva

3

These two cases happened with patients in Jakarta (above) and in Malaysia (below). And this also happened some years later with Dr. Paul in Stanford. What can we learn from such cases?

Title-page-600

Available:  http://bookoncancer.com/productDetail.php?P_Id=73

In Lung Cancer – Success Stories, I presented 12 cases of patients who opted for “alternative” treatment for their lung cancer.

Statistics of Lung Cancer Survival

4 5 6 7

 

Dr. Paul had Tarceva. This drug helped him for about a year. Then the cancer came back again. He then had chemotherapy and died. He survived 22 months after his initial diagnosis. That happened in Stanford under the care of the best oncologist in the world.

Back in Malaysia, there is also a professor who is the best for lung cancer. According to him, most of his patients who were treated in his clinic died after two years.

The same achievement as in Stanford?

If you do the same thing over and over again. You can expect the same results. Is that not what science teaches us? Remember what Henry Ford and Einstein said.

Insanity both

In this story above, mom opted for CA Care Therapy. She declined chemotherapy even though she was told that without chemo she would die within six months. Professor X was surprised how mom had survived for four years without chemo. Is that an achievement or quackery (like many in the medical industry want us to believe)?

Why haven’t you die yet?

89 10 11

CA Care has been around for about 20 years now.  Like Dr. Paul, my wife and I went into this because it was a “calling” — an answer to my prayer. Looking back, we have no regrets. Instead, we feel blessed to be able to help patients who need our help. They come from far and near.

 

 

 

 

Lung Cancer: Two Out Of Three Patients Cured By Chemo! True? False? Okay, Just Believe La

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Johnny is a 65-yer-old Indonesian. He had been smoking for about 30 years but since the past 15 years had stopped this destructive habit.

Johnny’s problems started in mid-20015 when he had coughs with blood. He went to a doctor in Jakarta and an X-ray was done. The doctor said Johnny had TB (tuberculosis) and was given TB medication for 2 months. His condition worsen. He could not sleep at night.

Not satisfied Johnny came to a private hospital in Penang. An X-ray was done and the lung specialist concluded that Johnny also had TB. But Johnny told the doctor that he had been on TB medication for 2 months and this was not effective. This made the doctor request for a CT scan.  The CT scan results showed a tumour in his lung.

The lung specialist suggested that Johnny undergo surgery. Johnny lost faith in the doctor and told him that he would need time to consider his suggestion. Johnny flew off to Singapore for a second opinion.

In Singapore, Johnny did a PET scan.

Composite-1 Composite-2

  • PET scan showed an intensely FDG-avid 50 mm cavitated lung mass in the left upper lobe with several small nodules. This lung mass is suggestive of a lung primary while the small nodules are suggestive of metastatic disease.
  • The FDG-avid left hilar nodes and bilateral mediastinal nodes are likely metastatic nodes.

A CT guided left upper lobe lung biopsy was performed and confirmed  a moderately differentiated squamous cell carcinoma.

Johnny was asked to undergo chemotherapy but he hesitated and decided to seek our help instead.

Listen to our conversation that day.

 

 

In Penang Hospital

Patient: After the CT scan he (lung specialist) asked me to undergo surgery.

Chris:  Operation?

Wife: Yes, within this 2 weeks.

C: Did you go for the operation?

W: No!

P: I did not want the operation.

C: Why did you not want to operate?

P: I am doubtful. We then flew to Singapore.

In Singapore Hospital

C: What did the Singapore doctor do?

P He asked me to do a PET scan.

C: You did the PET scan?

P: Yes.

W: We also requested him to do a blood test.

C: What did the doctor say after the PET scan?

P: There is tumour in my my lung and has “germ” but he was not sure what germ that was.

W: Not sure what kind of tumour. The doctor said it we want to be sure, we must do a biopsy.

C: Did you do the biopsy?

W: Yes this is the result: MODERATELY DIFFERENTIATED SQUAMOUS CELL CARCINOMA.

C: What did he want you to do after this?

W: He asked to go for chemo.

P: I did not want to do the chemo, so we flew to see youright away.

C: Did you ask how many chemos he wanted to give you?

W: Six times.

Can Chemo Cure You?

C: Did you ask if the chemo is going to cure you?

W: I asked. The doctor said, THREE persons did the chemo, TWO had “hasil” (results) but ONE person did not have result.

C: What do you mean by two people have “hasil”?

W: When three persons had undergone chemo, TWO persons will be cured. A majority were cured.

C: Can cure?

W: Yes, that’s what the doctor said. For most people.

C: Is this what you understand by two people had “results”. You understand it as being cured?

W: Yes, That is what the doctor said.

C: Really, can cure?

W: Yes.

C: Two had chemo and got cured, only one did not cure? And you don’t want that?

W: We don’t want.

C> Hey, this is better than gambling. Even gambling does not give you that chance! Please go and do the chemo because two out of three are cured — you better go for chemo. If this is true it is very good chance indeed.

Do You Believe This Statistics?

W: That is it. I did not believe (what they doctor said). That is why we come and see you.

C: Very smart indeed – that you don’t believe. That is why I ask patients to ask their doctors. One, can the chemo cure or not? Second, how much does it cost?

W: The doctor said the first shot of chemo cost SGD 12,500.

C: And you need to do 6 cycles?

W: Yes.

C: You need to pay quite a lot of money. Do you have to sell your house for this?

P: No, no, we never ask him what the rest of the treatment would cost. I told the doctor, I want to go home and to think about it first. My body cannot take the treatment!

Comments

Johnny, his wife and daughter came to CA Care. I must admit, when I first saw them, they appeared clueless (never judge the book by its cover!) but as I heard his story, I must admit this is what all patients should be — empowered and know what you want from your doctor! Don’t be led by the nose believing that you will find a miracle cure.

There are many lessons we can learn from this story.

