NPC: Undergo chemotherapy,100 percent cure; if radiotherapy, 80 percent cure. You believe that?

Posted on 02/07/2017 by CA Care

Dear DR Chris Teo,

I apologize for writing without the benefit of an introduction, I am writing this email, with hope that I can scheduled an appointment with you, on behalf of my father who has been diagnosed with nose cancer(T2N1).

My father, Aba (not real name), 58 years old, has been diagnosed with nose cancer (T2N1) in February 2017 and was scheduled for 33 sessions of radiotherapy and 6 rounds of chemotherapy (4 hrs of cisplatin IV infusion),with an approximate total cost of SGD$9,700.

He declined the chemotherapy treatment (oncologists here are very persistent, we had to go thru series of ‘debates’) but complied to radiotherapy treatments. We was initially ensured a total recovery. Doctor mentioned that only 30% suffered from mild side effects and seeing my father is young he is confident that my father will be able to spring back to life in seconds.

Little did we knew, radiotherapy is just as bad. He is currently on his 13th session. The tormenting days started as early as day 2. He is unable to eat maybe because of the many big ulcers, sudden chills, fever, nausea/vomiting and scalded skin. He is so weak. And ever since radiotherapy, I noticed he started to develop tight congestive cough at night. As of now, he said he had lost his sense of taste and hearing to his right ear.

On 6/6/17, during a scheduled consultation, we expressed our concern on his deteriorating health, and if there is anything that they can provide to aid him during this time, and they mentioned a few lists of medications in which they don’t recommended. Their only advice is to allow his antibody to fight it off naturally. At the end of the day, we was only prescribe with a tin of Ensure Vanilla powder.

Disappointed with their lack of concerned and couldn’t help feeling betrayed, that was when we finally decided to called it off and stop the radiotherapy treatments.

It has been more than 48 hrs from his last radiotherapy session and he doesn’t seems to be getting any better.

Our family do believe in herbs but we have no knowledge on it. He has been taking rodent tuber and jus rerama (butterfly plant) as supplements for almost a month now. We sincerely hope you are willing to look into my father’s case. My father is eager to take all possible aggressive measures to combat this disease or at least to live peacefully with it.

We understand that this is one of many such requests that come across your desk and greatly appreciate any guidance that you can lend. We live in Singapore and ensure that I have no issues travelling to Penang on behalf of my father for the consultation and also the follow up treatments.

Thank you, in advance, for your help. I look forward to hearing from you at your earliest convenience.

Best of regards.

Reply: Come and see me with all the medical reports and scans … no need to bring your father … only you come ….. fly in the morning … go back in late afternoon.

Summary of medical reports:

9 Feb. 2017: Right PNS biopsy — Non-keratinizing papillary squamous cell carcinoma.
23 Feb. 2017: MRI – Nasopharynx and Neck — right nasopharyngeal mass (4.8 x 3.9 x 3.0 cm) with extension across midline and into the right parapharyngeal space with right mastoid effusion. Enlarged right lateral retropharyngeal node, 1.4 x 1.2 cm.
23 Feb. 2017: Bone scan — there is no conclusive scan evidence of bone metastasis.
5 April 2017: Diagnosed with T2N1 nasopharyngeal cancer, EBV negative, p16 positive.
30 May 2017: MRI — Since the previous MRI stuy dated 23 Feb. 2017

stable size and extent of the known right nasopharyngeal tumour.
slightly larger right lateral retropharyngeal lymph nodes — 1.5 x 1.2cm fro, 1.4 x 1.1 cm.
larger cystic right level 2 lymph node suspicious for nodal metastasis — 2.2 x 1.5 cm fro, 1.3 x 0.7 cm.

Aba’s daughter (let’s call her Linda) and her husband came to seek our help. We talked for more than an hour. Below are some excerpts of our conversation that morning.

Here are some of the points we discussed.

Do chemo, 100 percent cure, if radiotherapy 80 percent cure

Linda: He was told to go for chemo – 6 times and radiotherapy – 35 times. He declined chemo but went along with radiotherapy.

Chris: Chemo! Can cure or not?

L: The doctor said, 100 percent cure with chemo. The doctor also said if the patient is my father or mother, I would also ask him/her to do the same.

C: So chemo can cure 100 percent. What about radiotherapy?

L: If he did radiotherapy it will be 80 percent cure.

Only 30 percent of patients will suffer mild side effects of radiation

L: The doctor also said that only 30 percent of patients will suffer from mild side effects of radiation.

C: Mild side effects? That’s what the doctor said?

L: The doctor said my father is still young.

C: Did you father know that the doctor said the radiation side effects is very mild?

L: He knew.

C: And after 13 times of radiation, why did he gave up?

L: He had bad mouth ulcers, etc. When to see the doctor and was told no medication to help him. Only let the body’s antibodies (immune system?) help him.

Why are you so against chemotherapy?

C: Chemo would give a 100 percent cure — why don’t you ask your father to go for chemo?

Son-in-law: He wanted to go for it.

L: I quarrelled with the doctor. I have read a lot of stories. Even my uncle — he had one cycle of chemo for his colon cancer and he wanted to die already. Only one shot, and want to die already.

Oncologist pushing my father to go for chemo!

