Foreword

Writing this book was full of twists and turns.

Society’s criticism of my book “Nothing But The Truth”published in 2010 by Guangzhou Press was good and I have no further “truths” to share. In January 2011, I was invited to deliver a presentation at MD Anderson Cancer Center in Houston, the United States. On returning to Guangzhou during the start of Chinese New Year, the Chinese-American Professors Tan Dongfeng and Lu Garry called, wishing me New Year’s greetings and told me “Your presentation at our hospital deeply moved the hospital's foreigners. They were shocked by the strange and challenging medical cases you’ve successfully treated, as well as your own miraculous cancer experience.” They suggested I should write a book about my own cancer journey, because it's a “valuable treasure” .

Figure 1 The author is taking a group photo with Dr. Epner

A few days later, I received an email form Dr. Epner, the Chief Professor of the International Department of MD Anderson Cancer Center saying that Fuda Cancer Hospital has achieved“incredible accomplishments” in cancer treatment, adding further “I’m very grateful you came to meet with us at our center, the success you’ve achieved at Fuda Cancer Hospital has left a strong impression. We’re very interested in working with your world class hospital & cooperating in establishing a bridge between our hospital's working teams. I believe by working together we will have greater potential to make significant achievements.”

MD Anderson Cancer Center is one of three major cancer hospitals in the United States and in recent years has ranked first. The main reason I visited, was to study. The presentation I made there was essentially about how to apply the “3C +P” model in treating those non-resectable cancers, further announcing that I personally suffered from cholangiocarcinoma. I recall the doctors there were very interested and asked lots of questions.

I always kept Professor Tan Dongfeng and Lu Gary’s suggestions in mind. These two professors are a pathologist and an experimental therapy expert respectively at the MD Anderson Cancer Center and are internationally recognized. But I didn’t start to write mainly because I wanted to trial my own cancer. In January 2006, I was diagnosed with liver cancer. I underwent a hepatectomy and the postoperative pathology indicated cholangiocarcinoma. I recall thinking that January 2011 was exactly five years away and the medical literature on the survival rate for this kind of liver cancer remains inconsistent, varying from 5-50%. Was I really a miraculous survivor?

A year passed and on the 23rd of January 2012 during Spring Festival I went on vacation with my family to Bali, Indonesia. My family and friends held a party to celebrate my “new life”. My grandson suddenly blurted out “Grandpa, you’re younger than me, I’m already seven and you're only six years old!” Saying this surprised everyone, but I immediately understood him; my new life started on the 26th of January 2006, the day I underwent surgery and I am, in his eyes only six years old.

A specialist article on cancer psychology states that having cancer is about suffering, dread, fear, pain, anxiety, joy and happiness. These conflicting emotions converge into a remarkable psychological state.

I’m characteristically competitive, but facing death I became a “paper tiger,” outwardly strong but crumbling inside, I felt psychologically paralyzed, but I'd lived for a remarkable six years! So as a “new six year old” I started writing this book, with the following intention: Although my cancer could suddenly relapse anytime, I still hope this book may inspire those newly diagnosed and living with cancer hoping to be ‘five year’ survivors of the disease. I’d say a fitting title of this book would be “Follow me to fight against cancer”.

In March 2012, Taiwan’s famous reporter and publisher Ms. Xie Xiuli was admitted to our hospital. Her husband Jiao Tong is a professor of Taiwan Culture University, a famous writer and food connoisseur. I gave the first draft to Ms. Xie, the following day as soon as I entered her room she said “Doctor Xu, your book has moved me to tears!” Mr. Jiao Tong took the electronic version of my books “Nothing But The Truth” and “Follow Me To Fight Against Cancer” to Taiwan. The later is a transcript of the former which was made into one book and published in traditional Chinese characters by Two Fishes Press. Ms. Xie Xiuli wrote a preface for the book and on the 7th of June the launching ceremony of the book was held at the National Taiwan Normal University. The chief editor of the Malaysia Sin Chew Newspaper Group, Ms. Shaw made a special trip to Taiwan for congratulations, where she requested Two Fishes Press authorize the Sin Chew Newspaper Group to publish the book in Malaysia in Chinese simplified characters with their Guangming Daily Newspaper holding responsibility for this task. I was invited to Kuala Lumpur on the 18th of August to hold a lecture at the Malaysian annual literary festival followed by a book signing ceremony.