  1. Many patients are often misdiagnosed — TB for cancer. And they were made to take TB medication for months before their doctors realized that it was a wrong diagnosis. So patients take note of this. If you are not satisfied with your diagnosis, go find another doctor to figure out what is wrong with you.
  2. After taking TB medication for 2 months, Johnny’s condition deteriorated. Do you want to continue taking the medication? Or is it time for you to find out what is actually wrong with you? Johnny took a wise move, he came to Penang to seek a second opinion. In fact, when you come to CA Care, we also tell you clearly and bluntly. If you follow our therapy for two weeks or a month and don’t get better, please go and find someone else for help.
  3. In Penang, Johnny was again told that he had TB — again a misdiagnosis. Johnny did not keep quiet. He told the doctor about the earlier misdiagnosis. It was wonderful that this doctor listened to Johnny (some doctors don’t listen to their patients!). The CT scan picked up a tumour in Johnny’s lung. Just imagine if Johnny took it as it is — go home with more TB medication from Penang, even though the TB medication in Jakarta was useless. So the lesson here is: Patients, speak up if you think the doctor is not doing it right!
  4. The lung specialist in Penang suggested surgery — to be done within 2 weeks. Unless it is an emergency, be careful about being pushed to do things immediately. Patients need to be give space and time to think things over or given a chance to seek a second or third opinion. Why the rush? Johnny was right again on this score. In his mind, the same doctor had misdiagnosed him and now this same doctor is rushing to “cut” him up. Johnny was doubtful and ran off to Singapore.
  5. In Singapore Johnny’s problem was more defined — PET scan and biopsy confirmed lung cancer. This time the doctor did not want to “cut” him up, he wanted to chemo him! Do you learn anything from this? If you go to the barber, know that he will snip your hair. If you go to the surgeon, no matter what, you will end up on the operating table. If you go to a radiologist know that his answer is radiation — they say “burn” you. And in the case of Johnny, he went to an oncologist who main job is to chemo you — or “poison” you. And if you come to us, we cannot do all these. So we ask you drink some herbs and take care of your diet. So what treatment you get depends to who to go to. Who is right, you want to ask. No one has the monopoly of being right. So pick your choice.
  6. The oncologist in Singapore suggested 6 cycles of chemo — the first cycle cost SGD 12,500. The remaining expenses, Johnny was not interested to know! Why? Because he did want to undergo chemo. We always remind patients to ask about the cost of the treatment so that you are aware of what you are going into. Don’t die a bankrupt! Many patients did tell us that they have to sell their house or land to pay for the medical bills. One lung cancer patient spent SGD 1 Million for his 2-year treatment. And he died.
  7. The most important question that patient should ask the doctor is, Will the treatment cure me? Some patients do not dare ask the doctor this, but some do. We wonder — why are you afraid to ask this question? If the doctor is not prepared to answer this question, then do you still want him to put the “poison” into you? Go find someone else who can do the same job but who is more caring. Also when you ask the doctor this question, look into his / her eyes and see how he /she react. See if he/she is being truthful in answering this question. One lesson to learn. Some doctors give honest answers but some give less than honest and biased answers.

Johnny was told that with chemo his lung cancer has a great chance of being cured. Out of THREE patients who have undergone chemo, TWO showed results. Obtaining results is understood by Johnny and his wife as being cured. We do not know how true it is but we again emphasize to Johnny that indeed if 2 out of 3 can be cured by 6 cycles of chemo, then he must go for it. That would be a great achievement. Our concern is that Johnny and his wife misunderstand the doctor — result does not necessarily mean  cure! Results can mean anything — dead, half dead , sufferings or half cured.

Below are some examples of what some oncologists told their patients about the “success” of their chemotherapy.

1

https://cancercaremalaysia.com/2015/05/04/npc-chemo-80-percent-cure-no-thanks-mom-died-after-5-cycles-of-chemotherapy/

2

https://cancercaremalaysia.com/2012/09/08/ovarian-cancer-after-chemo-99-percent-of-cancer-will-be-gone-do-you-believe-that-how-much-truth-has-to-be-told/

3

https://cancercaremalaysia.com/2014/07/29/do-chemotherapy-you-have-a-70-percent-chance-of-cure-for-your-breast-cancer-you-believe-that/

  1. We asked Johnny. Why didn’t you want to go for chemo? His wife replied, I did not believe (what they doctor said). As said earlier, here was a couple in front of us — they appeared “uneducated and naive.”  What make them so empowered to dispute the doctor?  We have no answer to that question.

Over the years, we did come across very educated patients but they appeared to being led by the nose — believing everything that is being fed to them. Yet, there are some others who appeared “naive” but they have a mind of their own and they know what the “truth” is!

Let us end this case story by asking you to ponder the documented facts about chemo treatment of lung cancer as we know today.

Lung survival rate Lung survival rate2Lung survival rateAustralia

Lung survival rate3

 

 

 

 

Chemo and Tarceva Did Not Cure His Lung Cancer: Another meaningless decline of tumour markers

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Jack (not real name) was 43 years old when he was diagnosed with lung cancer.  His problem started in October 2013, when there was a swelling in the right collar bone. Apart from this, there was no other symptoms — no cough, etc.  Jack said in 2013, he had fevers on three occasions that make him feel tired.

A blood test on 24 October 2013 showed his CEA was at 133.3 and CA 19.9 at 9,524.0

A CT scan on 30 October 2013 showed:

  • An irregular lesion in the right lung apex, 35 x 42 x 28 mm.
  • Speckles of calcification in both lungs upper lobe suggesting prior tuberculous infection.
  • Bilateral supraclavicular lymph node 10 to 20 mm.
  • Multiple enlarged mediastinal and right hilar lymph nodes.
  • Numerous small nodules in both lungs – likely metastases.
  • Liver shows a least 7 hypodense lesions, largest 30 x 32 mm in the left lobe – likely metastases.
  • Multiple enlarged lymph nodes in the celiac and paracaval regions.
  • Sclerotic lesions at vertebral bodies of L3, L4 and L5 – likely metastases.

A tru-cut biopsy of the right lung mass was performed and confirmed a moderately differentiated adenocarcinoma.

Jack underwent 6 cycles of chemotherapy. The drug used was Cisplatin. Each cycles cost about RM10,000. The treatment lasted until February 2014.