L: The doctor was very, very …

SIL: insisting.

L: When I told the doctor that I don’t want my father to go for chemo, she was like trying to put the blame on me — if my dies, I would be the one responsible for it.

C: The doctor was really pushing you on that? How old is this oncologist?

L: She is a young lady doctor.

SIL: Some young doctors are like that! Very pushy — chemo, chemo, chemo!

L: She said, this is the standard American protocol.

C: (From my experience) Nobody can cure any cancer! There is another young oncologist who told one of our patients. In my professional life as an oncologist, I have not come across a case where a patient dies because of my chemotherapy!

Fellow patient undergoing the same treatment already died!

L: There was another patient who also underwent the same treatment (like my father in the same hospital). Last week my father asked the nurse what had happened to him. The nursed checked and found out that he already died.

Mom with colon cancer. Surgery but refused chemo. Ten years still alive!

L: I read a lot.

C: Before you father got cancer, did you also read?

L: Actually my mother also had cancer — colon cancer. She went for surgery but she refused chemo. It’s now ten years. She never go for any check-up and she is still alive.

7. My take on this case

We cannot change human attitude. So let me tell you honestly — out of ten patients who come and seek our help, only three patients would benefit from our therapy. We cannot help the remaining seven patients because we cannot change their attitudes. We can help the cancer but we cannot help human beings.

You need to take care of your diet. You cannot eat anything you like. So what to eat now? I can’t help people like that! I know many people swear and curse me because I say you cannot eat this and cannot eat that.

SIL: My father is a very stubborn person. He likes to eat — so we have to change him on that.

C: That is the problem. I have no herbs to make him change his attitude, his stubbornness. I can tell you, I give up on such person. No use. My experience is when he gets well, he will not listen to my advice anymore. He eats anything he likes and he dies.

Comments

There are many lessons we can learn from this story.

It pays to read and read, to know more. It is not enough to just go and see an oncologist and believe he/she can take care of you.

Linda read about her father’s cancer treatment. She took note that her uncle almost died after one shot of chemo. Linda’s mother also had cancer. She was told to undergo chemotherapy after her colon cancer surgery. She refused. She is still alive after ten years!

When the oncologist told Aba and his family members that chemo was going to provide a one hundred percent cure of his NPC, Linda was skeptical. You can only be skeptical and dare to question the doctor if you have some basic knowledge of what cancer treatment is all about. Unfortunately, many patients dare not ask. And they don’t read. They swallow everything that is being fed to them!

Experience and wisdom are what you need to look out for when it comes to making life and death decision. Read and ponder the following wise words of Dr. Ruggeiri below.

It is not difficult to understand what Dr. Paul Ruggieri is trying to tell us. Substitute the word surgeon with oncologist and see how the message strikes you! It may sound like this … the first ten years of practice, an oncologist learns how to chemo people …. she is eager to chemo anyone who walks into her office … she is going to show off her stuff …. bla, bla, bla.

So if I have a choice, I would choose an experienced, sympathetic and wise doctor rather than a sweet, young one! (I know it is hard, wishful thinking?).

Radiotherapy provides a 80 percent chance of cure. And only 30 percent of patients suffer side effects. Even that, according to the oncologist, these side effects are mild. Do you believe that?

Obviously this oncologist does not know what it is like to suffer from the treatments she is dishing out to her patients!

Pastor Danny had NPC and underwent chemotherapy and radiation treatments (using the same drugs as recommended for Aba). And he suffered severe side effects.

Suffered severe side effects of radiation – mouth sore, difficulty swallowing, burnt skin, etc.
At the same time, he received two cycles of chemotherapy. The side effects were worse than radiation and he had to be hospitalized. He was unable to sleep, was in pain and became anxious and depressed. He was put on morphine and as a result suffered constipation and hallucination.
The treatment caused much misery. I would rather die – it was miserable and never again!

Dr. Peter Ooi related his NPC treatments as below:

Radiotherapy Experience

The treatment burnt my whole throat – like it was on fire.
My wife cried, because I couldn’t drink even a drop of water.
I could not walk by myself.
I was not told about the side effects of radiotherapy.
I have no more salivary glands (that is why in the video you see Peter having to taking sips of water very often when talking to us).

Chemo Experience

I was not told about the side effects of chemotherapy – the only thing mentioned was hair loss.
I stopped chemo after the fourth cycle – I was too weak.
I developed a phobia for “needle”. The veins in my hands just “disappeared” when I see a needle!

Doc, you call these mild side effects?

The oncologist told Linda that chemotherapy can provide a one hundred percent cure! What the oncologist did not tell is that chemotherapy can also come with a heavy toll! Sometimes, chemotherapy kills.

According to Linda, a fellow patient undergoing the same treatment as her father died along the way! Is that not proof enough? Read what these two doctors say.

Last week the newspapers reported that one of Singapore’s most prominent oncologist was suspended for eight months due to professional misconduct. According to this report, Dr. Ang Peng Thiam, a 35-year veteran and medical director of Parkway Cancer Centre, was found guilty of these charges:

That he made false representation to the patient who was suffering from lung cancer that there was a “70 per cent” chance of responding to the treatment he suggested, and
That he failed to offer her surgery as an option.

