Contrary to popular belief, patients who are found to have the advanced stages of cancer at the time of diagnosis are not necessarily elderly, uneducated or have a low income.

Sometimes, you just don’t know why you are not feeling well and the symptoms may be too vague to pinpoint the disease.

Headaches, tiredness, weight loss, weight gain, aches and pains – are they just signs of stress, normal ageing or cancer?

Madam Chua said: ‘My bones have been aching and painful for some months. But I always thought that this was part and parcel of the ageing process.’

As it turned out, she had stage four breast cancer.

The 50-year-old banker had stopped work some time ago.

She was well-dressed and conversed eloquently in English.

On each of her clinic visits, she was always accompanied by her husband, who was clearly concerned and cared very much for her.

Her bones started aching for almost a year prior to her seeing me.

She had consulted several doctors, who have been prescribing anti-inflammatory drugs to ease the pain and discomfort.

She had also been to a physiotherapist who taught her stretching exercises. She exercised regularly in the gym to keep fit.

Then she started feeling bloated and lost her appetite.

She read an article that said these symptoms suggested something could be wrong with her ovaries, stomach or colon.

So she saw her gynaecologist for a routine check-up.

He detected a lump in her left breast and immediately referred her to a general surgeon.

The surgeon carried out a biopsy (a procedure to remove tissue for testing) of the breast lump and arranged for her to have a series of investigations to determine if the cancer had spread.

A positron emission tomography (PET) scan showed that the cancer had spread to the bones, the lymph nodes and almost replaced her entire liver.

The abdomen was swollen because of the large liver mass and water.

Most patients with breast cancer are diagnosed reasonably early, that is, before there is evidence of the spread of cancer to other parts of the body.

In these patients, surgery to remove the whole breast (total mastectomy) or part of the breast where the cancer is sited (partial mastectomy) is often needed.

However, in the case of Madam Chua, although the tumour in the breast was quite small, there was evidence that the cancer had spread to many parts of her body.

So surgery would not be helpful for her.

It is puzzling why some cancer patients have big tumours which are relatively contained within the affected organ, while others who have relatively small tumours may have cancer cells that have escaped beyond the affected organ to other areas.

This could be due partly to the biological behaviour of the cancer.

Some cancer cells tend to be more aggressive and have a higher propensity to spread.

The grade of Madam Chua’s breast cancer was scored three out of three – which means it is highly aggressive.

The grade of a cancer is different from the stage of a cancer.

Simplistically, the grade of the cancer refers to the appearance of the cancer cell.

The more similar the cancer cell is to the normal cell of that body part, the lower the grade will be.

Conversely, the more distorted and strange-looking the cell is, the higher the grade of the cancer cell will be.

As a general rule, the higher the grade of the cancer cells, the more aggressive the cancer will be.

This may partly explain why Madam Chua’s cancer was diagnosed at such a late stage.

Even worse, her breast cancer cells contain a cancer gene called HER-2 (also called c-erbB2).

This gene is associated with the cell being more aggressive.

The good news is that there is an antibody called Herceptin (trastuzumab), which is extremely effective in treating HER-2 positive breast cancer.

This targeted agent, like several others for other types of cancer, has made the job of medical oncologists so much easier.

Madam Chua’s cancer responded marvellously, as expected, to a cocktail of chemotherapy drugs and Herceptin.

A PET scan done on her after four cycles of chemotherapy showed that the cancer in most of the diseased sites had reduced significantly or resolved completely.

Early detection is best but even when diagnosis has been made at a late stage, medical treatment can make a difference.

I would not recommend that we live life under a cloud of fear that this or that minor symptom is a signal of cancer.

What we need to do is to pay attention to our bodies and add a strong dose of common sense.

For Madam Chua, a combination of alertness and general medical knowledge, as well as discipline in going for check-ups, led to this relatively successful outcome.

This article first appeared in “Mind Your Body”, a Straits Times Supplement.



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