Let’s follow the progress of Jack’s treatment.

Table 1:  Blood test results during chemotherapy.

Date 24 Oct 13 25 Nov 13 16 Dec 13 6 Jan 14 27 Jan 14 17 Feb 14
Total bilirubin 18.1  H 13.7 15.5 13.5 14.8 17.8
Alkaline phosphatase 210   H 217 147 132 (normal) 148 125
ALT 49 62 59 34 26 23
AST 28 30 30 21 19 17
GGT 114   H n/a n/a n/a n/a n/a
Platelet 495   H 477 250 258 233
CEA 133.3  H n/a n/a n/a n/a n/a
CA 19.9 9,524  H 2,394 325 268 246 195
Before chemo After chemotherapy
At this stage, chemotherapy was very effective and helpful.  Alkaline phosphatase declined. Platelet count was down and CA 19.9 decreased from 9,524 to 195. Bravo – great results.

After the completion of chemotherapy in February 2014, Jack was put on the oral drug Tarceva. He was on Tarceva until June 2015.

His tumour markers – both the CEA and CA 19.9, continued to decrease (Table 2).

 

Table 2: After intravenous chemo, patient was on oral drug, Tarceva.

Date 25 Mar 14 15 Apr 14 14 May 14 16 Jun 14 21 July 14 18 Aug 14
Total bilirubin 31.6 37.7 27.5 25.5 24.6 27.8
Alakaline phosphatase 142 136 125 84 78 66
ALT 26 43 36 17 16 14
AST 27 56 24 20 19 16
GGT n/a n/a 40 26 23 23
Platelet 370 253 281 313 266 281
CEA n/a 28 2.3 1.9 1.6 1.4
CA 19.9 n/a 14 5.0 6.5 <2.0 3.8
Six months on Tarceva (from February 2014 to August 2014) the CEA and CA 19.9 decreased significantly.Again, great results!

From April 2014 to December 2014 Jack also received 6 to 8 monthly injections of Denosumab. This is a monoclonal antibody used to treat bone cancer. It is also known by its brand name, Xgeva and Prolia.

 

Table 3:  CEA and CA 19.9 started to increase even though Jack was on Tarceva.

Date 22 Sep 14 20 Oct 14 24 Nov 14 29 Dec 14
Total bilirubin 21.8 21.6 21.9 27.1
Alakaline phosphatase 66 76 69 77
ALT 16 15 16 16
AST 18 22 19 20
GGT 23 23 26 24
Platelet 277 329 294 299
CEA 2.2 3.9 7.4 12.6
CA 19.9 7.2 6.6 11.4 27.9
From September 2014 both the CEA and CA 19.9 started to increase in spite of Jack being on Tarceva. In September 2014 the CEA was 2.2 and it increased to 12.6 by December 2014. Similarly, CA 19.9 increased from 7.2 to 27.9 during the same period.

Because of the rising CEA and CA 19.9, Jack was again given 4 cycles of chemo. This time the drugs used were Carboplatin + Gemzar. The total treatment cost RM40,000.

 

Table 4: The second round of chemo with Carboplatin + Gemzar produced limited benefits.

Date 26 Jan 15 27 Feb 15 6 Mar 15 13 Mar 15 27 Mar 15
Total bilirubin 24.6 17.6 19.9 15.6 24.7
Alakaline phosphatase 74 87 54 67 61
ALT 16 19 25 20 15
AST 21 17 16 16 14
GGT 27 27 27 27 23
Platelet 315 295 453 192 259
CEA 22.3 21.6 22.0 28.6 29.9
CA 19.9 47.2 44.6 31.9 52.5 70.2
From January to April 2015, Carboplatin + Gemzar regime managed to stabalized the CEA level ranging from 22 to 30. CA19.9 stabalized from 31 to 70 during the same period.

 

Table 5: CEA and CA19.9 on the march — treatment failed!

Date 3 Apr 15 17 Apr 15 24 Apr 15 19 Jun 15
Total bilirubin 20.4 25.8 24.8 33.7
Alakaline phosphatase 49 73 65 73
ALT 24 14 23 12
AST 16 14 18 14
GGT 24 22 24 24
Platelet 509 276 268 321
CEA 29.6 32.7 31.6 93.2
CA 19.9 45.1 52.5 37.7 511.5
Error in platelet reading? In April CEA was around 29 to 31 while CA 19.9 was around 37 to 45.But  barely 2 months after the completion of chemotherapy, the CEA shot up to 93.2 and CA19.9 went up to 511.

Jack said he was disappointed with the results, in spite of the initial good response to chemotherapy. He decided to “shop” for alternative medicine while waiting for his doctor to take the next step.

Comments

This is indeed a sad case but not a unique one. Over the years we have seen cases after cases like this. After the chemo, the tumour markers dropped or the tumour shrunk or disappeared. But such responses did not last long. After a few months, the cancer recurred and this time it became more aggressive.

We sat down with Jack and tried to understand what was going on. No doubt about it, he was very much encouraged with the initial results. Within 8 months of treatment his CA 19.9 which was at 9,524 dropped to less than 2.0. That was a great achievement indeed. Who would not be excited about such feat? But what many patients don’t know or what those who should know do not want to know is that such dramatic drop of CA 19.9 (or even total shrinkage of tumour) is not permanent. It NEVER translates into a cure. It is meaningful in the short term but meaningless in the long term.

Read some of the stories here:

https://cancercaremalaysia.com/2015/04/02/lung-cancer-meaningless-temporary-drop-of-cea-after-iressa/

https://cancercaremalaysia.com/2014/07/05/the-story-of-moms-lung-brain-bone-cancer/

https://cancercaremalaysia.com/2014/04/24/two-billion-rupiah-chemo-and-surgery-failed-oncologist-said-more-chemo-you-just-have-to-trust-me/

https://cancercaremalaysia.com/2014/01/27/lung-cancer-meaningless-shrinkage-of-tumour-and-decline-of-tumour-markers-reading/

https://cancercaremalaysia.com/2013/11/29/lung-cancer-chemo-experiments-that-failed-and-failed/

https://cancercaremalaysia.com/2012/10/08/metastatic-lung-cancer-meaningless-fall-and-rise-of-cea-with-iressa-and-tarceva/

Let me ask you to ponder what Einstein wrote:

1 Insanity-by-Einstein

Do you see any truth is that statement?