But I was doubtful about the book being published domestically, as although I often said to patients “follow me” this essentially, was a joke. It was a question of whether or not using this line as the title of the book, published as a serious issue, could be misleading to patients?

Recently however a patient’s miserable experience dispelled all my doubts. On the 26th of August 2012, a gentleman from Beijing called me and said his wife was suffering from

peripheral cholangiocarcinoma. She had undergone a hepatic lobectomy the previous November in Shanghai. To consolidate a curative effect she also underwent radiotherapy and chemotherapy. But during her chemotherapy, she appeared to have liver, lung and bone metastases. He took his wife to Beijing hoping for her to receive immunotherapy. I told him on the phone that a single treatment would not prolong his wife’s life, but several integrated treatments could help improve her  condition. Four days later they travelled by train to Guangzhou. As soon as his wife was admitted to the hospital I went to see her. Her eyes were yellow and her skin dry and dull and although she didn’t moan I could see this 40-year-old woman was struggling to hold back the pain alongside projecting a strong desire to survive. The medical reports they brought with them showed that she had anemia and her PLT counts (platelets per cubic milliliter) were only 30,000 (a healthy person’s platelets should be greater than 100,000). On her second day of admission a CT scan showed that the liver metastases had significantly increased in the last two weeks and brain metastasis had appeared. Her blood platelet count had reduced to 8000.

In the following 10 hours, she had hematochezia (defecated blood) which further worsened her anemia. Apart from symptomatically treating her we couldn’t give her any other

special medical treatments. I went to see her in ICU, she said to me “I’m ready to return to my hometown in Shandong and recuperate there, afterwards I hope to come back here and receive further treatment.” She smiled, pulled my hand and firmly shook it. I felt overwhelming pain saying to her “Okay, I'll wait for you here”. I found an excuse to leave her room as my eyes were welling up with tears. That afternoon, her husband came to my office and said “in Shanghai, doctors had different opinions about whether my wife should have surgery or chemotherapy. But unfortunately we believed....” he couldn't continue and stopped speaking for a while, then taking a deep breath said “Doctor Xu, your disease is the same as my wife’s. How did you manage to survive? If only I had followed you earlier....”

“If only I had followed you earlier”, two years earlier a different patient, a CEO of a listed company with a similar cancer had said the same thing. I had introduced this patient to my book “Nothing But The Truth”. He also had peripheral cholangio carcinoma, the differences being his tumor was in the right lobe whilst mine was in the left and his tumor was smaller than mine. More importantly he was 20 years younger than me. We both underwent hepatolobectomy. After surgery there were certainly more people concerned about him than myself and he had far more ample financial means to seek out the best medical treatments than I did. He accepted procedural chemotherapy and radiotherapy, but the results were miserable. Within four months his tumor suddenly metastasized to his liver, lungs and bones. The tumor constricted his spinal nerves leaving him in enough

pain to lose his desire to live. In September 2009, he came to our hospital. As we suffered the same illness I could sympathize with him and as a doctor wanted to stop his pain by every means possible. One week later the pain had been eased, he walked from the seventh floor ward to my office on the ninth floor and said to me “we have the same cancer, dealing with your tumor you selected the manual operation, whilst I selected to have the procedural operation, like a production process organized in an assembly line. With a wry smile he added “I know that the improvement is temporary”. He stopped, his eyes were welling with tears. I stood up and made him a cup of hot tea. After a while he sighed deeply “Professor, I’m so upset! If only I’d followed your earlier...”

Myself, the Shandong sister and the CEO of the listed company all suffered from the same cancer. I had survived for nearly six years, whilst in pain and torment they had left the world. Is there a second Shandong sister, a second or third CEO of a listed company? I was in pain and couldn't sleep for several nights. I was a lucky, I didn't know how lucky until I compared myself to them, so I found myself asking “what doubts?!” I modified and added more content to the original copy of “Nothing But The Truth” for the Taiwan edition. I decided to share my experience, thoughts and behavior, both as a doctor and cancer patient with those who are fighting against cancer and those friends who care about people with cancer.