SK came to see us on10 August 2012. This 64-old, Indonesian lady looked frail and timid and did not seem to know what was going on. Her abdomen was distended like a pregnant lady. She handed us her CT scan report (dated 9 August 2012).
- There is left pelvic mass, measuring 5.3 x 3.6 x 3.6 cm, in keeping with dermoid cyst.
- There are multilobulated soft tissue lesions in the pelvis – the largest measures 4 x 2.7 cm.
- There are multiple peritoneal nodules.
- Impression: Likely ovarian carcinoma with moderate ascities, associated with peritoneal, omental and mesenteric metastases.
The gynaecologist suggested surgery and this costs RM 16,000. SK came to seek our advice. We told SK to go ahead with the surgery. There is NO way the herbs can help her with such an advanced stage cancer. The tumours have to be removed first, then she can come and take the herbs.
On 24 August 2012, SK came back to see us again, accompanied by her daughter. SK had undergone a surgery – TAHBSO (Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy ) with omentectomy + appendectomy. She was hospitalised for five days. She had the surgery at another hospital where the cost of the operation was only RM 12,800.
SK felt better after the surgery. It was a Stage 3B cancer.
SK was asked to return to the hospital on 25 September 2012 for chemotherapy. She and her daughter consulted an oncologist and below is an account of what happened during their meeting.
Chris: What did the doctor want you to do after the operation?
Daughter: Must do chemo – six times. I asked the oncologist if this can kill all the cancer cells in the body. He replied very confidently – Definitely, 99 percent of the cancer cells will be gone.
C: He said 99 percent will be gone? You asked him that? And this is his answer? Did he really understand your questions?
D: Yes, he understood me. I asked him if chemotherapy is the only best option for my mother. He said: Chemo is the only option – there is no other way.
C: You asked him in Bahasa Indonesia or in English?
D: In English – the cancer cells will be gone? Will it be 100 percent gone? He said: 99 percent gone.
C: Meaning, 99 percent can cure?
C: How many times did you ask him this question?
D: Two times. He was so sure about what he said. He said: Yes, you do six times of chemo, 99 percent of the cancer will be gone.
C: When you asked him this question – did he get angry?
D: No, not angry.
C: For six chemos, how much do you have to pay?
D: RM 3,000 each time. I also asked him if the treatment is going to be painful. He said: No, not painful at all.
C: Oh, chemo is not going to be painful? That is going to be good!
D: But he also said there will always be some side effects. There will be loss of hair and nausea. Then mama asked the doctor: Will I be strong enough to withstand the chemo treatment? The oncologist said: Sure, you are strong enough for the treatment.
C: How long did you talk to the oncologist?
D: About 15 to 20 minutes. And he said: Go back home and eat whatever you want – KFC, McDonald and anything.
C: Oh, you can eat KFC, McDonald and also anything?
C: What else did he tell you?
D: Cannot take herbs while on chemo. You cannot mix – chemo and herbs. Only after completing six times chemo, then we can take herbs if we want to.
C: How much did you pay for talking to him?
D: RM 100.
C: After he said chemo will give you a 99 percent cure and then you can eat anything you like when you go home, do you believe him or not?
D: I really want to believe him!
C: Go home and think carefully what you want to do now. Did you mother understand what you and your doctor were saying?
(Daughter broke down and cried)
C: Don’t worry. I understand. It is a difficult situation. Everyone who come here are really lost. Don’t worry. It is okay to cry. What is important is that after the surgery your mother feels better now. The doctor asked you to do chemotherapy – do you want to do that? It is difficult for me to say what you should do – to go for chemo or not to go for chemo.
But what the doctor told you – to eat what you like when you go home – that is not right. My advice is – Don’t eat anything that walks or has legs! Also avoid oil and sugar. Please listen to my advice. Again, other than that, whether you want to do chemo or not, I cannot say anything.
The doctor said you can’t take herbs while on chemo – that is also not true. Many of my patients take herbs while they are on chemotherapy. They came out better – they felt better. But I am not going to ask you to believe me. If you believe your doctor, go ahead and believe him.
Have you read or really understand what chemotherapy is?
D: I have heard about it from other people. I saw people going for six times of chemo and they never come back (die).
C: Honestly, tell me – when the oncologist said there is a 99 percent cure after the chemo – do you really believe him?
D: (shaking her head) No.