Many of us may want to ask: Where is the problem? What causes this problem? What can we do about it?

Jack told us that his oncologist is a very nice man and he was trying his best to cure him. Understandable. We cannot blame the doctor. Legally and medically, apart from chemo or oral drugs, he has nothing else to offer you. He can’t ask you to take supplements or herbs, etc.

Unfortunately, some oncologists will rip apart those who dare to suggest that patients  take herbs, vitamins or control their diet. Nonsense they say — all these non-medical ways are not scientifically proven.

But hang on, is the present day treatment like above  based on “real science”? Granted, these chemo-drugs have undergone clinical trials and have been approved by Government Authorities. But, what does all this mean? The approved drugs can cure your cancer? Far from it! Ask,  why do we see failures after failures being repeated over and over again? It appears that failures  seems to be the norm rather than an exception.

Chemo drugs 3 percetn effective chemo drugs only 25 percent effective

I have one suggestion for those who want to do something!  Think about it seriously.

Granted, chemo-drugs sometimes can make the tumour markers drop to normal level or the tumour shrunk completely after the treatment. But what do you do after this achievement? Send the patient home and ask him to live the same style of life that he/she had before — the earlier life that promoted his/her cancer?

Free fall

  • What if we have a program that teaches patients how to live a healthy life after being effectively treated?
  • What if we teach them to change their life style and diet?
  • What if we ask them to take supplements, vitamins or herbs to make them healthy?
  • What if we ask them to take time to exercise?

These are things that patients can do for themselves when they go home after their “apparently successful” medical treatment.  Above all, these are “harmless” efforts that can result in a better and healthier cancer-free life.

  • In short, why can’t the medical establishment work together with the alternative healers to try and help patients prevent or minimize their cancer recurrence?

At CA Care we teach patients all the above. We take over after patients decide not to go for any more medical treatments. And often for those who are really committed, we succeeded in helping patients to heal themselves.

 

 

 

Lung Cancer and Prostate Problem — Refused chemo & radiation, and still alive?

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Aman is a 72-year-old Indonesian male. He and his wife came to seek our help two years ago, April 2013.  He brought along the report of his Whole Body CT scan, dated 21 March 2013, which indicated the following:

  • Spiculated soft tissue mass noted in the right upper lobe of lung, measuring 4.7 x 4.2 cm. The mass extends medially to right hilum and is abutting the adjacent right oblique fissure.
  • No nodule noted in left lung.
  • Enlarged lymph node in precarina region, measuring 1.4 cm.
  • Prostate is enlarged, measuring 5.1 x 6.1 x 5.8 cm with compression effect to urinary bladder.
  • No evidence of distance metastasis in brain and liver.

Composite

Aman was asked to undergo chemotherapy. He refused. Later, he agreed to radiotherapy but could not start the treatment after the machine broke down. Aman then came to seek our help and was started on herbs. We did not get to see Aman again after his first visit.

About two years later, in June 2015, Aman ‘s wife came to our centre and said Aman was doing fine and she wanted some more herbs for her husband.

Here is the gist of our conversation that day (listen to the second half of video below).

Chris:  You (and your husband) first came in 2013 – two years ago. He was scheduled for radiotherapy — did he go for that radiation?

Wife: No, we came here right away — no radiation done. Since then he (husband) never came back to Penang again.

C: In April 2013, he took the herbs. Is he okay now?

W: Yes.

C: Did you ever go back to consult with the doctors again?

W: No.

C: It has been 2 years now and his condition is okay?

W: Yes, okay. Sometime in the morning he has phlegm in the throat. On and off there is a bit of cough.

C: Apart from that, are there any other problem?

W: No problem — every morning he goes for morning walk.

C: Oh, he does not stay home — feeling sick?

W: No, no. He operates a grocery store selling sugar, rice, etc.

C: And he can work?

W: Yes.

C: Amazing indeed. It’s been 2 years . I can’t believe this. (Tell me again) is he okay? No problem, can work?

W: He wakes up early morning and at 6 a.m. and goes for a walk, round and round the neighbourhood. Everyone who sees him says he is healthy!

C: Oh, and he has no other complaints at all?

W: No.

C: His breathing is good?

W: Okay.

C: What is the problem now?

W: No problem.

C: Okay, amazing healing indeed. Continue to do what you are doing!

Comment

This is rather an amazing healing story. How could he survived for that long without chemotherapy or radiotherapy? That is if you believe these treatments are good for cancer! But for us at CA Care, surviving lung cancer for a few years without medical treatments is nothing unusual.

Let’s go back to Aman’s first visit to our centre two years ago and see what transpired during that visit.

 

 

Chris: Come, come. You are from Aceh (Indonesia)?

Patient: Yes.

C: You speak Hokkien?

P: Yes.

C: Who is sick?

P: Me, with cancer.

C: What happened? Tell me what happened from the beginning.

Wife:  We went for a checkup in Hospital A. This was in September 2012. They said his lung was “dirty”.

C: He went for a checkup. He had no problem at all? No cough, etc.?

W: Nothing. Actually I went for a checkup. After that he also had a checkup.  The doctor said his lung was “dirty” and his prostate (PSA) was also high, 8.8.

C: Did the doctor give you any medication?

W: Nothing.

C: No medication?

W: No. So we went to Hospital B and did another CT scan. We were told there was a mass. But we went home without doing any treatment.

C: You went to Hospital B. Did another scan.  You knew there was something inside but you did not want any treatment? Now to come and see me — it’s already April 2013 — what did you do from September 2012 till April 2013?

W: We came back to Penang again in January 2013. This time we went to Hospital C. We did another scan.

P: They also took a tissue out — through my back.

C: What did they say?

P: It was cancer.

C: What did you do after that (biopsy)?

P: Nothing.

