It’s never easy to tell someone that he or she has an incurable cancer, and especially if the patient is seeing you for the first time. However, that’s the unenviable task that I’m faced with almost every day.
Madam Hor, a 53 year old Chinese lady, saw me a few days ago. She had complained of having blocked nose and blocked ears for about six months. When she finally saw an ENT (ear, nose and throat) specialist, he found a cancerous growth in her nasopharynx.
She was referred to a radiation oncologist for consideration of radiotherapy. A PET-CT scan was done. Besides showing a fairly sizeable tumour in the nasopharynx which had invaded into the base of the skull, there was already spread to the lymph nodes in the neck, chest and abdomen.
She was then referred to see me. After all, the cancer had already metastasized and radiation therapy by itself would not be beneficial to her.
She came to see me, accompanied by her husband. Needless to say, they were both shocked when I explained that she had Stage 4 cancer and that her cancer could not be cured.
However, I made it a point to emphasize that metastatic nasopharyngeal cancer (NPC) was a very chemo-sensitive disease and that with treatment and re-treatment, patients could sometimes live on for a long time.
Left with little choice, she started chemotherapy the same day I saw her.
As I reflected on the case later that evening, I wondered whether it was fair for me to say that there was no cure for Stage 4 metastatic NPC.
Complete remission is defined as complete disappearance of all measureable disease and recovery from all the symptoms associated with the cancer. Cure is often declared when a patient has remained in complete remission for five years.
Without effort, I can easily recall three patients with metastatic NPC who have done remarkably well and have “beaten the odds”.
There is Madam Ang, a lady from Penang, who was first diagnosed to have NPC in 2001. She was confirmed to have metastatic NPC less than a year later.
When her oncologist first told her that her NPC had recurred in the bones and that the average survival was between 18-months to 2 years, she was petrified.
She pleaded with her husband to find her another doctor and that was how she ended up seeing me in 2002. After a long course of “palliative chemotherapy”, she went in remission. We expected her cancer to recur but it has been more than 10 years and all is well.
I spoke to her daughter and found out that she turned 70 last year.
The second, Mr. Ang, was a 29 year old major in the army who completed his combined chemotherapy and radiation in April 1999. He developed bone metastases in November 1999. He was treated with “palliative chemotherapy” and went into complete remission in March 2000.
He had another three recurrences – in December 2001, in July 2002 and again in February 2003, affecting the bones and abdominal lymph nodes. Each time, he responded favorably to the “palliative chemotherapy” and achieved complete remissions. His last session of chemotherapy was in June 2003.
He has remained cancer-free since.
The third, Mr Lim, was a 38 year old interior decorator-cum-contractor, who was first diagnosed to have NPC in December 2009. He was treated with chemo-radiation and completed treatment in February 2010.
He was diagnosed to have Stage 4 NPC with metastases to the liver in May 2010. He was treated with “palliative chemotherapy” and by July 2010, the repeat PET-CT scan showed the disease was gone. He just had a PET-CT scan done in January 2015 and he remains in remission.
The question asked is why did these three patients do better than we predicted?
The medical literature suggests that metastatic NPC is not curable. Yet, the first two have remained in “sustained remission” for well over five years and qualify to be considered cured of their illness.
When I spoke to the three of them, there were several common factors.
The first was their “never-say-die” attitude. They had a positive attitude towards treatment and believed that the treatment would heal them. I recall how Madam Ang wanted to start treatment as soon as possible and was determined to stay alive. She joked that she had to continue living to make sure that her husband would not have a chance to marry a second wife.
All three patients talked of how they learnt to “let go” and adopt a less stressful life-style. They all believed that their cancer relapse had something to do working too hard and being stressed.
Another common factor amongst the three is the strong support from their family and friends. Mr Lim spoke of the constant support from his wife, the family and his friends. I cannot recall a single visit when his wife did not come along with him.
All three were believers in a higher being. Two spoke of the healing power of God and how they live transformed lives. One visited temples, churches and mosques and made offerings to all deities.
Of course, no one can be sure exactly why these three have beaten the odds. However, they are living proof of why we must never give up on patients with “incurable” cancer.
Dr Ang Peng Tiam