We have learnt from some of our Danish patients that doctors in Denmark were ‘arrogant’. They asked us to be extra cautious with Danish doctors who would always put us under tests. On 14th October 2008, Dr. Mufeng, the vice president of our hospital, and I went to Denmark. During our one week’s stay, we were ‘tested’ several times.
The flight to Denmark took nine and a half hours. We arrived at 6:30pm local time. When the Scandinavian Airlines plane we were travelling in landed at the Copenhagen Airport, we were very surprised to see a lady standing near the airport exit waving a China flag. She was none other than Gurlin, one of our pancreatic patients. We had not seen her for a few months and she looked younger in her windbreaker, her cheeks were rosy. She was full of smile and her eyes sparkling. We were like long missed family members and embraced each other warmly. From her look we knew that she had come out of the nightmare of her life.
On the way to the hotel, Gurlin told us that she had PET-CT done earlier that day and would be going back for the result the next morning. We felt tense upon hearing this though we continued with our lively conversation. Gurlin told us the schedule for the next few days which included a visit to the oncology department of the University of Denmark, an interview with TV2 station of Denmark, attending a forum with doctors of the Danish Cancer Society etc. However, our mind was clouded with the thought of the outcome of Gurlin’s PET-CT result the next day. What if the result showed that there was recurrence of cancer? Though we knew that all the programmes would continue as scheduled, we dared not imagine if ……. That night we thought of nothing but of Gurlin’s condition. We woke up early the next morning with the same worry. In Denmark, Christians accounted for 90% of the total population. Though we were not Christians, we followed the saying: “While in Rome, do what the Romans do”; we prayed to God to shower Gurlin with His blessings and for her good health.
Just like students anxiously waiting for their examination results, the next morning we hurriedly went down to meet Gurlin at the lobby at 10:30a.m. Gurlin’s face was beaming with delight. We took over the PET-CT report from her and looked at the diagnosis immediately. The report said that there was no evidence of cancer presence.
As I have said previously, happiness is a feeling. At that moment, we were the happiest people! Gurlin’s daughter was there also to share the joy and happiness with us. We hugged one another, hug of joy, happiness and success. The reporters from TV2 who had been waiting there also took pictures of the joyous occasion. Yes, we had passed the first test.
Gurlin suffered from pancreatic cancer, the deadliest of all cancer. Only less than 5% of pancreatic tumors can be removed surgically. Even after the resection, less than 20% of the patients can survive for a year. When pancreatic cancer came with metastasis of liver, it is considered at stage 4 and the median survival period is 2.8 months only. Last October, Gurlin felt a sharp pain at her gall bladder and went for investigation at a hospital. It was discovered that there was a lump about 2.8mm in her pancreas and there were three lumps in her liver. She was shocked to learn that. She had a biopsy done in the biggest hospital in Denmark. The result was out a week later which showed that she had pancreatic cancer with liver metastasis. The doctor did not hide the news from her but cautioned that though she could be given chemotherapy, she would have only two to three more months to live irrespective of whatsoever treatment. She was given gemcitabine based chemotherapy. She fully realized that the treatment would not bring her any real benefit; it was a conventional treatment for cancer patients. Though she worried about the side effects of the treatment, she was ready to loss all her hair and die peacefully so that her husband and daughter would not have to be tormented because of her sickness.
Gurlin’s husband was a fashion designer. They had two daughters and four grandchildren. Her daughters had their own careers and were independent of the parents. The family members met once a week. Her family members could not accept what the doctor had said and in fact they were angry over it. They decided to send Gurlin for treatment overseas. One of her daughters looked through all medical journals and literature and discovered to her disappointment that besides chemotherapy, there was no other treatment for pancreatic cancer. The median survival period for pancreatic cancer is at most 3 to 6 months. She was deeply disheartened and cried bitterly by herself. Several days later, the daughter read an internet article by Lena on her cancer treatment experience in China. Lena suffered from thoracic spinous osteochondroma. She was given surgery in Denmark. After the surgery, she got better but she had paralysis of the lower limbs. Later she was sent to the USA and was given high dose chemotherapy and stem cell transplantation. She recovered from paralysis but she had complications and developed sepsis. After a course of anti-infection treatment, she recovered from sepsis. But alas, there were more than ten lung and chest wall metastasis lesions. Gurlin’s daughter contacted Lena for consultation and she was determined to send her mother to China for treatment.