C: You came to Hsopital A, then Hospital B and then Hospital C. You did one scan after another. Then the biopsy. And you did nothing after all these — what were you trying to do? Okay, in January 2013, after the biopsy you did nothing. Was there any pain? What happened after that.

W: We came back to Penang again in February 2013 and went to a cancer hospital. They gave us an oral medication to take (showing the prescription of Tarceva). But the medicine was not good for him.

C: How long were you on this drug (Tarceva)?

W: After taking 28 tablets (two tablets per day), it was not suitable. We told the doctor about this but he said not to worry and asked us to continue taking the medicine.

C: Why did you say not suitable?

P: Rashes and itchiness (showing hands and face).

C: Whole body?

P: Yes.

C: How much did you pay for this drug?

P: RM 7,500 per month.

C: Before taking this drug (Tarceva) did the doctor not warn you about this side effect?

W: Yes, he did tell us. When we phoned him he told us: Continue. It’s okay. You are reacting to the drug!

C: Did you ask if the drug can cure you?

W: He (husband) did not want chemo injection. So the doctor offered this oral drug instead.

C: After you stopped taking this drug (Tarceva), did you go back to the doctor again?

W: We came back on 21 March 2013 and did a CT scan. They scheduled us for radiotherapy.

C: Did you go for radiotherapy?

W: Not yet. We were supposed to do 30 times. When we turned up for the treatment, we were asked to come back the next day because the machine was not working. Then, the next day, they called to say that the machine was still not working.

C: Have you paid the money for this treatment? How much?

W: Yes, we have already paid the money to the hospital. It was RM 8,000 plus. They told us to come  back again tomorrow to start the treatment.

C: So now, are they going to refund you the  RM 8K that you have you paid?

W: I don’t know.

Advice from CA Care

C: You come here to seek our help. I am going to tell you honestly that I cannot cure your cancer. You must learn how to take care of yourself. Now, you have to stop smoking! Go home and take care of your diet. You cannot eat all those fried foods. No sugar, no diary. No banana for people with lung problems. So you have to take care of your diet. Then take the herbs properly. No cure but these may help you. If you have no problems after this – that’s good enough.

Then don’t be “dumb” anymore — no more going from one hospital to another to take pictures. There are still many more hospitals for you to go to! There is no need to do all these scans. Enough. I can’t cure you but if you are okay — no problem — then don’t ask for more.

For those who want to know more about the “bad and good” stories about lung cancer, read these two comic books.

Lung Cancer: What Now?

Title-Page-Book 1

Lung Cancer Success Stories

Title page Book 2

 

 

 

 

Lung Cancer: Chemo prolongs life? Why do a biopsy if you don’t want chemo?

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KB is a 67-year old Indonesian — with a history of heavy smoking for some 50 years. About 3 months ago, he had fevers and started to cough; sometime with white phlegm and sometimes just dry cough. He also lost a lot of weight.

He went to see a doctor in a private hospital. X-ray and CT scan indicated:

  • a 9.8 x 11 cm mass in the right upper lobe.
  • a non calcified 1.2 cm nodule in the left lower lobe.
  • small (1-1.5 cm) mediastinal lymph nodes.

A FNA of the right lung mass done on 17 March 2015 confirmed lung cancer, likely an adenocarcinoma, Stage 4.

Composite

Chemo does not cure stage 4 ca

 

KB was asked to undergo 8 cycles of chemotherapy. The total cost of the treatment is about IDR 120 million.

Chris: Did you ask the doctor if chemo is going to cure your father’s cancer?

Daughter: Can only extend his life.

C: So what do you want to do now?

D: No, we don’t want to do chemo.

Questions to ask

The above are the standard questions I often ask patients when they come to seek our help. Almost all patients were told that in spite of their terminal cancer, they should undergo chemotherapy to either stop the cancer from spreading or to prolong their life. Chemotherapy is also said to improve quality of life.

Frankly, I find these justifications rather hard to swallow.

Ask these questions:

  1. Can chemotherapy really prolong life? Many patients told me that they would not go for chemo because their relatives, friends, parent, etc. had chemo and died. To these people chemo did not prolong life.

Nose (NPC) Cancer: Chemo and He was Dead Six Months Later – Why?

Dissecting Chemotherapy Part 7: Avastin + Alimta Nearly Killed Me (after saying this, the patient died).

Of course, some patients benefited from chemotherapy and remain alive but NOT without enduring severe side effects.

I googled “does chemotherapy prolong life” and here are some interesting answers I got.

One person asked: Does chemo work? I don’t think it will prolong my life, and most likely kill me? He got the following responses.

  • I was a cancer chemotherapy specialist doctor for twenty years.I treated thousands of people with various combination chemotherapy regimens. I don’t think I killed any of them with the treatment – though over two thousand died from their cancers. I often thought it would be better to not use chemotherapy in situations where no cure had ever been achieved with drugs – pancreatic cancers, advanced non-small cell lung cancers, many brain malignancies, etc. I spent a great deal of time trying to talk some patients out of taking chemotherapy. In the USA, many people will not accept the ‘supportive care only’ option no matter how carefully it is explained that chemotherapy has never cured some types of advanced malignancies.
  • Nobody can or will give you any guarantees with chemotherapy.Why do you think it will most likely kill you? What evidence are you basing this on? … Some people conclude that the treatment is worse than the disease, and myths about people being killed by chemo bolster this belief. It isn’t always effective. But in those cases it is the cancer, not the treatment, that kills the patient – they have died in spite of treatment, not because of it. Distressed relatives sometimes look for something or someone to blame, and some conclude that it was the treatment that killed the person. People with aggressive and advanced cancers who agree to chemotherapy aren’t duped; they do so in the full knowledge of these facts because they have a life-threatening disease and this is their best chance. Chemo and other cancer treatments are not perfect, very far from it.
  • No, if chemo worked there would be fewer people dying, and in most cases it’s the “therapy” rather than the cancer that killed the patient. The drug severely damages the liver and ravages the immune system.
  • Wow, what a question. It’s a personal choice. You should research it very carefully, all positive and negative opinions about it.I know that I would never choose chemo. I would be willing to have surgery, and I’m not sure about radiation, but chemo, never. We are all going to die anyway, and we should die the way we want to and not let others tell us how. Chemo would take away my will to live, so what’s the point?

