Sunday, June 15, 2008

Most solid cancers are treated surgically. Cancers such as breast and colon cancers require surgery as the mainstay of their treatment. However, for advanced diseases, other modes of treatment are required to eradicate 'left-over' cancer tissues or cancer cells that have spread to distant organs (metastasis). These treatments are called adjuvant therapies; examples are chemotherapy, radiotherapy, hormonal and etc. So if a patient presents with advanced disease, beside surgery, he or she would requires other form of adjuvant therapies to treat the cancer.
For example, patients with cancer of the rectum (the lower end of the colon) would need surgery to remove the segment that contains the cancer (see pictures below). The removed specimen would then subjected to a thorough examination by a pathologist to determine the aggresiveness (grading) and how advance (staging) the cancer is. The managing surgeon or the oncologist would then decides on whether the patient requires some form of adjuvant therapies or not.
Low rectal cancer removed in a surgery called abdomino-perineal excision
The specimen opened to show the cancer within it
What I want to highlight today is that many patients do not understant the importance of adjuvant therapy after having had their surgery. Today a patient whom I operated two weeks ago for 'stage 3' rectal cancer (Duke C - staging) refused chemotherapy. She is a nurse and she said "I have seen enough patients who suffers the side effects of chemotherapy.." What could I do? When I was a medical student, there was a patient with a lymphoma (cancer of the lymphatic system); the only curable cancer at that time (1984), when told that he requires chemotherapy, said 'cukuplah ..! Now almost 25 years down the line, the attitude is still the same. The problem is; when they are very sick and the cancers are very advance involving all over their body, they come back asking for all sort of things. Last month, a man requested me to insert a chemo-port (a special catheter for administeration of chemo-drugs). He had advanced renal cancer, had refused treatment earlier, and now in acute renal failure. In that condition nobody is going to give him the chemo ! He died a week later.
Bak kata pepatah....Bila sudah terantuk, baru terngadah.

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