Walking miracle
A patient fights back against the fear of nose cancer – and reaps the rewards
Madam Ang, a Malaysian patient in her 60s, recounted: "I was told my nose cancer had spread to the bone and that I had only 18 months to live."
When she saw me, Madam Ang recalled how she had wept when she heard the news. She was so upset that she lost control of herself and wet her pants as she sat in the doctor's room.
Her husband had said reassuringly: "Don't worry. I'll find someone who will take good care of you."
He brought her to see me in June 2003. Seven years later, we are more like friends than doctor and patient.
I love this woman because she is so full of life. She brings much joy to the clinic each time she is here. She speaks animatedly, has wonderful stories and gossip, and is kind and generous to all my staff.
Nasopharyngeal cancer, often called nose cancer or NPC, is common in Singapore. Radiotherapy has long been the standard treatment. Most NPC patients do well with just radiotherapy, especially if the disease is diagnosed early.
However, the cancer does recur in some cases, especially for those with cancer in the lymph nodes of the neck.
NPC responds very well to chemotherapy too. Up to 80 per cent of patients with NPC that has metastasised to other sites, like the lungs, lymph nodes, liver and bone, will respond favourably to chemotherapy.
However, while a large majority will improve, almost all will have cancer that will recur.
There is increasing evidence that supports the use of chemotherapy upfront with radiotherapy in the treatment of NPC, rather than wait till the cancer recurs. Taking this path has shown better cure rates.
However, some may argue that this may subject many patients to unnecessary chemotherapy treatment when they would otherwise have been cured by radiotherapy alone.
So the issue comes down to this: radiotherapy alone or chemotherapy and radiotherapy.
In mid-2002, Madam Ang had seven weeks of radiotherapy alone. Less than a year later, a PET-CT scan and a biopsy confirmed that the cancer had spread to the bones.
I treated her initially with an aggressive chemotherapy programme, followed by a maintenance treatment. Her disease responded well, as expected, and she went into remission within six months.
However, what surprised me was that her disease has remained quiet and undetectable ever since.
If indeed five years of remission is equal to a cure, Madam Ang would certainly qualify as a walking miracle. This is because the large majority of patients with metastatic NPC succumb to the disease within two years.
About a year ago, Madam Ang had a stroke when she was back in Malaysia. It left her with mild weakness on the right side of her body. An area of her brain that controlled speech was affected.
"I cannot talk, I cannot talk," she said, as I walked into her living room.
The fact was that she could talk, but the stroke had affected her ability to name objects. This also affected her pride and dignity.
She was so ashamed of herself that she stayed home for months after the stroke. She became increasingly depressed and paranoid.
I spent one morning with her at her home and managed to convince her to come to Singapore for an evaluation. Tests showed that a blood vessel on the left side of her neck was severely narrowed. This was very likely to have been caused by the radiation she received a decade ago.
Under the care of my friend Puay Yong, a neurosurgeon, a stent was successfully implanted to open up the blood vessel.
After that, her mobility and speech improved but, more importantly, her confidence and zest for life returned. "I went to the casino and had a good time. I can even count money," she told me excitedly.
Restoring a person's health is not only about killing off tumours or unblocking a blood vessel, but also requires conviction of the person's mind and will.
Madam Ang has shown that living well and resisting the temptation to give in to fear and panic are decisions the patient has to make. The rewards can be nothing short of miraculous.
~ Dr Ang Peng Tiam
