[Wanqingyi Care]Determine the treatment plan according to the condition…

By Liang Wanfu (geriatrician), Ming Pao

Cancer strikes, do we still have a choice?

Middle school classmate “Da Lao Rong” and his friend An Sen have recently been diagnosed with cancer. During a physical examination, Da Lao Rong was diagnosed with early-stage lung cancer, and An Sen was diagnosed with advanced cholangiocarcinoma due to swollen feet.

The two have different considerations regarding the choice, effectiveness, and side effects of cancer treatment, as well as arrangements other than treatment, which cannot be ignored.

(Hong Kong News) “Big Brother Rong” is one of my best middle school classmates, and he is also the “big brother” in our self-proclaimed “Alloy Five”. It is natural for Ah Wing to be respectfully called “Big Brother” because he not only has good academic performance and excellent interpersonal relationships, but is also a natural leader. He is responsible, independent, and has strong expressive skills. Therefore, everyone is considerate and considerate of him. Call him “big brother”.

Detected high cholesterol at 43 years old

After graduation, I don’t know when, but old friends started calling him “Lao Shirong” (boss), probably because of Ah Rong’s outstanding achievements in the workplace. He is the vice president of the company and the “old man” of all employees, so he changed from “big boss” to “old man”. Aaron has many things to do. Today he is either flying to the United States or going to China; tomorrow he is going to either South America or South Africa. As he said: “It’s hard to even have a meal in Hong Kong!”

Moreover, he had been diagnosed with high cholesterol as early as 43 years old. Although the doctor advised him to control his diet and eat lightly, it was not easy for Ah Rong. Not to mention quitting, I couldn’t even find time for a follow-up consultation. He said that he was riding a tiger and it was difficult to get off. How could he control cholesterol on the back of a tiger?

However, things are often not what you expect. Just when you thought the world couldn’t stop, suddenly a major epidemic, including flight bans, quarantines, and restrictions on gatherings, came one after another. A call to stop completely changed Ah Rong’s mind, and he realized that the person he was riding on might not be a tiger. Therefore, after jumping off, the first thing to do is a thorough physical examination.

The results of the physical examination will be available soon. Except for excessive cholesterol, all indicators are generally normal. However, the doctor still said: “Although you don’t have angina, your cholesterol has been high for more than 20 years, and you are a high-risk patient for coronary heart disease! Why don’t you do a coronary angiography?”

Just like that, Arong did the check-up. The report found that the coronary arteries were calcified and about 50% of the blood vessels were blocked. Although Tongbozi surgery was not necessary, a “disturbing” shadow was found in the right lung.

Middle lobe lung tumors are malignant

This report is truly disturbing. So Arong came to me and after reading the report, I tried to explain: “This computer scan is mainly a cardiac coronary angiography. If you want to know the actual condition of the lung tissue, you need to do a computer scan of the lungs to obtain the lungs and surrounding areas.” Further lymphatic information. If the report finds abnormalities and a tumor is suspected, further examination, such as a whole-body positron emission tomography scan, may be required to determine whether the tumor is malignant or has spread before a treatment decision can be made.”

Although Ah Wing was shocked, he was still willing to undergo further examinations. After all, his mother and aunt both died of lung cancer. The cancer of the two elders was already in the terminal stage when it was discovered. The cancer cells had spread and surgery was not possible.

To be honest, when I read Arong’s subsequent inspection report, I felt really uneasy. At the moment, I couldn’t tell whether it was good news or bad news. The bad thing is: the tumor in the middle lobe of the right lung is malignant, and lung cancer is diagnosed; the good thing is: the cancer cells are limited to one lobe and have not spread; the peripheral lymph nodes have not been affected. It is a stage one lung cancer and usually only requires surgery. It is possible to recover without chemotherapy or electrotherapy.

Although cancer is scary because it is always a serious disease, it is still treatable with current medical treatments. Common cancers such as breast cancer, thyroid cancer, colorectal cancer, etc., if it is in the early stage, the tumor can be removed through surgery. The patient does not even need follow-up treatment such as electrotherapy and chemotherapy, and the cancer can be eliminated from now on. Therefore, the first principle is to remove the tumor as soon as possible. So I persuaded: “While the tumor is still small, the relevant part should be removed as soon as possible. Ah Rong, can I recommend a surgeon to you?” Unexpectedly, he flatly refused.

Minimally invasive tumor resection with less pain

“Ah Fu, no need! I won’t do surgery. Cut off the lung lobes, how can I breathe! I would rather let nature take its course and not force it.” Ah Rong and his wife left the clinic. I feel even more uneasy. Later, I met Ah Rong’s wife Yingying, who was also my classmate, the “school beauty” of our middle school, and one of the most gentle and virtuous women I had ever met.

I explained my worries to Yingying one by one: “If you delay the operation, it will be even more troublesome if it spreads! My aunt and uncle couldn’t do the surgery at that time, but it is different now. Ah Rong can recover from the surgery. Not all cancers are terminal diseases, and with medical treatment !”

I introduced two doctors to them. One was a thoracic and pulmonary physician, who explained to Arong the necessity of surgery and the impact on postoperative function; the other was a cardiothoracic and pulmonary surgeon, who studied surgical practices and assessed postoperative risks.

