Monday, October 25, 2010

KANSER BUAH PINGGANG

A 40 year old man came with 'letih-letih' and not feeling well for the past one month. Ultrasound examination done by a general practitioner showed a tumour on the left kidney. CT-scan done revealed a large tumour arising from the upper pole of the left kidney.



This is one of his CT-scan films; it showed a large tumour involving the left kidney. This is most probably a Renal Cell Carcinoma (RCC) - kanser buah pinggang.


He was told of the diagnosis, treatment and the prognosis with and without treatment.
Prognosis tu maksudnya apa akan jadi dengannya selepas ini termasuk mati.



He was offered surgery; as the cancer is still resectable and most probably curable.
And the expected happened; the Kelantanese syndrome. He disappeared, I hope temporarily.

5 years ago, I operated on a 33 year old man with similar cancer; he survived. Now happily married and last week called me to inform me that he just got a baby girl.
This is the picture of his cancer.




The cancer was well-encapsulated, the capsule wasn't breached by the cancer. No chemotherapy was given.






And these are CT-scan picture of other patient with similar cancer on the right side (see how huge it is) and the picture of the removed specimen.












She waited for three months before agreeing to the surgery.

See, the cancer had breached the capsule, she was given chemotherapy. Two and a half years later, she came back with bone and brain secondaries (kanser merebak ke otak dan tulang) and died soon after.

Kadang-kadang, saya tak faham dengan orang kita. Bila doktor kata kanser, dia mungkin dengar risa; buang tak apa, tak buang pun tak apa.

In Kelantan, risa (pronounced reeso) is a benign tumour of the skin or subcutaneous structures; it could be a lipoma, sebaceous cyst, ganglion, etc.

Monday, October 18, 2010

SUDAH MUNTAH TAHI BARU NAK KOREK LUBANG..

Pepatah Melayu :

Sudah terantuk baru tengadah
Hendak terberak baru nak gali lubang.

Inilah yang jadi kalau susah sangat nak faham

A 59 year old man, had fecal incontinence (tak boleh kontrol berak) two years ago. He went to a private hospital, told to have cancer of the rectum (usus besar dekat dubur) and adviced surgery. Refused, went to HUSM and told the same thing. Tak puas hati, went to Kota Bharu Hospital (HRPZII). Tak mahu faham juga.

He has cancer of the rectum, very close to the anus resulting in fecal incontinence (meaning the cancer has already involved the sphincter muscles). The surgery to the remove the cancer would also remove the sphincters. thus he would need a permanent colostomy.

Sebabkan tak mahukan colostomy, langsung tak mahu rawatan. Obviously, Tok Bomoh kata kolostomi tak perlu.

Two years sengsara pakai diapers. Now the cancer has totally oblitrated the rectum causing intestinal obstruction. Apa lagi, perut jadi kembung, tak boleh berak. Makanan masuk ikut mulut, tahi pun keluar ikut jalan yang sama.




Gambar X-ray usus besar kembung tiga kali ganda










Terpaksalah buat emergency operation. Sekarang bukannya nak buang kanser yang telah merebak (inoperable), tapi nak selamatkan nyawa, supaya boleh makan.


Grossly distended large intestine.




Akhirnya kena buat juga kolostomi juga. Now dah selamat; dah boleh makan dan berak melalui kolostomi.
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Tapi kansernya tetap di situ.
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AlhamdulilLah sekarang baru nak kemoterapi dan radioterapi. Tapi apakan daya !!!
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Inilah cerita 'oghe kelate' ku.......

BARAH PAYU-JANTAN

KOTA BARU: Three cases of breast cancer involving men were reported at Hospital Universiti Sains Malaysia (HUSM) in Kubang Kerian, here last year with one patient succumbing to the disease.
Coordinator of HUSM's breast cancer information centre, Dr Nik Munirah Nik Mahdi, said according to the last national cancer registry in 2006, six men in Kelantan had died of breast cancer."Breast cancer is seen more as a disease that affects women but it is not necessarily so. That is why it is important for people from both sexes to be well informed about it," she said after the launch of the information centre's blog and a workshop on women's health yesterday by the chairman of USM board of directors, Prof Emeritus Datuk Dr M. Zawawi Ismail. Read more: 6 Kelantan men die of breast cancer http://www.nst.com.my/nst/articles/20brest/Article#ixzz12kjXZy27

Jadi jangan sangka barah payudara (breast cancer) hanya terkena pada wanita, yang jantan juga boleh kena. Unfortunately breast cancer in men tends to be more aggressive. I have seen a man with breast cancer presented with brain secondaries. Maksudnya datang dengan tanda-tanda barah otak, setelah disiasat didapati puncanya adalah barah payudara (dalam kes ini payu-jantan).
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Jadi abang-abang tu jangan asyik nak buat BSE (breast self examination) pada isterinya saje, sendiri juga mesti rasa .......

Monday, October 11, 2010

PRK DUN GALAS

Lunch time: I was joined by a radiographer (juru-Xray) asking me 'kenapa dah lama tak update blog doktor?' Tiba-tiba saya teringat.... dah lama tak buka blog ni ! mungkin sibuk dengan 'kegilaan' baru di facebook. So I said; OK saya pergi update sekarang jugak.
Just before the lunch hour, I was in the A & E Department; attending to a patient presented with cough and breathlessness. She was a 35 year old teacher, has been coughing since 2 months ago, went to Kuala Krai hospital yesterday and claimed the doctor there refused to give her any medication. When I came closer to her bed, I smelled something familiar; 'bila lagi dah ada penyakit ini?' 'Baru 2 bulan batuk-batuk ni'. 'Bukan batuk, your breast cancer?' 'Mana doktor tahu saya ada kanser?' ' I can smell it !
Reluctantly she exposed her self; and there you were... large left breast cancer with involvement of the contralateral breast. Jarang jumpa ni, kanser payudara kiri dan kanan serentak. I examined the lungs, and I told her that most probably the cancer has infiltrated her lungs as well. Suprisingly she suggested; mungkin infection doktor, TB ke.. beri saya ubat antibiotik je!
Unbelievable.... inilah sikap orang kita (oghe kelate kito) the big C is nothing. So, to made her understand the serious situation she is in, I told her ; Kalaulah cikgu ni Tok Wakil, selepas PRK Galas ni, kita pergi mengundi kawasan DUN awak pulak ........
Saya harap dia faham, her days are numbered !!