Dad's Final Decision

It was not an easy decision to make.  On one hand of the hope that surgery could cure (with risk of dying on operation table), and on the other hand was to have safer approach by treatment first, then probably surgery, i.e. neoadjuvant therapy - "The most common reason for neoadjuvant therapy is to reduce the size of the tumor so as to facilitate more effective surgery". (from wikipedia)

Only much later, we learned through the experience that the hope of getting cure through surgery is almost a miracle, given dad's conditions of large tumour, portal vein thrombosis and micro blood vessels invaded.

If you ever come to this cross road of making such decision, a third opinion is probably what you need. 

And we did.

My hubby and I went to see Dr Kong for third opinion.  Dr Kong agreed that going straight to surgery to remove the tumour had risk of fatality. Neo-adjuvant therapy such as tace or sirt would be his recommendation.

At night, we all sat around at sis's home to discuss. Sis made the stand that she was against of surgery as first line.  After much discussion, dad made the brave decision of going for surgery to remove the tumour. 

As family, we decided to to respect patient's will and support him through! 

這是爸在前天 等 C醫生的時候，有點累，眠了一會兒！

Surgery vs. SIRT

As I initiated the question if dad was a suitable candidate for surgery due to dad's heart-attack history and portal vein thrombosis, Dr C was somehow impatient with us and probably felt my challenge. He threw dad's scan report across the desk and asked, "Which line of the report said so?"

I pointed at no. 2 under the venous phase of the examination - 

Dad's CT report- Point no. 2 under venous phase examination - Tumorial Thrombus of right portal vein

Dr C eventually explained to us that the portal vein will be cut off and he was not fond of radiation embolisation, i.e. SIRT due to its risk of shunting. Based on my understanding, shunting means leaking of radiation and if too much has gone to other organs, it could be very damaging and even fatal.

FYI, SIRT using Yttrium-90 has become relatively safer because the doctor will do a test run for patient to access the shunting as well as the calculation of dosage.  Nowadays the doctors who are specialised in SIRT are rather precise of its dosage calculation.

At the end, we left Dr C's clinic in puzzles at the back of our heads with his comments playing repeatedly, 

"Surgery is the only cure for your father!"

"In fact, you should pray for a surgery!"

Dad the Warrior of Cancer- Diagnosis of HCC

My dad has been fighting with liver cancer - HCC (Hepatocellular carcinoma) for the past one year.  My parents are Malaysians. Ever since it happened, I have gained so much through some patients' sharings and experience through their blogs.  I thought it is time i could contribute as well especially to anyone/family out there who is seeking for more information or even just the support that, You/ your family is not alone!  

The following write-up is purely our personal experience and some feelings throughout this journey.  For privacy purpose, i will not enclose doctors' real identities. There is no right or wrong for the decisions we make. I guess I have often looked back and wondered what if we have made our first decision differently.  Rome wasn't built in a day.  It is true to most of the cancers.  They are fatal but not urgent. I wish any victim of this beastly disease would allow themselves to learn about disease and make the most rational decision for each individual patient.  One thing for sure, it is a journey that God has been watching and I thank Him for His protection.  The fight still goes on...

I quit my job last year, 2012 and thought of giving myself a break while searching for the next goal in life.  All of sudden, my family was devastated to learn the news that my dad of age 65 was diagnosed of HCC, probably stage 3b with portal vein thrombosis and micro-bloodcell invaded. Tumour size is estimated of 9cm.

It was around 22nd of March.

With the encouragement of our family doctor who has looked after dad for 20 years or more, we decided to start the journey of fighting the cancer.  Our first choice was to seek for quality medical professionals' advice in Singapore.  We were referred to see a world class surgeon, Dr. C whose speciality was in liver transplant at a private hospital. In the mean while, we also made appointment to consult another surgeon, Dr P at Singapore general hospital as second opinion.

Due to my parents' short stay in Singapore, we couldn't fit the appointments ideally but had to visit general hospital's doctor first. 

Dr. P was kind enough to squeeze us into his schedule after knowing that we traveled from Malaysia. He had two young doctors with him. During our consultation, he checked through dad's physical fitness and after that, of course to study the CT scan films.  He explained to the young doctors with patience. To summarise, he was against the idea of having surgery as first line. He told us that recurrence was almost guaranteed. How soon? Within 2 years. Survival around 2 years. His advice and method would be SIRT - selective internal radiation therapy using yttrium 90 and then only resection if there is shrinkage of the tumour.  Survival - 3 to 5 years.

The next day morning, we went to see Dr. C as scheduled.  The clinic was beautifully renovated and decorated.  Very pleasant ambience. During our consultation,  Dr. C briefly explained to us the procedure of liver resection.  First we had to see a cardiologist to access dad's heart function to go through such surgery.  It turned out that dad's heart function is 40% and the risk of operation went to 10% rather than 5%.

With many question marks and anxiety in our minds, we told Dr. C sincerely that we were not sure if surgery was the best way after Dr P's consultation at general hospital.  The risk of the surgery itself and recurrence after that.  

What is the meaning of this surgery for a patient to go through such trauma and recovery process, if the recurrence is going to happen within 6 months?  It is the word, FEAR, that we were encountered.