I
was stopped by a chap in the hospital lobby who was kind enough to
ask about my dear old Mum. I hadn’t mentioned her for a while and
he was hoping she had not been referred upstairs to see the Higher
Physician. He was pleased to hear that Mum is now 94, still
reasonably hale and very hearty. The hard winters in the north of
Scotland breeds tough people, in fact Scotland has more centenarians
than anywhere else in the British Isles.
So to my friend Alan. A spritely, feisty 70 year old. A couple of
years ago, he completed the cross bay charity swim. Very much
‘alive’ but who succumbed to bowel cancer in April this year, after
receiving the diagnosis in January. Previously I had witnessed
someone with this cancer remarkably recover. A true miracle, and
one that I had mentioned to Alan. I have kept his SMS on my phone
where he says, “Well, I need that second miracle in your life … the
cancer has gone too far.” Unfortunately, Alan was denied that
miracle. I miss him a lot.
So what should you do if given a diagnosis of “cancer”? It is not a
‘hit or miss’ diagnosis. It is not a diagnosis we take lightly. In
many instances, the diagnosis may completely alter the lifestyle of
the person. It may even herald the beginning of the end, as was the
case with Alan. It is at this stage you should be told whether the
cancer is benign or malignant. If it is benign, you can live with
it. If it is malignant, you may not be able to live with it.
So what should you do after getting the bad news? The first thing
to do if you feel there may be some doubt about the diagnosis, is
then go and get a second opinion, or even a third. It is your body
and your life that we are talking about.
Now, it is important for you to find out just how advanced is your
cancer. Is it still at the stage of being just a primary, or has it
spread, called secondaries or metastases?
This next piece of advice is somewhat contentious, but represents my
thoughts on the situation, after 40 years of medical experience.
(That’s why they call it medical “practice” - eventually you get it
right.)
There is a scanning procedure called a “PET” scan (positron emission
tomography) which can help to demonstrate a cancer, stage a cancer,
show whether a lump is cancer or not, to show whether a cancer has
spread to other parts of the body (metastasized), assist in choosing
the best treatment for your cancer, to show how well cancer drug
treatment is working and show the difference between scar tissue and
active cancer tissue. With some cancers, PET scans are often used
to look for cancer in the lymph nodes in the body, or to show
whether the cancer has spread to other areas such as liver, brain
and bones. This can help your specialist (and you) to decide
whether it is possible to remove the cancer with surgery.
Unfortunately, PET scans are not cheap, and not every hospital has
one. In fact, very few. The only one I know is in the Wattanasoth
Cancer Hospital in the Bangkok Hospital ([email protected]).
I believe that the most logical step after the biopsy is the PET
scan. You need to know whether your cancer is localized, or has it
spread? If it has, how many metastases are there, and where in your
body do they lie?
Now with all the information before you, as to the type of cancer
you have, knowledge of its aggression and response to treatment and
whether it is still localized or otherwise, means you can make an
informed decision on your future.
For me, if I had a localized tumor with a good response to
surgery/chemo/radiotherapy I would go for full-on treatment. If I
had a tumor that had spread everywhere with a poor response to
treatment I would go to Disneyland.
Finally, there is a new government approved “Living Will” form which
is available through the hospital. I recommend lodging one with us.