The patient died six months after seeing this famous oncologist.

The disciplinary tribunal found that Dr Ang “had no reasonable basis” for saying there was a 70 per cent chance of response and felt that he had “wrongly held out false hope” to the patient and her family. He made the claims intentionally even though he knew or ought to have known there was no basis for him to do so.

The judges said doctors were obliged to present the range of viable options and what the pros and cons of each of these were. Patients must get to decide for themselves what treatment they want, the judges added. “It was not Dr Ang’s role to decide, but to inform,” the judges said.

Cancer patients, can you learn anything from the above episode?

Let me end by asking you once again to reflect on the wise words of Dr. Ruggieri below:

Ovarian Cancer: “After chemo, 99 percent of cancer will be gone!” Do you believe that? How much truth has to be told?

Posted on 08/09/2012 by CA Care

SK came to see us on10 August 2012. This 64-old, Indonesian lady looked frail and timid and did not seem to know what was going on. Her abdomen was distended like a pregnant lady. She handed us her CT scan report (dated 9 August 2012).

There is left pelvic mass, measuring 5.3 x 3.6 x 3.6 cm, in keeping with dermoid cyst.
There are multilobulated soft tissue lesions in the pelvis – the largest measures 4 x 2.7 cm.
There are multiple peritoneal nodules.
Impression: Likely ovarian carcinoma with moderate ascities, associated with peritoneal, omental and mesenteric metastases.

The gynaecologist suggested surgery and this costs RM 16,000. SK came to seek our advice. We told SK to go ahead with the surgery. There is NO way the herbs can help her with such an advanced stage cancer. The tumours have to be removed first, then she can come and take the herbs.

On 24 August 2012, SK came back to see us again, accompanied by her daughter. SK had undergone a surgery – TAHBSO (Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy ) with omentectomy + appendectomy. She was hospitalised for five days. She had the surgery at another hospital where the cost of the operation was only RM 12,800.

SK felt better after the surgery. It was a Stage 3B cancer.

SK was asked to return to the hospital on 25 September 2012 for chemotherapy. She and her daughter consulted an oncologist and below is an account of what happened during their meeting.

Chris: What did the doctor want you to do after the operation?

Daughter: Must do chemo – six times. I asked the oncologist if this can kill all the cancer cells in the body. He replied very confidently – Definitely, 99 percent of the cancer cells will be gone.

C: He said 99 percent will be gone? You asked him that? And this is his answer? Did he really understand your questions?

D: Yes, he understood me. I asked him if chemotherapy is the only best option for my mother. He said: Chemo is the only option – there is no other way.

C: You asked him in Bahasa Indonesia or in English?

D: In English – the cancer cells will be gone? Will it be 100 percent gone? He said: 99 percent gone.

C: Meaning, 99 percent can cure?

D: Yes.

C: How many times did you ask him this question?

D: Two times. He was so sure about what he said. He said: Yes, you do six times of chemo, 99 percent of the cancer will be gone.

C: When you asked him this question – did he get angry?

D: No, not angry.

C: For six chemos, how much do you have to pay?

D: RM 3,000 each time. I also asked him if the treatment is going to be painful. He said: No, not painful at all.

C: Oh, chemo is not going to be painful? That is going to be good!

D: But he also said there will always be some side effects. There will be loss of hair and nausea. Then mama asked the doctor: Will I be strong enough to withstand the chemo treatment? The oncologist said: Sure, you are strong enough for the treatment.

C: How long did you talk to the oncologist?

D: About 15 to 20 minutes. And he said: Go back home and eat whatever you want – KFC, McDonald and anything.

C: Oh, you can eat KFC, McDonald and also anything?

D: Yes.

C: What else did he tell you?

D: Cannot take herbs while on chemo. You cannot mix – chemo and herbs. Only after completing six times chemo, then we can take herbs if we want to.

C: How much did you pay for talking to him?

D: RM 100.

C: After he said chemo will give you a 99 percent cure and then you can eat anything you like when you go home, do you believe him or not?

D: I really want to believe him!

C: Go home and think carefully what you want to do now. Did you mother understand what you and your doctor were saying?

(Daughter broke down and cried)

C: Don’t worry. I understand. It is a difficult situation. Everyone who come here are really lost. Don’t worry. It is okay to cry. What is important is that after the surgery your mother feels better now. The doctor asked you to do chemotherapy – do you want to do that? It is difficult for me to say what you should do – to go for chemo or not to go for chemo.

But what the doctor told you – to eat what you like when you go home – that is not right. My advice is – Don’t eat anything that walks or has legs! Also avoid oil and sugar. Please listen to my advice. Again, other than that, whether you want to do chemo or not, I cannot say anything.

The doctor said you can’t take herbs while on chemo – that is also not true. Many of my patients take herbs while they are on chemotherapy. They came out better – they felt better. But I am not going to ask you to believe me. If you believe your doctor, go ahead and believe him.

Have you read or really understand what chemotherapy is?

D: I have heard about it from other people. I saw people going for six times of chemo and they never come back (die).

C: Honestly, tell me – when the oncologist said there is a 99 percent cure after the chemo – do you really believe him?

D: (shaking her head) No.