Gurlin came to our hospital in Guangzhou, China for cryoablation and her condition was under control.
When Gurlin’s doctor heard that she was getting ready to go to China for treatment he frankly told her that she must be crazy. However, Gurlin was unstoppable. She and her husband sold their mansion at the centre of Copenhagen. With the proceeds from the sale, they brought a small one-room house in Copenhagen and used the rest of the money to go for treatment in China.
On 15th October, we visited the Rigs Hospital (Rigshospitalet) of the University in Denmark, the biggest university in Denmark. This hospital has a history of eighty-five years and is the most renowned teaching and research hospital in Northern Europe. It has 1100 beds and 7000 employees. It is responsible for providing medical services to 30% of Denmark population. The oncology centre of the hospital provides mainly chemotherapy and radiotherapy treatment. They are particularly strong in radiology. They have three units of PET-CT and thirteen units of accelerators. Everyday about 250 patients receive radiotherapy there.
Gurlin accompanied us to the 7th floor of the hospital. When we stepped out of the lift, we were met by a tall middle-aged man who greeted us with a firm handshake. He was the director of the oncology centre, Professor Hans Vonder Masse. He greeted Gurlin warmly and told us: “A miracle has happened to her.”His opening speech removed all the uneasiness in us.
Professor Masse led us through a long corridor to a small conference room. Inside the conference room were his colleagues.
We focused our discussion on the application of cryoablation on advanced cancer patients. We discussed on treatment of pancreatic cancer. Professor Masse said that they had paid close attention to several pancreatic patients who had returned to Denmark after receiving treatment in our hospital. According to Professor Masse, their hospital treated about 200 pancreatic patients each year. Out of these 200 plus cases, only about 7% could be given radical surgery. For metastatic pancreatic cancer with liver metastases, the objective response rate for chemo/radiotherapy was less than 5% with very short survival period.
We briefed them on cryoablation treatment for lung cancer, liver cancer and other solid tumors with special emphasis on results obtained using cryosurgical ablation combined with iodine125 seed implantation to treat advanced pancreatic cancer patients. There were 49 advanced pancreatic cancer cases treated in our hospital. The 1, 2 and 3 year survival rates were 63.1%, 22.8% and 9.5% respectively. In 8 cases, the survival was more than 1 year. There was a case whereby the patient had survived disease-free for a period of 4 years 3 months. None of these cases involved any Danish patient.
Our report led to a controversy. The main issues were: (1.) Advanced pancreatic cancer is always accompanied by vascular and lymph nodes invasion. How does cryosurgical ablation, in particular percutaneous cryoablation, eliminate these pathological changes? (2.) How do we prevent pancreatitis complications due to cryo-probe piercing? (3.) The temperature at the rim of the cryoablation area was 0 degree Celsius whereas the temperature needed to kill all cancer cells is minus 40 degree Celsius. How do we ensure that cancer cells on the rim of the tumor are frozen to death? We had anticipated these questions because before we published our paper on cryoablation for cancer, these questions were raised in the reviews by both domestic and overseas specialists and academicians.
For the first question, we could only speculate that cryoablation of tumors led to the release of tumor antigens which enables the body to acquire anti-tumor immunity that destroys the remnant cancer cells. We produced PET-CT images on an alveolar cancer case with lymph node metastasis. The alveolar cancer was treated with cryoablation whereas the lymph nodes metastasis was not treated. One month after the cryoablation, PET-CT was done and it was discovered that the primary and metastatic carcinoma were eliminated of their activation. We also showed a test conducted on mice. Both sides of the abdomen of a mouse were implanted with experimental tumors. Tumor on one side of the abdomen was given cryosurgery. One month later, it was noted that the tumor on the other side disappeared, too. In the case of a mouse which had tumor removed surgically from one side of the abdomen, it did not produce similar result.
