It is the doctors’ responsibility to diagnose cancer. Tumours are classified into benign and malignant; the former normally is not life-threatening while the latter is commonly known as cancer. Cancer, sarcoma included, is life-threatening. It is very critical to ensure the correctness of the diagnosis and to distinguish between benign and malignant tumours and more importantly not to confuse cancer with non-cancerous diseases. In most cases, modern technology including ultrasound, CT, MRI and PET-CT scan help to give correct diagnoses of cancers. However, equipment and technology alone are inadequate; it also requires doctors to be dedicated, prudent and patient.
Sometime in September 2007, I was invited to lecture at the Cancer Society of Jiangyin City in the Province of Jiangsu. Jiangyin City is one of the well known cities in China. The City People's Hospital of Jiangyin is the teaching hospital of Nantong Medical College, where I had worked. I had not come to Jiangyin for quite a number of years. One day after dinner, my secretary, Xiao Wang and I were walking aimlessly along a street until we saw a bookshop, Xinhua Bookstore, at the end of the street. We went to the medical section and selected some medical books on cancer. When Xiao Wang went to the counter to pay for the books, a young female sale executive asked: "Are you a doctor?" Xiao Wang nodded his head and said, “Yes.” The sale executive immediately asked, "Can you please help to examine a sick person here?” Xiao Wang introduced me to her. She immediately thanked us and requested us to wait for awhile for her to bring the sick person to us. From her solemn expression on her face, we told ourselves that the sick person must be an important person of the bookstore. About ten minutes later, a man and a woman came to us; they were in their 30s, with simple clothing and a rural look. A young man wearing a suit came with them. He introduced himself as the retail sale manager of the bookstore and told us that the man was sick. We were told that about two months ago, he suddenly had very bad coughs and chest pain. He had chest X-ray done in a local hospital and it was suspected that he had lung cancer. The man also underwent PET-CT in a medical specialist hospital and was diagnosed as “Stage IIIB lung cancer”; the hospital suggested for him to undergo chemotherapy. He had two courses of chemotherapy after returning to Jiangyin.
I looked at the PET-CT film and noticed that there were three patches at the upper top of the left lung. If it were lung cancer, it was certainly at an advanced stage and the only appropriate treatment was chemotherapy. The Retail Manager was very anxious and told us that the man and his wife, from Hai An Village, Jiangsu North, worked as cleaners in the bookstore. After knowing that the man had cancer, the general manager of the bookstore was very concerned and started to raise fund among his staff. Later, the man was sent for medical examination in Shanghai. The retail manager further told us that this couple came from a poor background; they had a five years old child and a seventy years old mother to support. He pleaded us to help and treat the man.
The deep concern shown by the general manager and his staff to a lowest rank temporary cleaner from a poor village in Jiangsu North was something that I had never heard of. The love and care shown by the rich Southerners towards a poor guy from Jiangsu North deeply touched me. My home town is also in Jiangsu North, not far from that of the cleaner. Jiangsu, a rich province in China, is divided into two parts, Jiangsu North and Jiangsu South by the Yangtze River. Jiangsu North is much less developed than Jiangsu South. People from Jiangsu South always feel that they are superior to their northern counterpart while people from Jiangsu North are full of inferiority complex. The love and care shown by the rich Southerners towards a poor guy from Jiangsu North deeply touched me. I told them that we would try our best to help and suggested to use percutaneous cryoablation to eradicate the tumours. The retail manager was very grateful to learn that and said, "I'll brief the general manager on this immediately and arrange to send him to Guangzhou tomorrow.” I promised him that we would provide the man with free medical treatment.
The next morning, I received a call from the retail manager informing me that the patient would fly to Guangzhou on that afternoon from the Shanghai Hongqiao Airport. I immediately called our hospital to arrange for airport transfer. I also told them to conduct further diagnosis before giving him any treatment. A week later I returned to work in our hospital. The first thing I did was to see that patient. Once he saw me, he jumped on his feet happily. Grasping my hand firmly he thanked me for saving his life. A biopsy of his chest tissues confirmed that he had tuberculosis, not lung cancer! Cancer and tuberculosis are worlds apart and their treatments are entirely different. Using chemotherapy to treat tuberculosis would only aggravate his condition leading to fatality. It was by chance that I met him in Jiangyin and as a result, he was saved.
In the night of 25th February 2009, I received a call from Beijing; it was from the wife of the former director of the Labour and Personnel Department of the Ministry of Transport. She told me sobbingly, "Professor Xu, please save my husband!” Her husband, Sun Zhegang, had just been diagnosed with unresectable lung cancer by XXXX Hospital in Beijing.
