A bright future clouded by cancer

A bright future clouded by cancer Mr Mohammad Khan had everything going for him.

A 38-year-old doctoral candidate, he had been living in Canada for the previous four years.

He was looking forward to completing his thesis, and he was deciding whether to stay in Canada or return home to Bangladesh.

He was married to a doctor and they had a lovely eight-year-old daughter.

The future was looking bright.

But one day he found himself boarding a flight to Singapore - a high-risk venture because, by then, he was desperately ill.

"I was so breathless that I was gasping for air on the plane. I wasn't sure I was going to make it to Singapore," he said.

His blood oxygen saturation on room air was only 87 per cent when he first saw me at the clinic.

The level for normal people is well above 95 per cent.

Once the figure drops below that level, most people experience shortness of breath.

Considering that air is thinner at high altitudes, his oxygen saturation while on the plane was probably even lower.

Three months earlier, he had a bad cough.

He saw a local doctor, whose diagnosis was that he had some form of allergy.

He was given some medication, which did not seem to help.

A fortnight later, a chest X-ray was done, which suggested that something serious was happening.

For the first time, the possibility of cancer was raised.

Then a computed tomography (CT) scan of his chest was done.

He had frequent episodes of "cough syncope",? meaning that he fainted from the violent bouts of coughing.

The CT scan revealed shadows on both sides of one lung.

He was admitted to hospital, where doctors thought he could be suffering from tuberculosis.

But after investigations, he was confirmed to have stage four stomach cancer.

The disease is among the top 10 cancers in Singapore. In Asia, it affects more than 700,000 people a year.

The cancer had spread to the lymph nodes in the abdomen and the lungs, as well as throughout the abdominal cavity.

By then, Mohammad was having a hard time eating and had lost about 10kg.

He made the decision to fly from Canada to Singapore - a 19-hour journey.

When I first met him, he was in a wheelchair. He was weak and breathing heavily.

That day, with blood tests and a positron emission tomography-CT (PET-CT) scan, we found much the same thing.

His cancer had gone from the stomach to the liver, adrenals, bones and lungs, as well as lymph nodes from the neck all the way down to the lower abdomen.

He was breathless because there was fluid accumulation in both lungs, which prevented them from expanding.

After we inserted chest tubes on both sides to take the fluid out, he could breathe normally again.

His stage four stomach cancer meant the disease had spread all over. Surgery was not an option.

One of his cancer markers - CA 19-9 - was at 15,130 units. The normal count is less than 37 units.

All we could offer him was palliative chemotherapy.

The aim of the treatment was solely to try to kill some of the cancer cells, control the spread of the disease, preserve his quality of life and hopefully help to extend his life.

He agreed and was started on chemotherapy two days after admission.

After one cycle of chemotherapy, he was well enough to fly home to Bangladesh to spend time with his family.

He then flew back and forth between Dhaka and Singapore for the second and third cycles of his chemotherapy.

On Dec 30, he was seen for his "big exam".

He had a repeat PET-CT evaluation to assess the progress of his treatment.

The radiologist concluded that the cancer in the stomach, liver, bones and adrenals had resolved.

The cancer in the lymph nodes had either disappeared or become smaller in size.

The abnormalities in his lungs were much smaller.

His CA 19-9 count came down to 516 units.

With cancer, one can never predict the response to treatment.

Mohammad had a good response.

He is feeling much better.

But with cancer, we can be so near and yet so far. It can look like a cure and feel like a cure, but the cancer remains as aggressive as it ever was.

After we wished each other the best for the new year, I watched as he strode briskly out my clinic door.

I thought of the gates that a doctoral candidate must pass through - gruelling exams, long nights writing papers - in hopes of a brighter future.

Mohammad, the young father, was so near to achieving the fruits of his labour.

And yet, so far.

Dr Ang Peng Tiam, medical director of Parkway Cancer Centre, has been treating cancer patients for 27 years.

This article was first published on February 23, 2016.
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