CA Care Therapy
C: Ibu (mom), when you go home please take care of your diet. Take time and go for exercise. Don’t just stay home and think too much about your problem. That will not be good for you. Try to be happy always. You are a Christian? Pray to God for help and guidance. God knows that you are sick. Pray that you have the strength to overcome this.
You may want read a related story: Cervical Cancer: Eighty-nine Percent Chance of Cure Vanished With the Collapse of Her Right Lung Four Months After Radiotherapy and Chemotherapy This patient underwent radiotherapy and chemotherapy. She was told that there was a 89 percent chance that she would be cured. However, barely four months later the cancer recurred.
Let me ask you this question: Should patient be told the truth? Some people would say yes, some people would say no. So, you decide for yourself the acceptable level of truth that you want. Then, let me ask another question: How much truth can you expect from your doctor? Let me ask you to reflect on the following quotations:
In the case of SK above, her daughter wanted very much to believe what the oncologist them – after six cycles of chemo 99 percent of the cancer will be gone! But will it come back again soon? That is not told! Anyway, the patient and her daughter did not have the peace of mind to believe what they heard. Otherwise they would not have come and sought our help. At this point let me quote what Dr. Walker wrote about his own experience:
Side effects of Treatment
Some patients suffer seriously from the side effects, others don’t. I wonder if it is all about luck (and not science)? Retired US Air Force Colonel, Thompson wrote:
Read what Rose Kushner said:
Cancer Patients – Eat anything you like! At CA Care we say this is not right! We are not alone in this. Read what some outstanding doctors in the US said about the importance of diet and cancer.
What You Need to Know About Ovarian Cancer
The information and data below are obtained from the internet and oncology text books:
- Around the world, more than 200,000 women are estimated to develop ovarian cancer every year and about 100,000 die from the disease.
- According to the National Cancer Registry, ovarian cancer is the fourth most common cancer among women in Peninsular Malaysia, making up five per cent of all female cancer cases.
- Epithelial tumors represent the most common histology (90%) of ovarian tumors. This type of cancer often spreads on the peritoneal surfaces – e.g., undersurface of the diaphragms, paracolic gutters, bladder, surface of the liver, mesentery and serosa of the large and small bowel, omentum, uterus, and para-aortic and pelvic lymph nodes.
- Most ovarian cases are diagnosed in an advanced stage and their prognosis is closely related to the stage at diagnosis. Overall, prognosis for advanced-stage patients remains poor. Overall 5-year survival of ovarian cancer is 45 percent. In the case of SK, who has Stage 3B, the 5-year survival is about 29 percent (Table below).
- As I have always told patients – we don’t have to believe this statistics but we also don’t want to bury our heads in the sand and pretend that everything will be okay. We need to know the reality and then try hard to beat the odds.
Source: DiSaia, P.J & W.T. Creasman. Clinical Gynecologic Oncology, pg. 298, Mosby.
- Currently, the standard treatment for stage 3 ovarian cancer consists of both surgery (surgical debulking) and chemotherapy.
- Unfortunately, less than 40% of patients experience long-term survival following standard treatment.
- Approximately 60-80% of patients with stage 3 cancer will experience a recurrence of their cancer, even after complete surgical removal of cancer.
- Nearly all patients with stage 3 disease have small amounts of undetectable cancer that have spread outside the ovary and were not removed by surgery. These cancer cells cannot be detected with any of the currently available tests and are referred to as micrometastases. The presence of micrometastases causes cancer recurrence.
Chemotherapy for Stage 3 Ovarian Cancer
- The chemotherapy drugs used to treat ovarian cancer are fairly standard. Typically doctors combine a platinum-based drug such as carboplatin or cisplatin with a taxane such as paclitaxel (Taxol) or docetaxel (Taxotere).
Perez, C.P. et. al, (in Clinical Oncology, 8th Edition, Health Science Asia, pg. 489) wrote: The combination of paclitaxel plus a platinum compound is considered by most to be the first-line adjuvant chemotherapeutic regimen in patients with advanced ovarian cancer. The pathologic complete response is only 20 to 26 percent (Table below).
Source: Thigpen, J.T. (in Clinical Oncology Pt.2, 2nd Ed., Harcourt Asia, pg. 2026)
- Ovarian cancers are very sensitive to chemotherapy and often respond well initially. Unfortunately, in most cases, ovarian cancer recurs.
