Sunday, June 15, 2008

CANCER TREATMENT; ADJUVANT THERAPY
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.


Tuesday, June 3, 2008

KAMU BOLEH TUNGGU, TUNGGU DIA MATI.

Semalam, dalam HARIAN METRO terdapat satu berita yang memapar kekecewaan sebuah keluarga yang kehilangan seorang anggota keluarga mereka. Yang mereka kesalkan adalah sikap doktor yang merawat anak mereka, bersikap sombong dan biadap, sehingga sanggup mengeluarkan kata-kata 'Kamu boleh tunggu, tunggu dia mati" Mulanya saya rasakan ini biasalah bagi seorang yang baru ditimpa musibah (grief reaction). Apatah lagi dalam kesibukannya doktor itu gagal memberi penerangan yang memuaskan. Di petang hari yang sama seorang lelaki datang ke pejabat saya, bertanyakan sanggupkan saya merawat anaknya yang mengalami perdarahan di otak selepas satu kemalangan jalan raya. Anaknya masa itu sedang dirawat di unit Neurosurgeri hospital yang sama; beliau takut anaknya itu 'diapa-apakan' oleh seorang doktor di situ yang dikatanya sangat sombong dan tidak bertimbang-rasa. Saya jelaskan kepadanya bahawa pembedahan otak bukanlah kepakaran saya, dan saya nasihatkan beliau untuk selesaikan perkara itu dengan pehak bertanggungjawab di hospital tersebut.
Wow, mungkinkah ini satu sebabnya pesakit datang lewat mendapatkan rawatan seperti yang saya 'highlight'kan sebelum ini. Sikap doktor-doktor yang dikatakan sombong dan kurang bertimbangrasa. Sedangkan rata-rata tok bomoh dan singseh bermulut manis memukau. Bomoh patah mengurut tulang penuh sopan dan mesra sedangkan doktor otopedik menarik tulang sambil menyumpah seranah (pesakit mungkin sedar walau pun diberi sedation).
Petang tadi seorang pesakit datang kepada saya memohon penjelasan tentang penyakitnya. Beliau ada satu ketumbuhan kecil dipayudaranya, telah dibiopsi di hospital (yang sama di atas) dan tak faham penjelasan doktor yang merawat beliau. Lapurannya (biopsy report) tiada dibawanya. Saya terangkan kepada beliau, yang saya tidak dapat membantu, lainlah kalau ada lapuran itu ataupun beliau dapat sebutkan nama doktor berkenaan. Bolehlah saya 'hello'kan kepadanya dan tanyakan perkara tersebut. Inilah masaalahnya, sukar sangatkah untuk memberi penjelasan. Kalau pesakit tak faham istilah perubatan, buatlah analogi dengan barang, tumbuhan sekeliling agar mereka mudah faham. Kalau bahasa yang menghalang carilah seorang penterjemah. Hendak seribu daya, tak mahu seribu dalih!
Fikir-fikirkanlah .....................
Senyumlah wahai doktor-doktor ! It makes a lot of difference.