CA Care Therapy

C: Ibu (mom), when you go home please take care of your diet. Take time and go for exercise. Don’t just stay home and think too much about your problem. That will not be good for you. Try to be happy always. You are a Christian? Pray to God for help and guidance. God knows that you are sick. Pray that you have the strength to overcome this.

Comments

You may want read a related story: Cervical Cancer: Eighty-nine Percent Chance of Cure Vanished With the Collapse of Her Right Lung Four Months After Radiotherapy and Chemotherapy This patient underwent radiotherapy and chemotherapy. She was told that there was a 89 percent chance that she would be cured. However, barely four months later the cancer recurred.

Let me ask you this question: Should patient be told the truth? Some people would say yes, some people would say no. So, you decide for yourself the acceptable level of truth that you want. Then, let me ask another question: How much truth can you expect from your doctor? Let me ask you to reflect on the following quotations:

In the case of SK above, her daughter wanted very much to believe what the oncologist them – after six cycles of chemo 99 percent of the cancer will be gone! But will it come back again soon? That is not told! Anyway, the patient and her daughter did not have the peace of mind to believe what they heard. Otherwise they would not have come and sought our help. At this point let me quote what Dr. Walker wrote about his own experience:

Side effects of Treatment

Some patients suffer seriously from the side effects, others don’t. I wonder if it is all about luck (and not science)? Retired US Air Force Colonel, Thompson wrote:

Read what Rose Kushner said:

Cancer Patients – Eat anything you like! At CA Care we say this is not right! We are not alone in this. Read what some outstanding doctors in the US said about the importance of diet and cancer.

What You Need to Know About Ovarian Cancer

The information and data below are obtained from the internet and oncology text books:

http://emedicine.medscape.com/article/255771-overview#aw2aab6b2b5aa http://www.acancer.net/ovarian_cancer/stage3.php

http://health.nytimes.com/health/guides/disease/ovarian-cancer/chemotherapy.html http://www.webmd.com/ovarian-cancer/features/ovarian-cancer-chemo-options?page=2

http://www.malaysiaoncology.org/article.php?aid=10

Around the world, more than 200,000 women are estimated to develop ovarian cancer every year and about 100,000 die from the disease.
According to the National Cancer Registry, ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia, making up five per cent of all female cancer cases.
Epithelial tumors represent the most common histology (90%) of ovarian tumors. This type of cancer often spreads on the peritoneal surfaces – e.g., undersurface of the diaphragms, paracolic gutters, bladder, surface of the liver, mesentery and serosa of the large and small bowel, omentum, uterus, and para-aortic and pelvic lymph nodes.
Most ovarian cases are diagnosed in an advanced stage and their prognosis is closely related to the stage at diagnosis. Overall, prognosis for advanced-stage patients remains poor. Overall 5-year survival of ovarian cancer is 45 percent. In the case of SK, who has Stage 3B, the 5-year survival is about 29 percent (Table below).
As I have always told patients – we don’t have to believe this statistics but we also don’t want to bury our heads in the sand and pretend that everything will be okay. We need to know the reality and then try hard to beat the odds.

Source: DiSaia, P.J & W.T. Creasman. Clinical Gynecologic Oncology, pg. 298, Mosby.

Treatment:

Currently, the standard treatment for stage 3 ovarian cancer consists of both surgery (surgical debulking) and chemotherapy.
Unfortunately, less than 40% of patients experience long-term survival following standard treatment.
Approximately 60-80% of patients with stage 3 cancer will experience a recurrence of their cancer, even after complete surgical removal of cancer.
Nearly all patients with stage 3 disease have small amounts of undetectable cancer that have spread outside the ovary and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests and are referred to as micrometastases. The presence of micrometastases causes cancer recurrence.

Chemotherapy for Stage 3 Ovarian Cancer

The chemotherapy drugs used to treat ovarian cancer are fairly standard. Typically doctors combine a platinum-based drug such as carboplatin or cisplatin with a taxane such as paclitaxel (Taxol) or docetaxel (Taxotere).

Perez, C.P. et. al, (in Clinical Oncology, 8^th Edition, Health Science Asia, pg. 489) wrote: The combination of paclitaxel plus a platinum compound is considered by most to be the first-line adjuvant chemotherapeutic regimen in patients with advanced ovarian cancer. The pathologic complete response is only 20 to 26 percent (Table below).

Source: Thigpen, J.T. (in Clinical Oncology Pt.2, 2^nd Ed., Harcourt Asia, pg. 2026)

Ovarian cancers are very sensitive to chemotherapy and often respond well initially. Unfortunately, in most cases, ovarian cancer recurs.
Fewer than 20% of patients treated with a platinum compound and paclitaxel survive without evidence of cancer recurrence 5 years following treatment.
Unfortunately, even in patients who respond, the disease eventually becomes resistant to the first-line drugs, and the cancer returns. Some ovarian tumors are resistant to platinum drugs. Once cancer recurs or continues to progress, the patient may be treated with more chemotherapy.
Despite the development of several new chemotherapy drugs over the past few years, there is no substantial evidence that any of the treatments have increased the number of women cured of ovarian cancer.
Gemcitabine (Gemzar) is also used in combination with carboplatin for women with advanced ovarian cancer that has relapsed. Other drugs include doxorubicin (Adriamycin, Doxil), etoposide (Vepesid), and vinorelbine (Navelbine).