For the second question, our concern was on its logicality. Pancreatic gland is the largest gland in our body. It is rich in digestive enzymes. With the insertion of a 2mm cryo-probe, digestive enzymes would leak out leading to pancreatitis. In our report on 49 cases, we only listed out complications due to acute necrotic pancreatitis. We showed them an experiment conducted to investigate the relationship between these types of complication and cryosurgery. Ten dogs were given low temperature and slow ablation of pancreatic gland. It was found that nine out of the ten dogs died of severe pancreatitis complications very soon after the treatment. Another ten dogs were given super low temperature quick freezing ablation. Only one out of the ten dogs died of severe pancreatitis complications. Quick freezing causes instant internal damages to pancreatic gland leading to localized coagulative necrosis. This prevented the release of digestive enzymes and thus prevented the occurrence of pancreatitis. We use argon-helium gas system in cryoablation of pancreatic tumors. The temperature at the tip of the cryo probe is lowered to minus 160 degree Celsius within tens of seconds. Hence it will not lead to pancreatitis easily.
As for the third question, we told them how we performed cryoablation. (1.) The frozen area was extended to a minimum of 1cm beyond the rim of the tumor to provide a “1 cm margin of safety.” (2.) We combined cryoablation with other treatments such as alcohol injection and iodine 125 seed implantation.
Professor Masse was very warm and enthusiastic. He led us on a tour of the radiology department which covered an area of 3000 square meters. He repeatedly told us that he and his colleagues would like to visit our hospital. He said that our success in treating and keeping pancreatic cancer patients alive testified that comprehensive cancer treatment was worthy of application. Professor Masse’s remarks showed the frankness and sincerity of Danish doctors.
After the academic exchange at the University of Denmark was over, we bid good bye to Professor Masse and went back to our hotel. At the main gate of the university, we met Gurlin who was waiting there. We went to a western restaurant. After we had seated, we touched on her sickness. Her eyes turned red and there was a deep silence and the atmosphere froze. After a minute or two, Gurlin recomposed herself and said “China has changed tremendously. It is a great country; it has saved my life. Your hospital has saved me and given me a new life. I would like to request CCTV to give me an opportunity to speak of my experience and the greatness of China. China had just held the amazing and successful 2008 Olympic Games that earned the respect and admiration of the whole world. As for myself, I too had my “life Olympic Games” in China. I love China!”
We talked about the life of Gurlin. She engaged herself in the education of the vulnerable groups. More than a decade ago, she was a teacher in a mentally-handicapped adult school. At the same time she was a physiologist offering rehabilitation therapy to disabled students for more than 10 years. She had a great sense of accomplishment, and she enjoyed doing it. She had been invited to train teachers in the neighboring countries. In recent years, she switched to adult vocational training. She still believed that her service to educate the mentally-handicapped adults as most meaningful. She said, “Happiness is to benefit others!”
Gurlin said that CCTV was well known all over the world. She wanted to let all pancreatic cancer patients worldwide know that China had effective treatment for the disease. Normally patients would not like to reveal their medical condition especially those who had pancreatic cancer and who were given only a few months to live. Her belief and wishes demanded a lot of courage. If it were not for her love for people having the same suffering, she would not pick up enough courage to reveal her condition.
In the morning of 16th October after a fast breakfast, we rushed to the Danish Cancer Society which was about 10 minutes away by car from our hotel. At the front entrance of an old building stood Gurlin and a medium-size lady waiting for us. That lady was Aarfen who visited our hospital with another doctor a few months ago. After we greeted one another, Aarfen led us into a reception room. We were greeted warmly by those specialists in the reception room. From the programme we knew that we would be there for about 25 minutes. Coffee, tea and cakes were served but before we could enjoy the food, our host started to introduce themselves. The Danish Cancer Society was the only cancer organization in Denmark. They had more than 600 employees and had several research departments including one on molecular biology and one on epidemiology. They were connected closely to the oncology department of various hospitals in Denmark. They collected all information regarding cancer patients in the whole country and tracked and followed up on them from the time they discovered cancer up to the time when they passed away. Definitely Gurlin was one of their objects as we noted that many people greeted Gurlin as we were visiting the premises.
