This book is the result of the notes I wrote in my spare time after work. When I was about to finish writing this book, I was invited to an ingenious seminar on the subject: Don’t let treatment add insult to injury” by the Sin Chew Daily, the Malaysian Chinese newspaper with the largest circulation. It provoked additional thoughts and feelings before I ended this book.
The seminar was held on 8th May 2010 at the auditorium of the Sin Chew Daily. Dr. Niu Lizhi, a cryoablation specialist, Dr. Park Sang-ho, a nano-intervention specialist and Dr. David Chiu, an immunotherapy specialist and I were speakers at the seminar. Zeng Yulin, the deputy chief editor said, “It is disastrous to have cancer. But if the treatment is not right, it will add insult to injury!”
The Sin Chew Daily has the largest readership in Malaysia. To be invited by their chief editor to speak in the seminar at their auditorium was indeed a great honour, an affirmation and trust. Our hospital and Sin Chew Daily established a mutual relationship of trust since seven years ago. At that time, Mdm. Hon, their general manager, had recurrence of thymic carcinoma; she came to our hospital for treatment and had been well ever since. A year ago she died due to dengue fever. For the past few years, we had been invited twice by the newspaper to talk on new advancement in cancer treatment. This seminar was held after the conclusion of their special column titled “Fear Cancer Not” in the newspaper after duration of half a year. More importantly, this seminar differed from other common topics in that it was most relevant and of greater practicality to cancer patients.
There were a few hundred listeners. Most of them were themselves cancer patients or family members of cancer patients. I spoke on “Adding insult to injury” and counter measures to take: 3C’s treatment Model. Dr. Niu spoke on the first C: Cryosurgical ablation (CSA), Dr. Park Sang-ho spoke on the second C: “Non-invasive Cancer Micro-vascular Intervention” (CMI) and Dr. David Chiu spoke on the third C: Combined Immunotherapy for Cancer,CIC.
From the stories I related in earlier parts of this book, the readers should be able to understand what is meant by the phase “adding insult to injury”. It is said that 1/3 of cancer patients die of fear, another 1/3 die of starvation while the remaining 1/3 die of treatment. While this saying may sound biased, it does reflect the shortcomings and sorrows of current cancer treatment and it can be concluded that improper treatment will result in adding insult to injury. I could feel and notice cases of adding insult to injury when I gave consultations to some patients the day following the seminar.
-A tall and fat young man aged 22, came to see me. He was accompanied by his mother and girl friend. He staggered and looked sluggish. I found out from his CT that he had pancreatic lesions with three tumors the size of 2-5cm. His blood report showed that his blood glucose was 40-55 mg/l. He had good appetite and needed frequent food intake without which he would faint. I asked for their medical history and learned that the mother had a mass in her upper abdomen for the past 7-8 years. Doctors told them that both of them could not be healed. They were scared to death and wanted to give up and let fate take its course.
-A 27 years old thin woman with a feeding tube passing through her nasal passage. There were three nodular masses at her neck. She had tongue cancer and half of her tongue was surgically removed half a year ago. After surgery, she was given more than ten courses of chemotherapy and score of times radiotherapy. However, a new growth emerged at the base of the tongue blocking her esophagus. She did not have oral food intake for more than a month solely relying on nutrient intake through tube feeding. Her husband worried that she might die of starvation.
-A young man about 30 years old came for consultation accompanied by his parents and wife. He was diagnosed with pancreatic cancer three months ago. He went aboard for surgery but the doctor failed to remove the tumor, and only biliary-enteric bypass was done. He was given 6 courses of chemotherapy after the operation. However, the tumor grew by 2cm with liver metastasis. Doctor was considering switching to another type of chemotherapeutic drug. He lost 15 kg after chemotherapy, had poor appetite and lost all his hair. He was worried that he would die of too much chemotherapy.
For the first case, it could be insulinoma, a type of familial endocrine cancer. It is 90% benign and could be removed surgically. Even if it could not be removed surgically, it could be removed by cryoablation.
For the second patient, conventional cancer treatment will not work. New therapies such as micro-vascular intervention therapy and photodynamic therapy would help to improve patient’s condition and more extensive nutritional support has to be provided.
The third patient felt he could die of too much chemotherapy and he was correct. According to three papers presented in ASCO General Assembly 2008, USA, there was no evidence that chemotherapy could prolong the lives of patients with metastatic pancreatic cancer. Our data show that cryoablation therapy and immunotherapy can be beneficial to patients’ survival.
Just from three cases stated above, we are very much distressed that in the treatment of cancer, doctors have to face great challenges and bear great responsibilities. They include techniques, humanities as well as social factors. We have to make a good choice for their first treatment as well as to plan out follow-up treatment after the first treatment so as not to add insult to injury.
“Adding insult to injury” is a term used in Malaysia. In China, it is “the second suffering” or “the second penalty”. In English it is “secondary injury”. The key to avoid adding insult to injury is to choose the correct therapy for the first treatment. I remember that a few years ago, there was an American patient with pelvic sarcoma which was unresectable. He was given chemotherapy and radiotherapy. These were not only ineffective but also caused severe side effects. Finally, he came with his personal doctor, an oncologist to get treatment in our hospital with cryoablation as the main therapy. He complained, “Knowing that chemotherapy and radiotherapy would not work on me, why did they apply them and make me suffer from it time and time again?”There was another patient from Kenya who had bile duct cancer. He underwent surgery but there was cancer recurrence. He was given chemotherapy and his condition worsened. He came to our hospital and underwent common bile duct cannulation and photodynamic therapy. He lamented, “Cancer treatment is very painful and most of the pains come from the doctors who make us undergo second suffering.”
I recall another patient by the name of Huang Zipu, an eighty years old engineer. He lived at Jiangmen in Guangdong. Sometime in July 2004, he had upper abdominal discomfort cum frequent bowel movement. His wife brought him to a local hospital for examinations. A lump was discovered in his pancreas. His wife who was a nurse knew it was a waste to undergo surgery as it was not possible to surgically remove pancreatic tumours. Chemotherapy could be applied but she had never seen any case of a pancreatic patient being healed by chemotherapy. “Why should my husband undergo a second suffering!” she asked herself. The following day, she brought her husband to our hospital and requested for percutaneous cryoablation. We examined Huang and found that he had uncinate process of pancreas cancer; the tumour was 3.5cm in size.
There was invasion of the surrounding blood vessels and lympn nodes; surgical resection was not possible. Ultrasound-guided biopsy was done and adenocarcinoma was confirmed. He underwent cryoablation and was discharged half a month later. In 2008, another patient from Jiangmen was admitted into our hospital. He said that he was recommended by Huang Zipu. I was shocked that after a lapse of four years, Huang, a pancreatic cancer patient, was still alive? I drove to Huang’s house. He was 84 years old by now. He told me that everything was alright except for his right leg which was injured a few days ago still hurt when he walked. When I asked him whether he received any treatment after his discharge, his wife said with a simile, “He eats what I cook everyday.” Taking a deep breath, the wife said, “I was glad for the decision that day to send him to your hospital. Otherwise, he would have to follow the routine procedures to undergo exploratory surgery and he would have to endure many more “second sufferings” and “secondary injuries”
Now I have come to the end of this book. In this book, I do not recommend any specific therapy. This book tells the experiences that my colleagues and I have gone through. I do not ask others to concur with the views and opinions I have put forward in the book. I only want to tell nothing but the truth. I would be very glad if cancer patients can get some inspiration or references in their choice of treatment.
May 12th, 2010 in Kuala Lumpur
Revised 5th July, 2010 in Bangkok