MOST liver cancer patients with his advanced stage of liver cancer do not live more than three to six months on average.
That is what doctors say.
But Mr Png Kok And (above), 60, has defied the odds and is still alive and kicking six months later.
There is also no sign that his cancer is growing.
And Mr Png intends to go on living longer than his doctor has estimated.
'God willing I can do it. It's all in his hands,' he said. 'Of course, I'm helping as much as I can by living a healthy lifestyle, eating healthy food, no more alcohol, no more durians or other 'heaty' fruits,' he said.
What is helping him do this is a newly- approved drug for the treatment of liver cancer called Nexavar.
Thanks to the drug, Mr Png now has a good quality of life - he gets out and about, drives himself everywhere he wants to go, and goes bowling.
Mr Png, who was diagnosed with inoperable liver cancer early this year, said: 'I feel great, everything is very normal. I live life one day at a time and I get to do everything I want to do, such as go to church twice a day, and meet up with my friends who are mostly retired.'
In March, things were very different.
Couldn't operate
Doctors had discovered three tumours in three different parts of his liver and said they could not operate.
Dr Tay Khoon Hean, a liver surgeon at Gleneagles Hospital, said: 'Mr Png had hepatitis B. The virus destroys the liver cells and leads to scarring of the liver called cirrhosis.
'The virus continues to attack the liver over time and it forms cancer. It's usually over a period of 10 years or longer.'
He said he could not operate on Mr Png because the tumours involved both lobes of the liver.
Dr Tay said: 'There would not be enough normal liver left if I operate. Then he'll go into liver failure and die.'
Doctors recommended that Mr Png undergo a procedure called transarterial chemoembolisation or Tace, which was to infuse chemotherapy directly into the tumours.
Mr Png was wide awake during the procedure, which was done via long narrow tube threaded all the way to the artery that was feeding the tumours.
After the tube reaches the correct artery, chemotherapy is infused.
Mr Png was extremely nervous during the procedure. He recalled: 'I had breathing problems. The radiologist who was performing the procedure asked me to cool down and gave me some more painkillers. But I couldn't, I had an anxiety attack.'
Unfortunately, the treatment did not help much to reduce the tumours.
Previously, if Tace did not work, that would be it, Dr Tay said. 'All we can do then would be to give some symptomatic medicine to help the patient feel better.'
He had referred Mr Png to oncologist Dr Tan Yew Oo, who thought Nexavar might be able to help.
Dr Tan, who is at Gleneagles Medical Centre, said: 'In the past, we had only chemotherapy to treat the patients. But they suffer many side effects and have a much poorer quality of life.
'With Nexavar, if the patient can tolerate it, he can have a good quality of life for longer without the disease progressing.'
Side effects
When Mr Png started taking Nexavar, he suffered terrible blistering on his hands and soles of his feet. He also had bad leg cramps which rendered him unable to walk. These are some of the known side effects of Nexavar.
The retired sales co-ordinator and father of two said: 'I could not cook, I could not drive, I could not walk.
Dr Tan then decreased the dosage from four tablets a day to three a day.
Since then, Mr Png has been fine. His blisters and cramps disappeared.
He is Dr Tan's longest surviving patient on the drug. Two of Dr Tan's other patients who were on the drug have died and two did not respond to it.
Mr Png now hopes that the drug company can do something to bring down the price of the drug for people like him.
He pays between $7,000 and $8,000 a month for Nexavar.
'It's a lifeline to us, so I would really like them to think about making it more affordable,' he said.
ABOUT THE DRUG
- Nexavar received approval from the Health Sciences Authority in July for the treatment of patients with inoperable liver cancer. It is the first approved systemic drug therapy in Singapore for liver cancer and the only drug therapy shown in studies to significantly improve overall survival in patients with the disease.
Nexavar is approved in more than 40 countries.
- Surgery offers the only chance of cure to liver cancer patients. But only about 15 per cent of patients have tumours which can be operated on. Surgery is only effective when all of the cancer is removed.
Liver cancer may be slow growing, but it is often not diagnosed until it is in an advanced stage, when surgery is not possible.
LIVER CANCER FACTS
In Singapore, liver cancer is the fourth most common cancer occurring in men. From 2001 to2005, 1,660 men contracted the disease.
Chronic hepatitis B and C infections are the leading causes of primary liver cancer worldwide.
The five-year survival rate for patients with liver cancer is less than 10 per cent in Asia among patients with inoperable tumours, less than 8per cent in Europe, and less than 11 per cent in the US.
More than 600,000 cases of liver cancer are diagnosed worldwide each year and the incidence isincreasing.
These stories were first published in The New Paper on Sept 19, 2008.