Later we visited the Institute of Molecular Biology. The specialist concerned briefed us on how they conducted tests on various genes, how did they come up with a treatment programmes and prognosis.
Westerners are meticulous indeed. The schedule and their briefing were precise and right on the dot to the very minute. There was a five-minute break in the schedule. Our host brought us to the reception room. To our surprise we saw a man. He was tall with moustache. By his side stood a lady who had rosy cheeks, two big and sparkling eyes below her silvery hair. “Isn’t she our former patient?’ I asked silently. I immediately recalled a lady patient with pancreatic cancer who was warded at the third ward of our hospital about half a year ago. Her name was Berit Urvang who had a pancreatic tumor as large as 7.5cm. We did not know whether it was a mere coincidence or it was with special arrangement that Berit was there. “Is it a means to test our accomplishment in treatment of pancreatic cancer?” I pondered. Gurlin and the host looked and smiled at each other with a comprehension only known to them. Before we could even ask Berit how she was getting on, our host brought us to the epidemiological cancer research laboratory. Two senior researchers had got ready all the multimedia equipment for presentation purpose. Once we had sat down, the white screen showed the statistics for the last ten years on types of cancer, their occurrence rates and mortality rates. Every year, there were, on the average, 746 new pancreatic cancer cases and 777 deaths. In other words, almost all the patients died. Our host said, “Pancreatic cancer is indeed a deadly disease to be feared. We are almost helpless in this.” We looked at Gurlin but she did not have any special reaction to what the host had said. Probably she was well prepared mentally.
We were concerned about Berit. When we were invited to the restaurant, Berit and her husband were there waiting for us. Our memory flashed back to early this year. Berit was warded in a hospital in Beijing. That hospital requested Dr. Niu Lizhi of our hospital to a joint consultation session. Dr. Niu went to Beijing on a Sunday and performed a cryoablation operation on Berit. When he came back he informed us that Berit had a large pancreatic tumor and it took him quite an effort to perform cryoablation on her. Two months later, Berit came to Guangzhou for follow-up. It was noted that the tumor had shrunk by more than 90%. A second cryoablation operation was performed. Iodine 125 seeds were implanted around the rim of the frozen region and she was given combined immunotherapy, too. A pancreatic cancer patient would have cancer cells spread to all parts of the body by the sixth month. But Berit who was right in front of us did not look a bit like a sick person. “Do you have good appetite?” I asked. “My appetite is very good indeed. I think I can eat more than you.” She said. “Did you lose any weight?”I asked again. The husband answered, “While in Beijing, she lost 10 kg. When she came back from your hospital in Guangzhou, she put on 6 kg.”Berit said, “I worry that I might put on too much weight and become obese. Obesity could enhance occurrence of pancreatic cancer. But I must not lose too much weight as weigh loss is a symptom for pancreatic cancer.”She answered professionally. Yes, we forgot that she was a nurse by profession. We asked her if she had any follow-up and the couple answered that she had had PEP-CT done and would go back for the report next day. Upon hearing that, our host who was standing next to us said, “We have made another arrangement for you to visit the cancer hospital of University of Aarhus tomorrow. Berit is being diagnosed with cancer and has follow-up in that hospital. Professor Jens Overgaard, the research director of the hospital would very much like to meet you. But be fore-warned, Professor Jens is well known for being a very critical person."
“Is it a mere coincidence that we are going to visit that hospital where Berit was first diagnosed with pancreatic cancer and at the same time it is where she is going for her PEP-CT report?” I pondered over the question. According to our host, the Danish Cancer Society would bear all the expenses incurred for the visit and that Gurlin would accompany us during the trip. Irrespective whether it was intentionally arranged or not, we would have to undergo a second test.
