There are some things that men avoid talking about because it is rather embarrassing, especially when it pertains to their private parts.
A man’s sense of identity is inextricably linked with his physical attributes.
That is why, perhaps, we are reluctant to face the truth.
PENIS HAD TO BE AMPUTATED
That was what happened to Mr Thang, a 56-year-old from Vietnam.
It all started with a wound on his foreskin which he thought was simply an infection.
By the time he saw a specialist, the cancer of the penis had already spread to the lymph nodes in the groin and along the blood vessels inside his abdomen.
He saw a doctor here who advised him to have his penis amputated.
For a man to lose his precious organ is no small matter.
Mr Thang struggled with the decision but finally agreed to it because there was so much pain and bleeding.
In any case, the penis was so badly damaged that it could no longer function as a sexual organ.
He also underwent chemotherapy and radiation therapy.
But the cancer returned in less than six months after he completed the treatment.
When he came to see me, together with his wife, he was in a wheelchair because of severe pain around his groin and along his back.
The positron emission tomography-computed tomography (PET-CT) scan confirmed that the cancer had recurred with spread to lymph nodes in the neck, chest and abdomen, as well as to the lungs and the bones.
By all accounts, we should be able to diagnose cancer of the penis at a fairly early stage.
Unlike other types of cancer that may occur within the body and not be visible to the patient, cancer of the penis is easily seen.
Symptoms of penile cancer include a redness or rash, an ulcer that does not heal, foul-smelling discharge, pain and bleeding.
However, patients and, sometimes, even doctors mistake this for an infection of the foreskin and penis that arises from poor personal hygiene.
When I saw Mr Thang, there was no consideration for further surgery or radiation therapy because the disease was widespread. He was offered palliative chemotherapy to which he readily agreed.
PAIN KEPT HIM AWAKE
He tolerated the chemotherapy quite well. He had no hair loss and minimal nausea and vomiting.
However, his pain did not go away; it was persistent and debilitating.
Despite the liberal use of several different classes of analgesia, including morphine solution, he kept complaining of intolerable pain.
Through the clinic’s Vietnamese interpreter, he would describe how he was tortured by the pain, which kept him awake at night.
Although I had initially planned to evaluate him after three cycles of chemotherapy, I decided to bring forward the PET-CT evaluation after the second cycle of treatment.
My suspicion that he was not responding to treatment proved to be true.
The repeat scan showed that the spread of cancer to the lungs had grown larger and more numerous, while there were new tumours in the liver, which were not evident in the pre-treatment scans.
It is never easy for any doctor to tell a cancer patient that the treatment had failed.
We often go into battle with the expectation that we would be able to kill the cancer cells, control the spread of the disease, preserve the patient’s quality of life and prolong his life.
When the outcome turns out to be the opposite of what we had hoped for, we often feel that we have failed the trust that the patient has placed in us.
AGAINST THE ODDS
That was exactly how I felt that day when I had to break the bad news.
On top of it, Mr Thang had spent a lot of money coming to Singapore every three weeks for treatment.
After showing him the scans and telling him that our treatment had failed, I asked if he would like to continue to be cared by a doctor in Vietnam.
The truth was that I had no confidence that further treatment would benefit him.
What surprised me was his response. Not only was he not upset with me, he asked me not to give up and encouraged me to come up with an alternative chemotherapy programme.
He said that he had faith in me.
His words touched me deeply and, not without some trepidation, I came up with another cocktail of chemotherapy drugs.
Three weeks later, Mr Thang walked into my room and he was beaming from ear to ear.
He looked very different from the last few visits – his hair had fallen off but what was also gone was his wheelchair.
Why one combination of drugs works better than another is difficult to explain.
And there is definitely an element of luck involved.
However it came about, I was gratified to see a man full of courage, even as he was physically ravaged and even when his own doctor had given up hope.
Long may he live to confound the odds.
Written by Dr Ang Peng Tiam