I recalled a scene 24 years ago. That was in 1986. I was the director of the Department of Gastroenterology in the affiliated hospital of Nantong Medical College. One day, the president of the hospital brought a senior officer of the Ministry of Transport to see me. At that time, Nantong Medical College was under the jurisdiction of the Ministry of Transport. The president introduced the man to me as Sun Zhegang, the director of the Labour and Personnel Department of the Ministry of Transport. I carried out gastroscopy on him. Sun was a jolly and frank person; he was rather reluctant to undergo gastroscopy as he had one about 6 months ago in Beijing which indicated that everything was basically normal. After some strong persuasion, Sun finally accepted the well-intended proposal from his subordinate to have gastroscopy. The gastroscopy was done smoothly; there was a little inflammation of the stomach. However, there was a light grey dot, the size of a grain, at mid oesophagus; it was neither ulcer nor tumour except for a slight colour change of the mucus membrane. A thought suddenly flashed through my mind; Sun was from the province of Henan which had very high occurrence of oesophageal cancer! I did several biopsies of the oesophagus.
The next day, Sun left the hospital for Beijing. The biopsy report came out; it was oesophageal cancer. I immediately went to the Department of Pathology requesting them to ascertain that the biopsy’s result was correct. The Pathology Department countered-checked the biopsy reference number closely and reconfirmed the result. I made an urgent call to Beijing. Sun and his senior officers were all shocked by the result. Sun went for another gastroscopy in a Beijing hospital but the result was in the negative; no cancer was detected. I believed strongly that our pathological examination could not be wrong. I insisted that Sun should undergo surgery. Two weeks later, Sun underwent surgery at the Oncology Hospital of China Academy of Medical Sciences in Beijing. During the oesophagus examination, the surgeon found no lesion; he immediately called me. I suggested to him to perform oesophageal resection on Sun as was commonly practised. A post-operation pathological examination confirmed oesophageal cancer in situ; an early occurrence of cancer at the mucus membrane.
In September 2008, I travelled to Beijing on official duty. One afternoon, I passed through Hepingli where Sun once lived. After a lapse of 22 years, he should be 80 years old by then. “Is he still alive?” I asked myself. As I did not have his house phone number, I phoned one of Sun’s former colleagues. Surprisingly, the lady who picked up the phone immediately recognised me and told me that Sun was very well. A few minutes later, my cell phone rang; it was Sun’s wife who called. She was very joyous and repeatedly invited me to their house.
That evening, Sun and his wife prepared a sumptuous meal for me. They kept on telling me that it was I who had saved and changed the rest of his life and enabled him to live for another twenty plus years. He told me with sadness that almost all of his peers had passed away.
In fact, Sun’s case had also transformed the rest of my life. The early detection of oesophageal cancer in Sun shocked the whole Ministry of Transport. That was because for decades more than 20 officers of the ministry had died of advanced cancer. For three consecutive years I was invited to lead a group of doctors and nurses to conduct physical examinations on all the officers in the ministry. We detected one case of early stage colon cancer. In 1989, I was sent by the Ministry to the United Christian Hospital, Shekou in Shenzhen to set up a digestive disease centre. This was the beginning of my medical career in Southern China which I was very grateful and always cherished.
Now learning that Sun was diagnosed with lung cancer really shocked me. According to Sun’s wife, this was confirmed by chest X-ray and CT scan. I asked Sun to go for PET-CT immediately. A week later, Sun’s wife called again and informed that PET-CT also confirmed that Sun had lung cancer. A medical specialist prescribed 4 packages of Chinese herbs for Sun because all the doctors felt that Sun was not fit to undergo surgery or chemotherapy. Sun was advised to rest well at home. Sun’s wife cried and said to me, "Professor Xu, you had saved Sun’s life once. Please help to save him again!”
On March 11th, Sun and his wife came to Guangzhou by train. Sun was admitted into our hospital. Sun said that he had escaped death once from oesophageal cancer and had lived for another 20 plus years. He said: "Now I have lung cancer. I want you to examine me and if you find that I have no chance to survive, so be it and I would die without regret."
The next day, we performed CT-guided percutaneous cryoablation biopsy. In order to prevent the spread of cancer cells due to biopsyneedle, we froze the tumour with a freezing probe at -180 degrees Celsius, and then inserted biopsyneedles to extract five living tissue samples. These samples were sent to two different pathology centres for analysis. Both the two pathological reports revealed that it was chronic inflammation; no malignant cells were detected. It was a great relief to Sun. He stayed back in Guangzhou for two months before returning to Beijing. During the Chinese New Year of 2010, he called me and said that God willing, he would like to live for at least another 10 years.
Sun was a high-ranking officer and was accessible to top medical treatment. He had had medical examinations using the latest equipment and technology available; yet, he was given the wrong diagnosis and as a result he almost lost his life. Doctors have to be extra prudent in the diagnosis of cancer.