The understanding and support of family members are often the biggest support for patients. After calm analysis, Yingying and Ah Rong visited two doctors within a week. I would especially like to thank my colleague from the Department of Cardiothoracic and Pulmonary Surgery. His extremely detailed professional analysis and empathy greatly cleared Arong’s doubts. Minimally invasive surgery greatly reduced pain. Ah Wing was able to go home and rest 5 days after the operation. He recovered quickly. In the past six months, he said he was healthier than before.

Later, I received a message from him:

“Six months later, the computer scan report came out. I am grateful that everything is normal and there has been no spread.

If you want to go deeper, maybe you should be grateful for this disease.

Because after I stopped, I discovered that life could be so happy and leisurely.

Thank you, Afu! “

Surgery for cholangiocarcinoma cannot be cured Adopting medication and planning the aftermath

Just when I was feeling comforted, another friend’s message came from my phone: “Edward, I’m sorry to bother you. After I got the news, I thought of you immediately. I hope you can give me some advice.”

Oh, what happened? It seems that my friend Anson has encountered a problem. Anson has been retired for many years and has a very exciting life. He often jokes that he is a full-timer. She is a full-time volunteer and is busy with many voluntary tasks in the Catholic district and her alma mater every day.

The patient has a tumor in his abdomen

Although it was already 11:30 pm, I thought she must not be able to sleep. So, I called her directly. Anson informed that due to persistent edema in both feet, he saw a family doctor and had a check-up. She uploaded the blood, magnetic resonance and positron scan test reports and asked me to read them and give her some opinions.

The report is: The patient has a tumor of about 7 centimeters in his abdomen. The tumor presses against the main vein, blocking blood flow and causing swollen feet. The blood cancer cell index is 100 times higher than the normal index. Such a report really makes people feel calm instantly.

It seems that cancer is inevitable and the condition is quite difficult to deal with. What tumors could arise in that location? Are any other organs affected? Can removing the tumor stop its spread? Are there any other ways to treat it? For a moment, it was hard to tell. Therefore, I advised Anson: “At this stage, the most important thing is to find a specialist and get more actual information about the condition before making a treatment decision.”

Within 3 days, the specialist made the following analysis: The patient suffered from cholangiocarcinoma, and the cancer cells had spread to the main vein and peripheral organs, including the liver and kidneys. If you want to remove the tumor through surgery, you need to remove a large part of the liver and right kidney, and reconnect the main vein to surrounding organs. This is a very large operation and the risk is quite high.

High risk of surgery

I believe that anyone who knows this will be frustrated and worried. Many cancers that grow in internal organs, such as the lungs, liver, gallbladder, pancreas, esophagus, stomach, ovary, prostate, etc., have symptoms that are discovered late and are already stage 3 or 4 cancers. Surgical removal alone may not be enough. Cure. Therefore, when considering treatment options, it is best to understand the pros and cons of various therapies, such as radiation therapy, chemotherapy, targeted drugs, immunotherapy, etc. Before communicating with the doctor, we must first do our homework, collect more relevant information, and understand the similarities, differences, pros and cons of various treatments. Only then can we know how to ask the doctor the “right” questions and clearly understand the side effects and costs of the treatments. .

Because drugs for the treatment of cancer vary in price and efficacy. Of course, the more expensive the drug, the better. Suitability is the most important. Because of genetic differences and different physical conditions, the effectiveness of cancer drugs in different patients is different.

Therefore, you must fully weigh it according to your own ability to bear it, including physical, mental and financial burdens. When considering treatment, you should also consider how to reduce the pain caused by future symptoms. For example, although colorectal cancer has spread, if the patient has a life expectancy of 1 year or more, we should still consider tumor resection surgery, because this can avoid the pain of intestinal obstruction and continuous bleeding in the later period. Local radiotherapy can reduce the risk of brain cancer and bone cancer. Cancer brings symptoms, and drainage and drainage can relieve the discomfort of pulmonary fluid accumulation. Therefore, different forms of palliative care should be considered simultaneously.

Do the Three Treasures of Old Lai

Anson promised to have a good discussion with her son. After her husband passed away from pancreatic cancer two years ago, her only son Howard was her mother’s biggest support. A week later, I received a message from Anson: “Edward, thank you for your recommendation. I have made appointments with several specialists. Howard accompanied me every time, and we discussed it many times. Howard was worried about the risks of surgery. He said Now I only have swollen feet and no other discomfort. I can still walk, run, and do volunteer work every day. However, after the surgery, I am expected to become disabled immediately, and I don’t know when I will be able to get up and take care of myself. Another important point Yes, surgery should not be able to cure my disease. Therefore, we plan to use drug treatment. What do you think?”

I have to admire Anson’s will and psychological quality. Her calmness and positive attitude are commendable. Later, she sent me another message: “We are currently working hard to complete the ‘Three Treasures of Lao Lai’; the ‘Will’ and ‘Advance Medical Directive’ have been signed, and now only the ‘Enduring Power of Attorney’ remains. Once completed, I I will go on a river cruise with my family first. After I come back, I will start my medication journey, don’t think about it.”

May God protect my old friends. I wish you all the best.

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