Another person asked: Will Chemo buy me more time ?? Anyone, Ideas? I was diagnosed 6 weeks ago with stage IV non small cell lung cancer with a tumor in left lobe, 1 brain tumor and several swollen lymph-nodes. I was told today I could expect to live 1 year. Beyond 12 months will be in God’s hands. I had targeted radiation on the brain tumor. I have started chemo and it has made me feel horrible. I’m short of breath and I little tired. But when I take the Chemo I feel like it’s speeding up my clock. What I mean is I cannot help but wonder if the side effects of the chemo will steal more days of my life than this dreaded cancer. Close friends and family are telling me to stop killing myself with chemotherapy!!! Has anyone out there been thinking the same way? I’m so afraid of losing the ability to function normally daily.

The following are some comments from readers.

  • My mother struggled with this decision when she was diagnosed with leukemia. Hers was a very aggressive form that didn’t respond well to treatment. Her doctor then wanted to start her on a very aggressive chemo regimen called CVP, which has tons of nasty side effects (it is one of the regimens they give when getting patients ready for bone marrow transplants). She was torn with the decision of what to do. I had already told her that if I had to choose between quality and quantity, I would rather have her feeling good for a month, than a year of her being miserable. When the decision came, she asked me what she should do (I am an only child). I told her there was no way I could answer that. It was her decision, her body, her life. I told her that I would love her and support her in whatever decision she made. She went to church regularly, so I told her to pray about it and she would find the answer. In a few days, she told her oncologist that she wanted to suspend her treatment. She never started the aggressive chemo, and I cared for her until she passed away.

    Now as I watch my husband go through chemo for lung cancer, and see how he suffers with it, I can even more clearly see how my mom made the right decision for her. My husband is a different personality, therefore he has a different approach. No one can blame you for the choice you make at this point. It is yours to make. I know you will make the right choice for you, and I pray you find peace as you make that choice.

  • I’m sorry that this disease as come in to your life, yes it SUCKS!!! I pray that you will feel better soon. My dad is 55yrs old and was diagnose just about a year ago, and yes they told him he’s terminal and only had 6 months to a year to live. Is going to chemo worth it?? That just depends on YOU ….
  • My wife, 53 years of age, was diagnosed in May 2011 with two tumours in the lung and three brain mets. We were told ‘months rather than years’! Decided on no radiation treatment as there is no conclusive proof that it extends life. Began chemo at the end of June (Cisplatin and Pemotrexed). The first two scans on the lung showed a reduction in the tumour size each time. The third lung and brain scan in December showed that the lung tumours were continuing to shrink and one of the brain mets had disappeared completely. The oncologist told my wife ‘that without this treatment you wouldn’t be here now’. My wife has had a pretty horrid time with nausea and vomiting … Fatigue is another problem, along with a sore mouth but she hasn’t lost her hair. She’s been working in our garden, and has considered going back to work but I think the constant need to have naps might prevent that. Overall, very happy with the way things are going.
  • It’s definitely your choice. Chemo is doable and not everyone has a horror story to tell about it. For me the worst part was the fatigue. Maybe I’m fortunate that I have no long term side effects. No doctor should be telling you that you only have a year to live, as they’re not God and don’t know how you’ll respond to treatment.
  • My husband, Jerry, was diagnosed with stage IV lung cancer the last week of Jan. 2011. When his oncologist saw him for the first time he said “I can’t cure you, but I can give you an extended amount of time, and a better quality of life”. After 7 weeks of chemo and radiation the tumor that was the size of an orange is now the size of a pea and is inactive. The other four active spots in his other lung are gone as is the spot on his lower neck and lower spine. His oncologist now is saying he can have surgery to remove the dead tumor (we have till Jan. 26 to decide if he wants to go through surgery as he is 74 years old). Please don’t believe everything your doctors tell you. With your own determination, the help of all medical options, and with prayer, anything is possible.
  • My sister just passed from non-small cell lung cancer (BAC). She was on Alimta as her chemo drug. As soon as the dr. gave her a time frame of life expectancy she went downhill. We had her on supplements, vitamins, etc. There are tons of alternative treatments if you just type in alternative cancer treatments you will find tons of treatments. Most of the alternative treatments you can do at the same time as chemo. I believe all green is the way to go – I could not get my sister to try that.
  • The first line of chemo can be very difficult – I won’t sugar-coat it. But they should know pretty quickly if it’s working or not, and may be able to adjust your dosage if the side effects are too hard. When I got the first scan back that said the chemo had shrunk my tumor by almost half, I decided I could handle it for awhile longer. It was worth it. The second line of treatment was much, much easier My hair grew back, the side effects were only 2 or 3 days and very manageable. That chemo worked so well that all signs of active cancer have disappeared, and I was able to stop chemo and do a watch and wait. I am now 2 1/2 years past my Stage IV diagnosis, and doing great.
  • If only we could clone ourselves, try various treatments, then pick the one that worked best.
    I was diagnosed in August with stage IV NSCLC with a dozen mets to ribs femur pelvis, skull, and spine.
    I had 2 week radiotherapy to the skull, which was effective in stopping progress, and headaches.
    I cancelled my scheduled Chemo after testing showed I had no identifiable mutations, So was not eligible or targetted therapy. I have adopted a strict vegetarian diet, I meditate and do Gigong. I have 5 fresh vege juices a day, and take a few supplements. A herbalist specialising in traditional medicine has made me a tonic I take 3 times a day. This is my alternate chemo.
    My latest scan showed no new cancer and a mild progressive enlargement of the existing ones.
    I feel fine, no one would suspect I was ill. Apart from the 2 weeks Radio I have spent VERY little time in the hospital environment
    I had chemo 30 years ago for leukemia, so it does not worry me. I do not believe chemo offers me much advantage. It will also do a huge amount of damage to my own defense system.
    Maybe I am just fortunate to have a slow growing cancer, or maybe what I am doing is right. I will never know. But I am so happy i gave my body a chance to figure this out for itself before embarking on toxic intervention. Chemo might be the right thing for me down the track, but for now my body’s immune system has a chance to catch up to the disease and maybe stop it. Myself, my wife and my oncologist are very happy with my situation and see no reason to change, at this stage.

