It started off with severe back pain for Madam K, who had to rely on walking sticks because the pain was so intense that she was unable to walk on her own.
At age 41, the active scuba-diving lover found herself unable to go to work, much less enjoy her favourite activities such as taking long walks in the park.
When Dr Sue Lo examined Madam K, she found a 10cm lump in her breast. Tests confirmed that Madam K was suffering from stage four breast cancer, and that the cancer had already spread to her bones and the lower part of her spine.
"Everyone has a different perception of stage 4 breast cancer. Some would associate it with imminent death, and some would relate it to many months of chemotherapy along with side effects such as hair loss and vomiting. Some people might also think of extensive and aggressive treatments including surgery to remove all the cancer, or having a liver transplant to get rid of the cancer cells that have spread to the liver," Dr Lo says.
The hallmark of cancer is its ability to travel from the original site to other organs in the body. In the case of breast cancer, the original site is the breast, and from here, the cancers cells can travel to other organs through the lymphatic path or blood stream, Dr Lo explains.
The organs that breast cancers tend to spread to include the bones, lungs, liver and brain. Life expectancy varies widely in patients as the cancer can present itself in various ways. This ranges from a few spots in the bone to widespread cancer cells in the brain, lungs and liver.
Some stage 4 breast cancer patients can live well beyond 10 years while some die within months of diagnosis. "These are the extreme ends of the spectrum. The life expectancy really depends on the sub-type of breast cancers, which organs the cancer has spread to, and what treatments are available," says Dr Lo.
The breast cancer found in Madam K was a hormone sensitive type. As a result, Dr Lo started Madam K on hormonal manipulation therapy, as well as strong pain killers and bone strengthening therapy.
Dr Lo explains that in many cases of hormone sensitive breast cancer, the cancer can be treated with hormonal manipulation therapy for many years before chemotherapy is needed.
Hormonal therapy has relatively few side effects and does not have the same side effects as chemotherapy such as complete hair loss, weakening of the body's immunity or vomiting.
However, it takes at least 4 to 8 weeks for a response to be seen in the tumour. In Madam K's case, she was able to wean off all her pain killers within four weeks. She also regained the ability to walk without walking sticks, and she returned to work part-time.
The lump in her breast, which was previously 10cm in size, was also significantly reduced to 5cm.
After 8 weeks of treatment, Dr Lo could no longer feel the lump in Madam K's breast.
More than a year after starting treatment, Madam K was able to go on a scuba-diving trip overseas.