- Fewer than 20% of patients treated with a platinum compound and paclitaxel survive without evidence of cancer recurrence 5 years following treatment.
- Unfortunately, even in patients who respond, the disease eventually becomes resistant to the first-line drugs, and the cancer returns. Some ovarian tumors are resistant to platinum drugs. Once cancer recurs or continues to progress, the patient may be treated with more chemotherapy.
- Despite the development of several new chemotherapy drugs over the past few years, there is no substantial evidence that any of the treatments have increased the number of women cured of ovarian cancer.
- Gemcitabine (Gemzar) is also used in combination with carboplatin for women with advanced ovarian cancer that has relapsed. Other drugs include doxorubicin (Adriamycin, Doxil), etoposide (Vepesid), and vinorelbine (Navelbine).
Side Effects of Chemotherapy
- Chemotherapy can cause side effects during and after treatment. The type and severity of these side effects depends upon which chemotherapy drugs are used and how they are administered.
- The most common side effects are nausea, vomiting, mouth soreness, temporary lowering of the blood counts, and hair loss.
Surveillance After Treatment
- At the end of treatment (both surgery and chemotherapy), a patient is considered to have a “complete response” if her physical examination is normal; there is no evidence of cancer on imaging studies (such as a CT scan); and the blood level of the tumor marker like CA-125 is normal.
- However, even when all of these criteria are met, microscopic amounts of residual cancer (i.e., not visible on imaging studies) can still be present. Growth of these microscopic tumor cells is probably responsible for tumor recurrence at a later date.
- To monitor for the possibility of recurrence, blood tests, physical examinations, and imaging tests are to be done.
Signs of Recurrence
- The likelihood of a tumor recurrence is highest in women with more advanced-stage disease at diagnosis, particularly if the initial debulking surgery was unable to remove all visible tumor.
- The earliest evidence of recurrent ovarian cancer can be indicated by a rising blood level of one of the tumor markers (CA-125) and symptoms such as abdominal pain or bloating with or without back pain, or presence of pelvic mass.
What Can I Expect After Chemotherapy Treatment?
- Surgery plus chemotherapy drugs can get rid of ovarian cancer, but often they can’t keep it away forever.
- Surgery and chemotherapy are usually effective in treating the cancer so it will go away for a while, but in most cases the cancer ends up coming back.
- Often, the cancer will return within one to two years after treatment is finished. If the cancer does return, another round of chemotherapy is necessary.
Some Cases of Ovarian Cancer at CA Care
Over the past two years, some patients came to CA Care for help after medical treatments have failed them. Unfortunately, we did not get to see most of these patients after one or two visits. We are not sure what had happened to them. The cases below will portray the reality of ovarian cancer. Compare the facts of these cases with the readily available information found in the internet above.
Case 1: H297 was a 66-year-old female. She was diagnosed with ovarian cancer, Stage 1C. She underwent an operation followed by six cycles of chemotherapy. Three months later, the cancer spread to her liver. She was asked to undergo more chemo. She refused.
Case 2: H256, 34-year-old lady, had pains associated with lower abdominal mass in December 2008. She had bilateral ovarian tumours. Her left ovarian tumour invaded the sigmoid colon. There were extensive small nodules all over the peritoneal cavity. The undersurface of diaphragm was also extensively involved by the tumour nodules. She underwent TAHBSO, omentectomy, appendictomy and resection of the sigmoid colon. All significant sized tumour nodules were debulked.
She received six cycles of chemo – carboplatin + paclitaxel. And this completed in June 2009. A repeat CT scan did not show any evidence of recurrent or residual tumour. Her CA 125 which was in the range of 11,000 pre-op normalised after three cycles of chemo and remained below 10 after that.
However, six months later, December 2009, she had severe pains and was hospitalised. There were tumour nodules in her pelvis and she had extensive recurrence of her cancer. Overall her prognosis appears poor. Her surgeon wrote: Nevertheless, I believe we should make one final attempt at chemotherapy.
Case 3: H394, 40-year-old lady, underwent an operation to remove a malignant ovarian cyst in 2007. This was followed by a hysterectomy. It was a Stage 3 cancer. Not satisfied, she went to Singapore for consultation. She was told her cancer was a Stage 4. H294 underwent six cycles of chemotherapy with carboplatin + taxotere. In addition she received 25 radiation treatment and 2 brachytherapy (internal radiation treatment). All treatments were completed in October 2007. She was well for a while.
