Cancer of the heart

PHOTO: Cancer of the heart

It was 3am on Palm Sunday, the start of the Holy Week for Christians on April 13, when my phone rang.

The call was from Rachel, the wife of a patient.

She was speaking from a plane, tens of thousands of feet above the ground, with about two hours of flight time remaining.

She was accompanying her husband, Raphael, back from Houston, United States, when he suddenly lost the use of his right arm and leg.

Just as she was describing his condition, the line got cut off.

I switched on my bedside lamp and waited.

When the call was reconnected, before she could start talking, I calmly said: "Don't worry. Once you land in Singapore, proceed directly to Mount Elizabeth Hospital and I shall have a team on standby."

At 5am, I received a call from her brother to say that the plane had landed at Changi Airport.

I got up from bed immediately and rang the neurosurgeon and radiologist to meet me at the hospital. Within 30 minutes, the three of us were huddled at the radiology department.

When Raphael, a business development manager in his 40s, was wheeled into the radiology department, the accompanying doctor from the airport reported that his pupils were fixed and not responding to light.

As we moved him from the emergency trolley onto the computed tomagraphy (CT) scanner, he was not responsive and had laboured breathing.

Two minutes later, images of his brain appeared on the screen.

There was a massive haemorrhage in the left side of the brain and this clot extended across the mid-line and was compressing the right side of the brain.

I stepped into the waiting area to brief Rachel of the findings.

The options were to either call it quits or prepare for emergency surgery to get rid of the blood clot in the brain.

I didn't really need to hear her answer because I knew that she would want to go all the way.


This had been Raphael's and Rachel's approach to their fight against his cancer from the very beginning.

His initial complaints, back in July and August 2012, were of chest pain followed by shortness of breath.

He was found to have fluid around his heart, and doctors had created a "window" to allow the fluid to flow out.

This operation had to be repeated in October 2012, when the fluid was found to have accumulated.

This time, however, the doctors discovered the underlying cause of the problem - an angiosarcoma (cancer of the blood vessels) arising from his heart. Besides affecting the heart muscle, the cancer had also spread to the lungs.

He was seen by several oncologists and they told him that he had at most six months to live.

"They considered his case to be hopeless," recalled Rachel.

Considering that the cancer was an aggressive one that involved the full thickness of the heart muscle, their guarded prognosis was a fair one.

However, Rachel refused to give up. Her husband came under my care in November 2012.

After several rounds of chemotherapy, we were pleasantly surprised that the tumour responded.

Not satisfied with only having the disease under control, Raphael continued to search for options that would give him a chance of being cured. He ended up seeking a second opinion at MD Anderson Cancer Centre, one of the leading cancer centres in the US.

They suggested that he should maximise what benefits he could from the chemotherapy and then consider surgery to remove the remaining cancer from his heart.

In total, Raphael must have received more than 20 cycles of chemotherapy under my care.

Every three to six cycles, he would head back to Houston to determine if he was suitable for surgery.

Finally, at the end of last year, he received the news that he was ready for surgery to remove the cancer from his heart.

I was not in favour of the operation because the cancer had already spread to his lungs when the disease was first discovered.

While I explained to Raphael my concerns, I appreciated his "never say die" attitude and respected his decision to go ahead with the operation.


On February 18 this year, the tumour was successfully removed from his heart with clear margins.

The resulting hole in the wall of the heart was patched up with muscle from a cow.

This finding of a "clear margin" is very important in cancer surgery.

It means that all the local disease was successfully removed.

The joy was short-lived because one month after the heart operation, Raphael had his first bleed in his brain caused by small cancer spread to the brain.

One week later, there was a second bleed.

On both occasions, the blood clots were successfully evacuated.

When Raphael boarded the plane to return to Singapore, he needed to use a wheelchair.

Nevertheless, he was able to walk a few steps to get to his seat and to hold his wife's hand as the plane took off.

Unfortunately, he bled again on the plane and almost lost his life.

When I saw Raphael the day after the operation, he was able to open his eyes when we called out to him, and obey a few simple commands.

Despite these encouraging signs, the road ahead is likely to be a rocky one.

Things look pretty grim from where we stand.

But, seeing how far he has come, we simply cannot give up.

As we entered the week of Good Friday, I was reminded once again that palms stand for peace, both in this life and the next.

Dr Ang Peng Tiam, the medical director of Parkway Cancer Centre, has been treating cancer patients for 23 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.

This article was published on April 24 in Mind Your Body, The Straits Times.

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