O Cancer! Where is thy claw?

CONQUEST OF DEATH 8

 “Doctor, my mother has a tumor in her breast,” said her son.

“Tumor?,” I asked.

“Yes,” she replied. 

“How old are you?” I asked the old lady.

“I am an illiterate peasant. For the last seven-eight years, I stopped my menses. So....,  may be I am fifty six, fifty eight. Well, you only judge.

“How did you notice it?”

While taking a bath”

“When did you first notice it”

“May be two-three years back,” interrupting me she said, “It does not pain, nor do I get a fever,  but for a few months it is ‘growing’"

“What have you done for that?,” I inquired.

“We are farmers staying in a remote village on the coastal line of the state of Maharashtra, India. We do not have good medical facilities, no x-ray machine, not even a laboratory for blood-testing. We took her to a lady doctor nearby, she gave her some medicines for a few days but the ‘tumour’ did not subside. She suspected a ‘growth’, so she recommended your name for medical advice,” replied her son.

I examined her. She had a tense, cystic, vascular swelling about eight to ten centimeters in diameter in her left breast. It was warm but non-tender. It was freely mobile. Lymph nodes in the axilla and in the neck were not enlarged.

To ease their anxiety, giving assurance to them, I said, “Your maa (mother) has a small ‘growth’ in her breast. Let us get her chest x-ray and blood reports done. Thereafter, we shall decide the plan of treatment. Okay?”

Breathing a sigh of relief, her son and daughter in law said, “Okay!”

Two days later, they brought me her reports. Her chest x-ray and blood reports were normal. 

“Maa, to remove this ‘growth’ you are required to undergo a small operation.” I told her.

“I shall be guided by your advice. I am willing for it,” she replied. 

“On the operation table, I shall put in a needle in the swelling and aspirate, if there is a clear fluid I shall remove the swelling, but if the blood is aspirated I shall remove the swelling and the whole breast,” I explained my plan to them.

“Whatever is required to be done, you do. We are willing to face it,” came the reply.

To begin with, I gave her local anesthesia. As per plan, I aspirated. It was blood. I showed her and her relatives the aspirated blood and took their consent for mastectomy (removal of the breast). I removed the breast and got the tissue tested. It was a ’non invasivecarcinoma in situ’ (an early cancer).

Since it was a very well localized, non invasive cancer and the lymph nodes were not enlarged, I did not give her radiotherapy or chemotherapy. For fifteen years, she attended my clinic for regular follow up.

Thereafter, she did not attend my clinic. Is she alive? Did she pass away? Who knows? I did not get any follow-up from her relatives either.

For fifteen years, she was symptom free, disease free and had no relapse of cancer.

Can I not say then, that at least for her, the dreadful, life threatening disease like cancer was ‘cured’?

Non- invasive cell

 There is another similar case that I encountered during my clinical practice.

Many years ago accompanied by husband, a lady visited my clinic. 

“Doctor, I have a small, hard lump in the left breast. It is not painful.”

“How did you notice it?” 

“For so many years, while bathing, I used to examine my breasts. About six to seven months ago, I felt a small nodule in the upper outer quadrant of my left breast. It was mobile at that time. Now it is increasing in size and becoming harder too,” she said.

“You are giving your case history so... accurately, what is your academic background?”

“S.S.C. (high school graduation exam). I wanted to go for graduation in chemistry but..”

I examined her. She had the lump that she described. The lymph nodes in the left axilla were enlarged, non tender, mobile.

“She is unnecessarily worried for the ‘growth’ to be ‘cancer’. Is this cancer, doctor?,” asked her husband.

“We will investigate.” I said.

Advanced investigations like ultrasound, CT, MRI scans etc. were not available in India then...

 

“Let us get her blood reports and chest x-ray done and then decide the plan for treatment,” I explained them.

Two days later, they brought her reports. They were normal. 

“Let us do a fine needle aspiration biopsy and according to the histopathology report, plan our treatment”

They agreed. I took tissue for biopsy. The report was positive. Cancer!

“She requires a radical operation, i.e. removal of the breast, the muscles and the axillary lymph nodes!”

“Go ahead,” they said.

I performed the surgery and got the tissues tested. The cancer was localized to the breast; the lymph nodes were free from the disease. I, therefore, did not advise radiotherapy or chemotherapy.

She used to come for follow-up regularly. I followed up this case for twenty years. She was symptom free. The cancer did not relapse nor did it spread.

She died of ‘heart attack’ but not of cancer!

Can I not say then at least in this case the cancer was ‘cured’?

Even today whenever doctors say ‘cancer is cured!’, they mean that a patient is symptom free or the cancer has not relapsed for a period of five years. In predicting the progress of a cancer patient, the doctors talk about ‘five-year survival rate’. Is breast cancer an exception then? Maybe some types of breast cancers are!! 

Today, worldwide, millions of women who were once victims of this insult but have taken treatment for it, are not only surviving for more than twenty five years, but are symptom-free, disease-free, show no signs of relapse and are living a very good quality of life!

                                          

May I say a bit more (too much?) in optimism though, no cancer is so trivial as to be ignored or neglected nor so severe as to be despaired of!

 

Tomorrow, with better understanding of the disease process underlying cancers, with the availability of better and safer surgical procedures, with the availability of cancer-specific, tissue targeted anti- cancer drugs with very few or practically no untoward effects or side effects, may be, may be, doctors will be able to say,

Mother Nature, we’ve understood your law

O Death! We’ve corrected our flaw

Tell us o cruel, killer cancer!

Where is thy crooked claw? 

A True Story in Real Life!!

A Drama in My Life!!