But two years later, October 2009, her CA 125 started to increase. A CT scan showed the cancer had recurred and spread. She received another three cycles of chemotherapy with cisplatin. The treatment was not effective. Her CA 125 increased further and the tumour grow bigger by 1 cm. She went to China for further treatment. This too was not effective.
Case 5: H284, 50-year-old lady, had ovarian cancer and underwent a surgery – TAHBSO in February 2006. In addition she received 3 times brachytherapy (internal radiation) and six cycles of chemotherapy. Two years later, in September 2008, CT scan showed lesions in her liver and soft tissue mass in her pelvis. Her CA 125 was in a rising trend.
In April 2009, she felt pains in her abdomen. A PET scan confirmed cancer recurrence. The soft tissue nodule in her pelvis was 2.9 x 2.6 cm in size. Nodule in Segment 6/7 of her liver was 2.2 c x 2.5 cm in size. She underwent 6 cycles of chemotherapy. The pains were gone but three months later, the pains came back. The doctor said more chemotherapy!
Case 6: H813, 54-year-old lady, went for a general checkup. The doctor found something in her uterus. Subsequently she underwent an operation, TAHBSO. It was a Stage 3 ovarian cancer. She underwent 12 cycles of chemotherapy with Gemzar + Carboplatin. All treatments were completed in August 2009. Everything was okay.
About two years later, September 2011, the doctor found lesion in her pelvis. In January 2012, CT scan showed the lesion was still there. A biopsy was done and was found to be malignant. She was asked to undergo another 18 cycles of chemotherapy with Taxol + carboplatin.
Case 7. Dying In the ICU After Surgery for Ovarian Cancer and Chemo for Lymphoma.Wan went to see a doctor in a private hospital. She was told that she had ovarian cancer and needed an operation. Wan then moved on to another private hospital believing that another doctor was better able to handle her case. On 16 February 2009, Wan underwent an operation to remove her so-called cancer in the ovary. It was a total hysterectomy. But Wan’s condition did not improve in spite of the surgery. Read more of her story here: http://cancercaremalaysia.com/2010/12/11/dying-in-the-icu-after-surgery-for-ovarian-cancer-and-chemo-for-lymphoma/
Success Stories of Ovarian Cancer with CA Care Therapy
Case 1: Siti was 48 years old when she was diagnosed with ovarian cancer Stage 4. She underwent a total hysterectomy in 2005 followed by three cycles of chemotherapy. She gave up chemo. At first Siti and her husband did not believe in what we at CA Care are doing. Many times, they were “pushed” by a friend to come and see us. Eventually Siti and her husband relented and came to Penang. From then on it was no turning back. Siti’s health improved. It has been seven years now and she is going well.
Case 2: June (not real name) was 42-years old when she was diagnosed with ovarian cancer in December 2006. A TAHBSO surgery was performed. The histopathology report confirmed a bilateral ovarian adenocarcinoma with metastasis to the omentum. June underwent chemotherapy and took herbs. Unfortunately the cancer recurred. The doctors wanted her to undergo more chemo. She refused and continued with the herbs. This time June’s spleen became swollen and caused severe pains. She had no choice but to undergo more chem. She was well up to this day.
Related Cancer: The Endometrium
Case 3: GS (T791) is a 54 year-old lady. A cervical biopsy and endometrial curetting indicated a moderately differentiated adenocarcinoma of the endometirum. Subsequently, GS underwent a surgery – TAHBSO at a private hospital. The pathology report confirmed a well differentiated adenocarcinoma of the endometrium, classical endometrioid type, Stage 3B (T2bNxMx), tumour invades into cervical stroma.
Case 4: Ella was diagnosed with endometrial cancer. She underwent a TAHBSO and resection of the omentum and left and right pelvic nodes. After the surgery, her surgeon told her: No chemo, you have three months. With chemo, it would be two-and-a-half years. She asked: What? Ella was started on herbs right away – and NO chemo of course. As of this writing, it is about four years now and Ella is well and healthy.
Read more: http://cancercaremalaysia.com/2012/01/28/cancer-of-the-endometrium-no-chemo-you-live-only-three-months-with-chemo-two-and-a-half-years-with-herbs-she-is-still-having-fun-after-more-than-three-years/
Let me conclude by quoting a wise man who I have much respect for – Jewish Rabbi Harold Kushner. His words have always been my moral compass whenever I deal with patients who come to us for help.