This was our fourth day in Denmark. We were going to Aarhus by train together with Gurlin. We were not particularly worried over harsh questions going to be put forward by the critical Professor Jens. We were anxious about Berit’s PET-CT results. We read the summary of all the papers published by Professor Jens Overgaard given to us by the Danish Cancer Society yesterday. The summary was 12 pages thick with the titles of all the articles and papers published in world renowned journals such as the Science and the New England Journal of Medicine. There were roughly more than 200 papers. Professor Jens was indeed a top-notch medical specialist. Gurlin probably read my mind. She pointed at the papers in my hand and said, “Danish doctors are also fortune tellers.” It was a doctor from that hospital who told Berit that she had only another two more months to live.
The cancer hospital of Aarhus University has more than fifty years of history. It is the largest clinical cancer centre in Denmark. Professor Jens and his assistant, a medical doctor in his mid forty, received us at the experiment centre of the hospital. They brought us for lunch at the hospital canteen. When we were all seated, Professor Jens’ assistant asked, “Reports by Danish newspapers and TV claimed that your hospital had cured patients with advanced cancer. How did you cure them?” He launched an offensive question. We spontaneously replied, “The reports were incorrect. We never claimed that we had cured them. As for those patients from Denmark receiving treatment in our hospital, what we can say is that their quality of life has improved and they have gained survival benefits.” Professor Jens smiled and said, “That is right. We do get to know some of the patients who had received treatment in your hospital. For example, among them, there is one lady from this town who has advanced pancreatic cancer. She is fine up to now. That is a big surprise to us.” He was probably referring to Berit. Professor Jens seemed to be a meticulous person. He must have made some surveys beforehand.
After lunch, Professor Jens and his assistant escorted us to visit various departments of the hospital. Finally we went into his laboratory. After a cup of coffee, we began our discussion. Using computer, we showed him the experience we gained through the 3580 cases of treatment of cancer by cryoablation. Professor Jens and his assistants asked many questions especially those related to CT images before and after treatment for pancreatic cancer, lung cancer and liver cancer. We had to stop frequently to enable him to study it bit by bit. As we showed him the survival period of liver and lung cancer patients, Professor Jens immediately asked what calculation methods we used and what software we used for statistical tests.
After that we had more discussion. We learned from their papers that they were researching on cancer risk factors, prognostic indicators and measures to improve survival rate. They do not provide cryoablation but they do conduct research on hyperthermia. Professor Jens suggested for the two hospitals to have a mutual cooperation. He said, “The cases you provided are convincing with great persuasive power. Treatment of advanced cancer, in particular pancreatic cancer, is a global problem. Application of modern technology looks promising. However, it is not easy to persuade and change the conventional point of view. I would suggest that we combine your practical application with our research, and use evidence-based medicine to summarize and conclude your treatment outcomes.” The proposal of Professor Jens enhanced a closer communication and raised it to a higher level. By now we truly understood that the visit arrangement by the Danish Cancer Society was not to assess or test our competency but in fact they valued us and hoped that we could work together to achieve greater results. Of course, a ‘practical examination’ involving a real patient was inevitable.
After the discussion, Professor Jens and his assistant escorted us to the hospital hall. Berit and her husband were waiting there with Gurlin by their side. Dr. Mufeng stepped forward, took over the PET-CT CD and inserted it into the CD ROM drive of our laptop to view the outcome. Thank God there was no recurrence of cancer. Berit and her husband dragged us to take a group photo together. Ordinary people would find it hard to fully comprehend the feeling and emotion of a cancer patient, who against all odds, had lived for a year disease-free when her doctor pronounced earlier that she had only two to three months to live. Professor Jens and his assistant were very happy for Berit, too. Yes, the Chinese saying that doctors do have parental love for their patients is applicable to doctors worldwide.
Professor Jens said: “We will visit your hospital and hope that you will come again to have further exchange and research with us together. By that time, we hope that you will have ample time to admire the beauty of this city.”
We were pleased to undergo ‘tests’ in Denmark and are concerned with the long term results as well. On 4th June 2010 we received an email from Gurlin saying that she was well and fully prepared to come to our hospital for DC vaccine therapy.