Many thanks to each of you who took the time to give me your opinions. I will re read your notes and think carefully. My Dr was intent on me starting chemo full speed ahead. To be honest I wonder if money is a driving force in the push for so much random chemotherapy. I wonder how they select a drug for each person. I would like be sure it’s not eny meney miney mo —- let’s try this one to see if it will help her. They gave me so little information I have had to hunt the internet for details … Poison is poison —- and poison kills right?

  1. If chemo prolongs life, don’t you want to ask ” prolong by how long or how much” – – days, weeks, months or years?
  2. Next question, Prolonging life at what cost — in terms of suffering and money?

Drs Tito Fojo and Christine Grady in the USA appear to swim against the current too. They wrote an interesting paper: How much is life worth: Cetuximab, non-small cell lung cancer and the $440 billion question. The first author is from the Medical Oncology Branch of the National Cancer Institute, Bethesda, USA, while Dr. Grady is from the Clinical Center, National Institutes of Health, Bethesda, USA.

This is what Dr. Fojo & Grady wrote in their paper:

  1. In the United States, Treatment with Erbitux treatment for lung cancer costs an average of US$80,000 (to prolong life by 1.2 months), which translates into an expenditure of US$800,00 to prolong life of one patient by one year.
  2. The median US household income is US$50,233.
  3. The cost of Avastin treatment is US$90,816 and that is said to prolong life by 1.5 months.
  4. The cost of Tarceva treatment is US$15,752 and it is said to prolong life by 10 days.
  5. The cost of Nexavar treatment is US$34,373 and it is said to prolong life by 2.7 months.
  6. Greater than 90% of the anticancer agents approved by the FDA in the last 4 years cost more than US$20,000 for a 12-week treatment.
  7. These examples challenge the oncology community to address some serious questions:
  8. What should count as a benefit in cancer?
  9. What is the minimum amount of benefit needed to adopt a therapy as the new standard?
  10. Is 1.2 months of additional life a “good” in itself?
  11. How much should the quality of that 1.2 months matter? Or the cost?

(Take note: none of these drugs cure cancer. They just prolong life by just a few days or months)

In concluding their paper, Dr. Fojo & Grady wrote:

  • The all too common practice of administrating a new, marginally beneficial drug to a patient with advanced cancer should be strongly discouraged.
  • In cases where there are no further treatment options, emphasis should be first on quality of life and then cost.
  • For therapies with marginal benefits, toxic effects should receive greater scrutiny.
  • We must deal with escalating price of cancer therapy now.
  • The current condition cannot continue … the time to start is now.

For more read:

1.  Dissecting Chemotherapy Part 4: How Much Is Life Worth? Erbitux for Lung Cancer

2.  Are Medical Bills Killing Patients?

3.  The cost of cancer drugs 

What about the side effects?

Read this research paper on chemo-radiation. http://www.oncologynurseadvisor.com/chemoradiotherapy-prolongs-life-for-older-patients-with-lung-cancer/article/245291/

Median overall survival for the chemoradiotherapy group was 22.4 months, compared with 16.9 months for the radiotherapy-only group. This means chemotherapy prolongs life by 5.5 months.

Although chemoradiotherapy was well tolerated, grade 3 and grade 4 hematologic toxic effects were more prevalent among those patients:

  • Leucopenia occurred in 63.5% (61) of the chemoradiotherapy participants, but in none of the radiotherapy patients;
  • neutropenia in 57.3% (55) of the chemoradiotherapy patients and none of the radiotherapy patients; and thrombocytopenia in 29.2% (28) of the chemoradiotherapy patients and just 2.0% (two) of the radiotherapy patients.
  • Grade 3 infection also was more common with chemoradiotherapy (occurring in 12.5%, or 12 patients) than with radiotherapy (4.1%, or four patients).
  • Incidences of grade 3 and grade 4 pneumonitis and late lung toxicity were similar between groups.
  • Seven treatment-related deaths occurred, in three chemoradiotherapy patients (3%) and four radiotherapy patients (4.0%).

No thanks to chemo

In this case, KB decided not to go for chemo. The choice is easy to make. The treatment is going to cost him IDR120 million or RM 33,171 — to prolong life with no cure. Then there are the side effects to contend with. The daughter said, My father would not be able to stand it.

Yes, chemotherapy can make you feel nauseated and make you throw up. It can make your hair fall out. It can temporarily depress the immune system. It can cause bleeding complications, such as GI bleeding. It can cause kidney damage. It can cause heart damage. It can cause lung damage. it can cause nerve damage. It can make you lose weight. It can even result in your death from complications. In short, it is not something to be taken lightly. Unfortunately, the disease it’s meant to fight is a formidable foe indeed. It is your own cells, and often the difference between the toxicity of chemotherapy against the cancer and against normal cells is all too often not that great. http://scienceblogs.com/insolence/2009/05/20/chemotherapy-versus-death-from-cancer/

  1. Does chemo really improve quality of life?

Chemotherapy is the primary treatment approach for metastatic … lung cancers. Although the treatment can prolong life—by weeks or months—it is not likely to produce a cure. While chemotherapy may prolong life and provide some relief from symptoms of disease, it is also associated with substantial side effects. Patients facing incurable cancer must weigh the risks and benefits of a treatment that will not cure their disease, but could prolong their life. Unfortunately, the reasons for choosing chemotherapy treatment in the face of incurable disease may be unclear to patients. http://news.cancerconnect.com/patients-with-advanced-cancer-may-have-inaccurate-expectations-of-chemotherapy/

Our advice

  • As you can see from the above, different people have different perceptions about chemotherapy –confusing indeed. Eventually it boils down to, It is all about your own choice! Do what you feel comfortable with… follow your heart! There is no definite answer, we are each different and for some chemo works and for some others it does not.
  • Referring to this case (and many others like this), I have this advice: If you don’t want to do chemo, why do a biopsy?

