Never say die

When I saw my young patient, My Thuy, she had already been given cocktails of chemotherapy drugs.

She and her father had come here from Ho Chi Minh City more than two years ago because they had heard about the good medical care in Singapore.

After seven treatments here and the changing of drugs, repeated scans showed that her cancer continued to grow. She struggled through the toxicities of therapy.

In March this year, the scans showed that the cancer was still uncontrolled. She was then offered an oral chemotherapy drug.

My Thuy was already weakened from her many bouts of chemotherapy when her father brought her to see me. She was breathless, coughed incessantly, and had a poor appetite.

“She is only twenty-five years old. Please do what you can to help my daughter!” her father pleaded.

I looked at her medical history. The problem started when she developed pain and swelling of her left cheek.

Although her tumor was large, there was no evidence that it had spread to other parts of the body. A decision was made to remove the entire cancer in a major operation.

This meant that the much of the patient’s face had to be removed. This included the roof of her mouth, the bony structures beneath the both cheeks, her nasal cavity, and the lymph nodes from the left side of her neck.

With all the bony support from below the eyes removed, her face collapsed, giving the appearance of a face that had been punch in.

My Thuy bravely went through the surgery in December 2008. She had no chemotherapy after that.

She stayed home most of the time after the operation. It took a while for her to get used to looking at herself in the mirror.

Just as she was beginning to readjust to life, she was dealt a second blow in December last year. A routine check up revealed that her cancer had come back with a vengeance – with disease involving the nasal passages, neck, bones, lungs and liver.

Her original cancer was a rather unusual one. It was reported by the pathologist as a carcinoma with sarcomatoid features.

A sarcoma is a cancer of the connective or supportive tissue (bone, cartilage, muscle, fat or blood vessels). A carcinoma arises from the epithelial tissue (breast, colon, lung and others).

In other words, her cancer had features like a carcinoma and also those of a sarcoma.

It was at that time that her father brought her to me. I faced the dilemma of not knowing what we were treating. Was it a carcinoma, a sarcoma or a combination of the two?

I gave her two options. One option was to come to terms with that fact that she had a chemo-resistant malignancy, surrender and go home to live what was left of her life.

The other was to allow a repeat biopsy of the cancer so that we could determine what cancer it was. This would allow us to determine if the cancer was likely to benefit from further chemotherapy.

Her father decided to proceed with the biopsy. Peter, an interventional radiologist, localized the cancer under radiological guidance and took a core biopsy of the cancer.

To my relief and joy, My Thuy was found to have a rhabdomyosarcoma, a cancer of the muscle. This is a highly chemo-sensitive cancer, difficult to cure but almost always responsive to chemotherapy.

She was started on the appropriate chemotherapy in April. After one cycle of chemotherapy, My Thuy’s breathlessness resolved. After the second cycle of treatment, a PET-CT scan showed that more than 80 per cent of the disease was gone.

To date, she has completed four cycles of chemotherapy and the latest PET-CT is almost normal. We are jubilant.

There are so many lessons to be learnt from this story – a father’s uncompromising love, the human spirit of never-say-die, and the importance of a careful histological diagnosis before the start of any chemotherapy.

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