I make rounds in the clinic and wards. Whenever I discussed chemotherapy with patients, I’m often asked if I had received chemotherapy? Some patients said, “We will follow you”; sometimes when I suggested patients receive chemotherapy, they did not accept it but asked me: “Why did you not have chemotherapy?”
Indeed, I did not receive chemotherapy. After surgery my colleagues suggested I have chemotherapy. I responded by asking, “Are my type of cancer cells sensitive to chemotherapy?” A colleague said that according to the literature it was not necessarily proven. I further questioned, “Is there any literature that proves chemotherapy can prolong the life of cholangiocarcinoma patients?” They were not able to answer this. In fact, in 1988 it was reported that ninety-seven cholangiocarcinoma patients received chemotherapy, which included Mitomycin, Epirubicin and Fluorouracil. The result showed that only 29% of the patients’ tumor shrank but none of the patients’ tumors disappeared. After 1988, there were no further reports about chemotherapy for cholangiocarcinoma.
However, it is wrong to deny chemotherapy altogether. Questioning whether it is beneficial or not, to receive chemotherapy depends on several factors: (1) the sensitivity of the cancer cells to the chemotherapeutic drugs. Around 7% of cancers are highly sensitive to chemotherapy and this should be the preferred treatment for lymphoma, testicular seminoma and choriocarcinoma. Some cancer cells have a definite sensitivity to chemotherapy which can be applied before or after surgery to increase the efficacy and reduce cancer recurrence. For example, breast cancer even though it may be discovered in its early stage when the tumor is still small, cancer cells are likely to exist in the peripheral blood or bone marrow. Preoperative or postoperative chemotherapy may reduce recurrence. (2) Can patients tolerate chemotherapy? Side effects caused by chemotherapy may accelerate progression of the disease for the aged with poor bodily organ function, which does greater harm to the patients than the cancer itself.
Today it seems the approach taken on chemotherapeutic drugs is the same as that of antibiotic use, the main problem being excessive application and misuse.
On the 13th of December 2010, I received a letter from a teacher in Nantong, Jiangsu. He wrote that he was suffering with pain. A month prior he had taken the oral chemotherapeutic drugs which caused numbness and pain in his limbs. His oral cavity had ulcers which prevented him from eating and he was only able to consume liquidized food through a straw. He said that he had read my book “Nothing But The Truth” and decided he would follow up on the treatments. I felt guilty that I had not told him “the truth”.
My teacher suffered from gastric cancer. Three months ago, his stool was black so he had a gastrointestinal barium meal examination which found that he had the possibility of gastric cancer. I was naturally anxious over his illness. In retrospect, at the beginning I was concerned about him as he had a PET-CT scan which was inconclusive and found no issues. He called and told me but I suggested he undergo a gastroscopy because the PET-CT scan can appear “false negative” for gastric cancer. He said he had heart and kidney dysfunction so the doctor did not dare do the gastroscopy for him. I suggested he have a light anesthesia, the result proved he had gastric cancer. But there
was great debate whether or not he should have surgery. Some people thought because his cardiac function was poor, surgery would carry a large risk. The patient was a digestive expert who suffered from the disease he had researched for a long time, he certainly knew what this treatment involved. One can imagine how ill he felt. He was hoping I would return to Nantong to see him. On National Day I went to his house as soon as I could, where he excitedly opened the door and pulled me in for a chat in the living room, talking nonstop about his treatment process.
Two weeks later the teacher had surgery. The operation went smoothly and the tumor was completely removed. Pathological examination showed that the tumor had infiltrated into the muscular layer of the stomach but without lymph node metastasis.
The teacher’s wife, Professor Yang whom was also one of my teachers called and asked if he should receive chemotherapy. I hesitated and decided to send him my book “Nothing But The Truth”. I could not give an affirmative response as to what further treatment he should have. Because I knew this teacher was highly respected and had many people caring about him, I felt I should not be responsible for the decision of whether or not he should receive conventional treatments.
So when I received a letter from my teacher I felt very guilty. I thought if the patient were myself or my father how would I deal with it? I undoubtedly knew gastric cancer was rather insensitive to chemotherapy and was aware of the negative attitude in the literature concerning the chemotherapeutic value for gastric cancer prolonging survival time. Furthermore, chemotherapy is not really suitable for the elderly. I asked myself, why had I failed to tell the truth?
There is a saying: a teacher for a day is a father for a lifetime. This was the teacher that had influenced me for a lifetime! If I had viewed my opinion earlier perhaps my teacher would not have to go through this suffering, I was regretful about that.
In the majority of cases excessive use of chemotherapy is mainly due to doctor’s good intentions, which consider it better to apply chemotherapeutic drugs than do nothing at all, using chemotherapy as a safeguard so to speak. Of course there are those that use it for other intentions. It is said that a foreign famous doctor treated a royal breast cancer patient of an oil producing country, the patient spent tens of millions of dollars, but still passed away. This famous doctor is now under government investigation.
I often advise doctors in our hospital that when treating a patient, conscience comes first and we must keep practical and realistic. This is especially true of chemotherapy. Chemotherapy should be undertaken when we fully weigh the possible benefits and side effects.
The World Health Organization (WHO) published The “National Cancer Control Outline” which outlined their opinion on the guidance use for chemotherapy.
The first type of tumor: Evidence shows that drug therapy orcombined therapy will at least help certain patients survive.
The second type of tumor: Evidence shows that the use of certain drugs or several combinations of drugs can shrink these tumors or improve the patient’s quality of life.
The third type of tumor: These are tumors without effective drugs. Although certain drugs can shrink the tumors, this is only to a small extent. The patient’s quality of life may not have any improvements (with very few exceptions) and would more likely be damaged. Furthermore the chemotherapy used on this third type of tumor could even shorten their life.
With regard to chemotherapy, in recent years the issue has been raised that chemotherapy may have the opposite effect. There are two research reports listed below:
In 2008, the famous magazine “Cancer Research” published Kensuke Yamauchi and Robert Hoffman’s research reports carried out by the University of California in the United States and the Kanazawa University in Japan. They injected human fibrosarcoma cells into the abdominal vein of naked mice. If the mice were administered the chemotherapeutic drug cyclophosphamide twenty-four hours prior, fibrosarcoma cells increased visibly in the blood vessels, there was exosmosis and strong establishment (these are all the steps needed for
metastasis), whilst those intravascular fibrosarcoma cells that did not receive the cyclophosphamide remained in a static state. This example illustrates that chemotherapeutic drugs can produce the opposite effect that enhance cancer cell activity and promote cancer metastasis.
The American Vanderbilt-Ingram Cancer Center Research Group published an article in the “Journal of Clinical Investigation” in 2007, considering that part of the current anticancer treatments may work partially or not at all, even accelerating cancer progression. They discovered that giving transplanted breast cancer mice chemotherapeutic drugs (Epirubicin, Taxotere), the tumor growth factor β (TGF) level in the blood and inside the tumor increased, the number of cancer cells in the blood and the cancer metastasis increased as well. The β TGF is considered to be the key factor because it can increase regulatory cell proliferation in vivo and inhibit the immune function, weakening the effects of the anti-cancer treatment. They also found a similar phenomenon in patients with breast cancer. The principal of the research project, Arteaga is the only recognized deputy director of the Breast Cancer Research Project in the Tennessee Comprehensive Cancer Treatment Center by the National Cancer Institute. The American National Institute of Health and pharmaceutical companies also funded this project.