Tuesday, November 18, 2008

3 in 1
Three cancers in one patient

Last year, a woman came to me with progressive jaundice (deepening yellowish discoloration of the skin). Initial investigations showed that it was an obstructive jaundice; meaning, the bile flow was obstructed resulting in bile seeping into the skin and sclera. In this lady, the obstruction was caused by a cancer in the head of pancreas, as shown in the CT-scan picture below.

However, she was also noted to have a fungating
tumour in her left breast. (picture below)

Biopsy (core-needle biopsy) showed that it was an infiltrating ductal carcinoma; meaning this was a confirmed breast cancer.

The CT-scan film showing the primary cancer of the left breast

Further examination also revealed a tumour in her right thyroid lobe.

Biopsy (Fine needle aspiration cytology - FNAC) showed that it was a follicular lesion.

A follicular thyroid swelling can be either benign or cancerous, but looking at the tumour clinically and on CT-scan, I was almost certain that it was a follicular cancer.

She underwent a surgery for the breast cancer (left mastectomy with axillary clearance ), a palliative by-pass of the pancreatic head cancer (gastro-jejunostomy, hepatico-jejunostomy - biopsy confirmed adenocarcinoma of the pancreas)

So, what am I trying to say ?

I am saying that this lady had three (3) primary cancers. This is extremely rare (I am waiting for my report to be published in a peer journal). But this is not my point to you. What I want to highlight here is how 'fantastic' our patient can be. Should she presented much earlier, she could have been saved. She succumbed to her diseases not long after the surgery.

By the way, it was reported in most news today, that the country is in need of more oncologists (cancer specialists) - "We need more than 200 oncologists but the country has only 39" - say the Health Minister. But with this attitude of not seeking treatment until it is too late, I dont see the urgency. The ministry of health has to come out with a policy / campaign / or what so ever to get cancer patients to the hospital, and to do so early !

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