Side Effects of Chemotherapy

Chemotherapy can cause side effects during and after treatment. The type and severity of these side effects depends upon which chemotherapy drugs are used and how they are administered.
The most common side effects are nausea, vomiting, mouth soreness, temporary lowering of the blood counts, and hair loss.

Surveillance After Treatment

At the end of treatment (both surgery and chemotherapy), a patient is considered to have a “complete response” if her physical examination is normal; there is no evidence of cancer on imaging studies (such as a CT scan); and the blood level of the tumor marker like CA-125 is normal.
However, even when all of these criteria are met, microscopic amounts of residual cancer (i.e., not visible on imaging studies) can still be present. Growth of these microscopic tumor cells is probably responsible for tumor recurrence at a later date.
To monitor for the possibility of recurrence, blood tests, physical examinations, and imaging tests are to be done.

Signs of Recurrence

The likelihood of a tumor recurrence is highest in women with more advanced-stage disease at diagnosis, particularly if the initial debulking surgery was unable to remove all visible tumor.
The earliest evidence of recurrent ovarian cancer can be indicated by a rising blood level of one of the tumor markers (CA-125) and symptoms such as abdominal pain or bloating with or without back pain, or presence of pelvic mass.

What Can I Expect After Chemotherapy Treatment?

Surgery plus chemotherapy drugs can get rid of ovarian cancer, but often they can’t keep it away forever.
Surgery and chemotherapy are usually effective in treating the cancer so it will go away for a while, but in most cases the cancer ends up coming back.
Often, the cancer will return within one to two years after treatment is finished. If the cancer does return, another round of chemotherapy is necessary.

Some Cases of Ovarian Cancer at CA Care

Over the past two years, some patients came to CA Care for help after medical treatments have failed them. Unfortunately, we did not get to see most of these patients after one or two visits. We are not sure what had happened to them. The cases below will portray the reality of ovarian cancer. Compare the facts of these cases with the readily available information found in the internet above.

Case 1: H297 was a 66-year-old female. She was diagnosed with ovarian cancer, Stage 1C. She underwent an operation followed by six cycles of chemotherapy. Three months later, the cancer spread to her liver. She was asked to undergo more chemo. She refused.

Case 2: H256, 34-year-old lady, had pains associated with lower abdominal mass in December 2008. She had bilateral ovarian tumours. Her left ovarian tumour invaded the sigmoid colon. There were extensive small nodules all over the peritoneal cavity. The undersurface of diaphragm was also extensively involved by the tumour nodules. She underwent TAHBSO, omentectomy, appendictomy and resection of the sigmoid colon. All significant sized tumour nodules were debulked.

She received six cycles of chemo – carboplatin + paclitaxel. And this completed in June 2009. A repeat CT scan did not show any evidence of recurrent or residual tumour. Her CA 125 which was in the range of 11,000 pre-op normalised after three cycles of chemo and remained below 10 after that.

However, six months later, December 2009, she had severe pains and was hospitalised. There were tumour nodules in her pelvis and she had extensive recurrence of her cancer. Overall her prognosis appears poor. Her surgeon wrote: Nevertheless, I believe we should make one final attempt at chemotherapy.

Case 3: H394, 40-year-old lady, underwent an operation to remove a malignant ovarian cyst in 2007. This was followed by a hysterectomy. It was a Stage 3 cancer. Not satisfied, she went to Singapore for consultation. She was told her cancer was a Stage 4. H294 underwent six cycles of chemotherapy with carboplatin + taxotere. In addition she received 25 radiation treatment and 2 brachytherapy (internal radiation treatment). All treatments were completed in October 2007. She was well for a while.

But two years later, October 2009, her CA 125 started to increase. A CT scan showed the cancer had recurred and spread. She received another three cycles of chemotherapy with cisplatin. The treatment was not effective. Her CA 125 increased further and the tumour grow bigger by 1 cm. She went to China for further treatment. This too was not effective.

Case 5: H284, 50-year-old lady, had ovarian cancer and underwent a surgery – TAHBSO in February 2006. In addition she received 3 times brachytherapy (internal radiation) and six cycles of chemotherapy. Two years later, in September 2008, CT scan showed lesions in her liver and soft tissue mass in her pelvis. Her CA 125 was in a rising trend.

In April 2009, she felt pains in her abdomen. A PET scan confirmed cancer recurrence. The soft tissue nodule in her pelvis was 2.9 x 2.6 cm in size. Nodule in Segment 6/7 of her liver was 2.2 c x 2.5 cm in size. She underwent 6 cycles of chemotherapy. The pains were gone but three months later, the pains came back. The doctor said more chemotherapy!

Case 6: H813, 54-year-old lady, went for a general checkup. The doctor found something in her uterus. Subsequently she underwent an operation, TAHBSO. It was a Stage 3 ovarian cancer. She underwent 12 cycles of chemotherapy with Gemzar + Carboplatin. All treatments were completed in August 2009. Everything was okay.