Read more:

1.  Lung Cancer: Why do a biopsy when you don’t want to go for chemotherapy?

2.  The Truth About Biopsy

 

 

 

Lung Cancer: Meaningless Temporary Drop of CEA After Iressa

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In September 2013, Liz – a 54-year-old Indonesian – has pains around her right rib-cage. An USG indicated fluid in her lungs. Liz was referred to a lung specialist who thought she had tuberculosis (TB). Liz was prescribed TB medication for three months.

After three months, there was again fluid in her lungs. About 1.3 litres of fluid was tapped out. Liz was told to continue taking her TB medication.

Liz went to Jakarta and  consulted another doctor. Pleural tapping was again done and 0.6 litre of fluid was removed from her lung. Liz was again asked to continue with her TB medication.

Not satisfied Liz went to Singapore. Blood test, CT and PET scan were performed (note: no CT or PET scan were ordered by doctors in Indonesia).

Blood test results, 14 April 2014

Alkaline phosphatase 188 (H)
AST/SGOT 84  (H)
ALT/ SGPT 83  (H)
GGT 100  (H)
CEA 44.3  (H)
CA 125 26.6  (H)
CA 19.9 4.6
AFP 6.4

 

CT Scan of the Thorax, 14 April 2014

  • A large right -side pleural effusion is seen involving the upper lobe of the right lung and extending to involve the middle lobe.
  • Suspicious of a nodular mass more than 2 cm in size present in the upper lobe of the right lung.
  • Presence of a small nodule in the left lung in the lower lobe, 6 mm in size. This is suspicious of a possible metastatic lesion.

Cytopatholoogy report of right pleural fluid, 14 April 2014

  • pleural fluid negative for maligancy.
  • pleural fluid is haemorrhagic with few inflammatory cells and an occasional mesothelial cell.

PET/CT Study on 15 April 2014

  • Hypermetabolic mass in the upper lobe of the right lung is consistent with pulmonary malignancy.
  • Mildly hypermetabolic paratracheal and precarinal nodes are suspicious of nodal metastasis. Multiple nodules scattered in both lungs are suspicious of pulmonary metastasis.
  • Hypermetabolic lytic lesions in the thoracic vertebra and left ischium are compatible with metastases.

Cytopathology report – FN lung biopsy, 17 April 2014

Malignant cells present consistent with infiltrative moderately differentiated pulmonary adenocarcinoma.

MRI Brain

No MRI imaging evidence of intracranial metastatic disease is detected.

Liz was not able to walk by herself and had to use the wheel chair. She received 10 sessions of radiation treatment. After radiotherapy, she was able to walk. But she still had cramps and numbness in her legs. Liz told us that this leg numbness and cramp developed after 2 months on the TB medication.

For her lung cancer, the oncologist prescribed Iressa, costing SGD 3,500 per month. 

Meaningless temporary decrease of CEA after taking Iressa

April 2014 Started on Iressa, CEA = 44.3
11 June 2014 X-ray chest: Slight interval improvement. CEA = 18.7 (decrease from 44.3)
13 August 2014 X-ray chest: Stable lobulated opacity seen. CEA = 31.2 (started to increase)
14 October 2014 X-ray chest: No significant change. CEA = 36.0 (slight increase)
20 January 2015 X-ray chest: Right pleural effusion is stable. CEA = 47.6 (increase from initial value)

 

Meaningless improvements of PET scan images after taking Iressa (Study of April 2014 versus October 2014).

April-2014-bad

(Top: April 2014 after Iressa bottom: October 2014)Oct-2014-improve

(Left: April 2014 after Iressa right: October 2014)Meaningless-bone

Iressa did not help Liz. The oncologist offered two options:

  1. Stop taking Iressa and go for chemothrapy.
  2. Or continue taking Iressa for another 2 months and see what happen.

Liz decided to stop further medical treatment and came to seek our help.

 

Scientists find lung cancer can lie hidden for 20 years

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On 9 October 2014, Reuters carried this news report: Scientists find lung cancer can lie hidden for 20 years

  • Lung cancer is the world’s deadliest cancer, killing an estimated 4,300 people a day, according to the World Health Organization.
  • The current prognosis for NSCLC is grim, with most patients diagnosed when the disease has already spread and only around 15 percent surviving for at least five years after that.
  • Around 85 percent of patients have non-small cell lung cancer (NSCLC).
  • To get a clearer understanding of the disease, the two groups of British and American scientists looked at genetic variability in different regions of lung tumors removed during surgery and worked out how genetic faults had developed over time.
  • What they found was an extremely long latency period between early mutations and clinical symptoms, which finally appeared after new, additional faults triggered rapid disease growth.
  • (What this means is) Lung cancer can lie dormant for more than 20 years before turning deadly.
  • In the case of some ex-smokers, the initial genetic faults that started their cancer dated back to the time they were smoking cigarettes two decades earlier.
  • On the evolution of lung cancer, scientists in Cancer Research UK reveal how after an initial disease-causing genetic fault — often due to smoking — tumor cells quietly develop numerous new mutations, making different parts of the same tumor genetically unique.
  • (What this means is: Not all cancer cells in a lung tumour are the same). This helps explain why a disease that kills more than 1.5 million a year worldwide is so persistent and difficult to treat.
  • By the time patients are sick enough to be diagnosed with cancer, their tumors will have developed down multiple evolutionary pathways, making it extremely hard for any one targeted medicine to have an effect. (What this means is: ONE drug cannot kill all the different types of cancer cells in the lung).
  • “Previously, we didn’t know how heterogeneous these early-stage lung cancers were.”
  • Currently, doctors use computerized tomography (CT) to detect lung cancer — but by the time a nodule is big enough to be spotted it on a scan it may contain a billion genetically diverse cancer cells.

Sources: http://www.reuters.com/article/2014/10/09/us-health-cancer-lung-idUSKCN0HY23Q20141009

http://www.sciencedaily.com/releases/2014/10/141009154007.htm