About two years later, September 2011, the doctor found lesion in her pelvis. In January 2012, CT scan showed the lesion was still there. A biopsy was done and was found to be malignant. She was asked to undergo another 18 cycles of chemotherapy with Taxol + carboplatin.

Case 7. Dying In the ICU After Surgery for Ovarian Cancer and Chemo for Lymphoma.Wan went to see a doctor in a private hospital. She was told that she had ovarian cancer and needed an operation. Wan then moved on to another private hospital believing that another doctor was better able to handle her case. On 16 February 2009, Wan underwent an operation to remove her so-called cancer in the ovary. It was a total hysterectomy. But Wan’s condition did not improve in spite of the surgery. Read more of her story here: https://cancercaremalaysia.com/2010/12/11/dying-in-the-icu-after-surgery-for-ovarian-cancer-and-chemo-for-lymphoma/

Success Stories of Ovarian Cancer with CA Care Therapy

Case 1: Siti was 48 years old when she was diagnosed with ovarian cancer Stage 4. She underwent a total hysterectomy in 2005 followed by three cycles of chemotherapy. She gave up chemo. At first Siti and her husband did not believe in what we at CA Care are doing. Many times, they were “pushed” by a friend to come and see us. Eventually Siti and her husband relented and came to Penang. From then on it was no turning back. Siti’s health improved. It has been seven years now and she is going well.

Case 2: June (not real name) was 42-years old when she was diagnosed with ovarian cancer in December 2006. A TAHBSO surgery was performed. The histopathology report confirmed a bilateral ovarian adenocarcinoma with metastasis to the omentum. June underwent chemotherapy and took herbs. Unfortunately the cancer recurred. The doctors wanted her to undergo more chemo. She refused and continued with the herbs. This time June’s spleen became swollen and caused severe pains. She had no choice but to undergo more chem. She was well up to this day.

Related Cancer: The Endometrium

Case 3: GS (T791) is a 54 year-old lady. A cervical biopsy and endometrial curetting indicated a moderately differentiated adenocarcinoma of the endometirum. Subsequently, GS underwent a surgery – TAHBSO at a private hospital. The pathology report confirmed a well differentiated adenocarcinoma of the endometrium, classical endometrioid type, Stage 3B (T2bNxMx), tumour invades into cervical stroma.

Case 4: Ella was diagnosed with endometrial cancer. She underwent a TAHBSO and resection of the omentum and left and right pelvic nodes. After the surgery, her surgeon told her: No chemo, you have three months. With chemo, it would be two-and-a-half years. She asked: What? Ella was started on herbs right away – and NO chemo of course. As of this writing, it is about four years now and Ella is well and healthy.

Let me conclude by quoting a wise man who I have much respect for – Jewish Rabbi Harold Kushner. His words have always been my moral compass whenever I deal with patients who come to us for help.

Surgery for Liver Cancer: Eighty Percent Success?

Posted on 22/11/2010 by CA Care

Wang (not real name, M872), 48-year-old male from Medan had been living with “blood-in-his-stools” for the past ten over years. This problem was attributed to piles. In November 2010 he came to a private hospital in Penang for a medical checkup. A scope of his colon did not show anything wrong. However, an ultrasound of his abdomen showed an ill defined, 7 x 9.2 cm mass in the right lobe of his liver.

Blood test was positive for Hepatitis B. Liver function test indicated elevated liver enzymes – ALT = 101, AST = 43 and GGT = 107. Alpha-fetoprotein was normal at 4.84.

CT scan done on 12 November 2010 indicated a 8.2 x 7.2 cm mass suggestive of hepatoma in segment 8 of his liver. A small solid lesion is also found in segment 7 measuring 1.8 x 1.2 cm. This may represent a satellite lesion of hepatoma. A simple cyst is noted at segment 8 below the right hemidiaphragm.

Wang went to see another doctor in another hospital. A repeat CT scan was done on 13 November 2010. The results were similar to the one done a day earlier.

The surgeon suggested that Wang undergo surgery to remove the tumour. The operation would cost RM 40,000. After the operation, Wang would have to undergo chemotherapy. The cost of each chemo is around RM 4,000 to RM 5,000.

Wang and his wife were disappointed and decided to go back to Medan without doing any surgery or chemotherapy. Someone learnt about their predicament and suggested that they come to CA Care for advice. We spent more than an hour with them. Below is a video recording of a part of our conversation that day.

Comments:

Most of the story-telling was done by Wang’s wife. She only talks Chinese! It appears to me that she is a “smart and wise” lady even though she is not educated.
She said: “When the doctor (surgeon) said that my husband had to undergo surgery and chemotherapy, I knew that this is a serious case”. This shows that she is not a dumb, naïve village girl – never mind if she does not know how to read the CT scan report or figure out what the blood test shows.
I asked her: “Did you ask the doctor if surgery can cure his cancer.” She replied yes. Most patients who come to us did not do that! How could that be? They don’t even want to find out what the prognosis is like! Not this lady.
She even asked the doctor: “What if we do not do the chemotherapy?”. The surgeon replied: “It is like cutting the lallang. You need to apply chemical after you mow it down. Only then can it be eliminated.” The answer was right on spot because this lady works in the farm – she understood it well. To kill off the lallang you need to apply chemical poison. Sometimes the land had to be dug up or overturned to get rid of the rhizome. So she said: “Then what would that do to my husband?” The implication is – what would happen to the patient if you poison him like you poison the lallang?
She also asked the surgeon: “When you cut up my husband, what are the chances that his cancer is cured?” Again this kind of question is never asked by most patients before they undergo an operation. The surgeon replied: “More than 80 percentage success rate.”
I asked the lady: “The doctor said 80 percent success – did you believe him?” She replied NO. I asked her why. She said: “There is one statement that the doctor made which got stuck in my head. Earlier I asked the doctor about the risk involved – how certain was he that everything would turn out right.” The doctor replied this lady: “The same case like you flying in from Medan to Penang. The airline does not guarantee that you are risk free.” Though the doctor did not admit outright that the treatment has risk, his reply very much implies that there is risk – the lady got the answer.
Later in our conversation, I came to know that Wang’s sister also had liver cancer. She received chemotherapy. She died after four cycles. While many patients or their loved ones appear naïve – don’t under estimate them! They have gone through some bitter experiences in life and they are not about ready to forget them. For such people, doctors need to do a lot of convincing to make them accept chemotherapy again.
I feel sorry for this couple. They came all the way to Penang and had to spend so much money. They can do the treatment – no problem about that for as long as they can pay the hospital bills – but cure appears to be elusive.

There is one important lesson we can learn from this story. How reliable or true are statements made by a doctor? Is it backed by good statistics and good research? At this point I am reminded of what some doctors wrote. Let me quote.

Dr. Block, herself a doctor, wrote in the foreword of Fight for Your Health: “Don’t just blindly follow what your doctors say. Find out the truth for yourself.”

Dr. Mendelsohn, in his book Confessions of a Medical Heretic wrote: “Doctors in general should be treated with about the same degree of trust as used car salesmen. Whatever your doctor says or recommends, you have to first consider how it will benefit him … because surgeon gets paid when he performs surgery on you, not when you’re treated some other way.”

Dr. Chestnut in his book, Lying With Authority wrote: “Somebody has got be lying – lying with an air of authority. The vast majority of surgery and drugs, including chemotherapy, does not treat or cure disease; it treats symptoms – often with devastating side effects.”

Dr. Hamilton in his book, The Scalpel and the Soul wrote: “As doctors, we generally don’t tell outright lies. We just don’t speak the truth fully.”

It is not nice to say that doctors tell lies – but the above quotations seem to say that some do, though they represent a minority. But I must say I like what Dr. Hamilton said: “We generally don’t tell outright lies. We just don’t speak the truth fully.” In this story, the surgeon told Wang and his wife that the treatment has more than 80 percent success.” His answer can be dead right or dead wrong! Let me explain.

From the perspective of this surgeon he is absolutely right to claim that the treatment has more than 80 percent success rate. A surgeon’s job is to cut up patients. After that he passes the patient to the oncologist or someone else. As far as he is concern his part of the cancer war is done. With the present state of the art technology, surgery carries minimal risk – like us flying in an air plane. The possibility of a crash is there but it is not likely (yes, it can happen!). Dying from surgery does occur although it is not likely.

But is that what the patient is looking for – just not dying from surgery? From the perspective of Wang and his wife, they are looking for a cure of his cancer! To them, the answer of 80 percent success takes an entirely different meaning. Cure means completely elimination of the cancer and it will not come back. That is what all patients ask for. Therefore, if patients are made to believe that they can attain an 80 percent chance of cure if they undergo surgery or chemotherapy is definitely false.

Let me repeat what Dr. Hamilton said: “we just don’t speak the truth fully.” Does this mean that doctors intentionally withhold some vital information which patients should know? If so, is that fair? I think the most vital information not told to patients is that though surgery is safe it will NOT cure the cancer. The chances of recurrence after an apparent successful surgery are very high. If you follow the case studies presented in this website, you will know that some patients die not long after their liver surgery.

Perhaps is this the reason why Dr. Mendelsohn said we should regard doctors in general “with about the same degree of trust as used car salesmen”?

In this article I have refrained from commenting if indeed the advice to operate is appropriate or otherwise. I would like to believe that the doctor has recommended this path with the best of intention. Even that, we need to be reminded that according to liver experts only 10 % to 30% of those who present with HCC are candidates for surgery. Meaning surgery is not the answer for all cases of liver cancer. Also surgery is good for only small tumours. Again, Dr. Mendelsohn’s words come to mind, they do this “because surgeon gets paid when he performs surgery on you”.

Let me conclude this article by trying to answer my earlier question: to what extent is the statement “after surgery there is a more than 80 percent success” true. I spent time reading my oncology books again. Below are the scientific facts written by liver experts. Read them carefully and come to your own conclusions.

Review of Medical Literature on Liver Cancer (Hepatocellular Carcinoma – HCC)

Research Reports

Ikeda et al., Cancer, 71:19-251993, reported: Eighty-three patients with HCC were treated with curative surgical resection during the past 8 years. No operative deaths occurred. Recurrence rates after resection at the ends of years 1, 2, and 3 were 37.0%, 57.1%, and 71.6%, respectively.

Iwatsuki et al., Ann Surg. 1991 September; 214(3): 221–229, reported: From 1980 to 1989, 76 patients with HCC underwent subtotal hepatic resection. Only 12 patients lived more than 5 years.

Vauthey, et al., American J of Surgery; Vol: 169, pg. 28-35, 1995, reported: Between 1970 and 1992, 106 patients underwent hepatic resection for HCC at Memorial Sloan-Kettering Cancer Center. Overall survival was 41% and 32% at 5 and 10 years, respectively.

Nagao et al., Ann Surg. 205(1): 33–40; 1987 reported: Ninety-four patients underwent hepatic resections from 1963 to 1985.One-, 3 and 5-year survival rates were 73%, 42% and 25% respectively. The recurrence of carcinoma was the main cause of death in 56% (42 patients) who died after discharge from the hospital. Prognostic factors that influenced the long-term prognosis were: preoperative alpha-fetoprotein level (less than or equal to 200 vs. greater than 200 ng/mL), tumor size (less than or equal to 5 vs. greater than 5 cm), and tumor capsule.

Shyh-Chuan Jwo, et al. Hepatology , Vol. 1367–1371; 1992 reported: A total of 238 patients who received curative hepatic resections during the last 10 years were observed. The results revealed that tumor size, tumor appearance and DNA ploidy were the factors in predicting tumor recurrence after resection for HCC. Patients with a tumor size less than or equal to 5 cm or a tumor appearance of the solitary type had better disease-free survival than did those with a tumor size greater than 5 cm or a tumor appearance of multiple/daughter nodule types.

Poon et al. of the Centre for the Study of Liver Disease, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong,, Ann Surg. 234(1): 63–70 2001, wrote:

HCC is notorious for poor prognosis because of its invasiveness and frequent association with cirrhosis.
Hepatic resection remains the treatment of choice for HCC.
During the past decade, hepatic surgeons have focused much effort on improving the surgical techniques and perioperative management for resection of HCC, resulting in greatly improved perioperative outcomes. By the end of the 1990s, studies from our institution and others have demonstrated that a zero hospital or surgical death rate could be achieved in large series of patients.
Long-term prognosis after resection of HCC remains unsatisfactory. Disease-free survival has been poor because of a high incidence of recurrence. A 5-year cumulative recurrence rate of 80% to 100% has been reported.
Reports in the 1990s from Eastern and Western centers have documented a 5-year overall survival rate of 26% to 44% after resection of HCC.

Oncology Textbooks

Harrison’s Principles of Internal Medicine 15th Ed., pg.589.

Staging of HCC is based on tumour size, ascites (present or absent), bilirubin and albumin.
If untreated, most patients die within 3 to 6 months of diagnosis.
If detected very early, survival is 1 to 2 years after resection.
Surgical resection offers the only chance for cure, however, few patients have a resectable tumour at the time of presentation because of underlying cirrhosis or distant metastases.
Radomised trials have not shown a survival advantage after chemoembolization.
Liver cannot tolerate high doses of radiation.
The disease is not responsive to chemotherapy.

The American Cancer Society’s Clinical Oncology, 3rd Ed., pg. 399-401.

Only 15% to 30% of patients with HCC are candidates for surgery.
Conditions that render HCC unresectable are extensive disease within the organ itself and metastases.
Large tumour size, bilobar involvement and presence of cirrhosis do not necessary preclude resection but adversely affect mortality and prognosis.
Resection generally is limited to patients with small peripheral lesions and preserved hepatic function.
Five-year cure rate for all HCC who have undergone hepatic resection is approximately 30%.
The value of radiotherapy is limited in treating HCC.
Chemotherapy is palliative. Patients who respond to chemotherapy will survive 9 to 12 months longer.
Mean survival for patients receiving chemotherapy is approximately 5 months (1- year survival is 27%, 2-year is 8%).
Cure and long-term survival are possible only when tumours can be resected completely.

Martin Abeloff, et al. Clinical Oncology, Vol: 2, pg. 1697, 1703-1721.

Median survival of Hong Kong patients with inoperable HCC – tumour larger than 6 cm in diameter and receiving no treatment – was 3.5 weeks.
Tumour size at diagnosis is an important prognostic variable.
Tumour doubling time ranged from 1 to 19.5 months, with an average of 6.5 months.
Study in Japan showed that for patients with cirrhosis and HCC less than 3 cm in diameter and without treatment, 1-year survival rate was 90.7%; 2-year was 55.0%; and 3-year was 12.8%.
Unfortunately only 10 to 15% of newly diagnosed HCC patients are candidate for resection.
Presence of cirrhosis is a negative prognostic indicator.
Operative mortality rate of liver resections for HCC is les than 10%, but post-operative morbidity rate remains high – between 40 to 60%.
85% of hepatic recurrences develop within 2 years of resection.
There is little evidence of significant therapeutic activity for any single chemo-agent. There is also no evidence to support the routine use of combination chemotherapy.

Liver resection is the operation of choice for patients with tumors less than 5 cm in the absence of cirrhosis. In these patients, an operative mortality rate of less than 2% can be expected in experienced centers.Following liver resection, up to 75% of patients will develop intrahepatic recurrence within 5 years. Source: http://emedicine.medscape.com/article/197319-treatment

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