Sitting in the doctor’s office and hearing her diagnosis left Calise speechless. From her pregnancy until the day her daughter was born, she never felt anything was amiss with her body and yet the CT scan and full body scan results showed otherwise. The lump was located much further down her breast and with the swelling in her breasts during pregnancy, it was difficult for the lump to be detected. When she found out, the cancer had unfortunately already spread to her spine, kidneys and other parts of her body.
Without any time to be left in shock or grief, Calise immediately started looking for doctors to treat her cancer. After seeing a few clinical oncologists, she decided almost immediately that she would seek treatment from Dr John Low from Sunway Medical Centre, Sunway City. “I asked this same question to all the doctors I met, which is—What is my survival rate?” Calise said. “Dr John Low’s response was the only one that gave me hope and confidence. He told me that it doesn’t matter which stage of cancer I was in, as long as there was a chance for treatment, I would be able to have a better quality of life.”
For Dr John Low, quality of life is more important than how long one lives. If a person spent the bulk of their lives being unable to care for themselves and lived in constant pain, it wouldn’t matter if they lived until a 100 years old. “We want to live happy and fulfilled lives, so having a good quality of life is very important. When I propose treatment options, especially to someone who has end stage cancer, I have to consider the patient’s quality of life. At the end of the day, my goal is not to have my patient live longer, but to help them live better.”
During her first visit, Calise’s PET/CT scan showed that the cancer cells covered her entire spine. And on the top part of her spine, the cancer cells were pressing on her spine and limiting her movements. If she didn’t seek immediate treatment, she would have lost control of her arms, becoming semi-paralysed. After confirming that Calise had HER-2 positive breast cancer, Dr John Low recommended she do targeted therapy in combination with chemotherapy in order to treat her cancer quickly and effectively.
“I was concerned about the cancer on her spine, so for that area I suggested she undergo radiotherapy. As for the other areas of her body, we used targeted therapy in combination with chemotherapy instead. Targeted therapy actually limits and controls the HER-2 gene from mutating into cancer cells, while chemotherapy attacks the tumour’s DNA in order to remove it. This method thankfully worked well for Calise.” With Dr John Low’s treatment plan, Calise who was diagnosed with cancer in July 2020, was able to clear the cancer cells from her body after just 4 months of treatment. It was like a miracle!
Compared to her first consultation when she had to be wheeled in, Calise has recovered a lot of her movement. Even her quality of life has improved tremendously where she can finally return to her daily activities and spend time with her young daughter. Given the efficacy of targeted therapy in combination with chemotherapy, is it possible to treat all patients with terminal cancer using these methods?
According to Dr John Low, there are different treatments for different types of cancer. In the past, cancer was typically treated with surgery, radiotherapy and chemotherapy. However, after years of research, the medical community now knows that the main cause of tumour growth is gene mutation, so medical treatment has now advanced to using targeted therapy to attack the site of the mutation directly. "Some form of cancers are now being treated with oral drugs that target the site of the tumour, and this has proven to be effective. A perfect example is lung cancer, where 20 or 30 years ago, terminal lung cancer was a death sentence. Now, many patients with terminal lung cancer can survive for many years and have a good quality of life. Therefore, the most important thing in cancer treatment today is to know what’s causing the tumour, and then the right treatment plan can be prescribed for it."
Hence, the most important thing for cancer patients is to trust the doctors to give them the right treatment. Calise is a good example of this.
One in every 19 women in Malaysia will develop breast cancer; while cervical cancer is the second most common gynaecological cancer in Malaysia besides ovarian cancer. In the case of cervical cancer, 40% of women are diagnosed at stage 3 or 4, while among ovarian cancer patients, this figure goes up to 70%. This shows us how easily these gynaecological cancers are overlooked by patients at an early stage.
The reason ovarian cancer is so difficult to detect in its early stages is because the symptoms are not like those of breast cancer, where a lump can be felt at an early stage. As a result, ovarian cancer is usually diagnosed at a more advanced stage, with a lower chance of survival compared to breast cancer, and is sometimes more difficult to treat than breast cancer. To detect ovarian cancer early, women should have regular check-ups, especially in their 30s and 40s, and ask their gynaecologist to check their ovaries as part of their regular Pap smear. Also, if you have abnormal symptoms such as abdominal pain or bloating that do not improve for two weeks, you should see your doctor as soon as possible and not ignore these warning signs. If you have a family history of ovarian or breast cancer, you should definitely do regular check-ups; otherwise, keep to your annual check-ups and see a doctor if there are any problems.
"Ovarian cancer has a high chance of being treated in its early stages, but it is often more difficult to treat when it reaches stage 3 or 4. By this time many patients have tumours all over their abdomen, requiring surgical removal by a gynaecological oncologist followed by chemotherapy. However, in recent years there have been major breakthroughs in the treatment of ovarian cancer, and we have discovered that the BRCA gene mutation, which causes ovarian cancer as well as breast cancer, is a gene mutation that many patients carry. There is now a drug that can prevent the recurrence of these tumours, so the survival rate of patients with this mutation in stages 3 and 4 has improved dramatically. All of this brings great hope to patients."
Dr John Low wants people to treat cancer like any other disease. Once diagnosed, patients should always go with scientifically and clinically proven therapies rather than going with “alternative” and unproven treatments. With medical research into genetic mutations and new treatments for cancer, there may be a good chance that tumours and cancers can be completely eradicated in the near future. So, patients with terminal cancer should not give up hope so easily. "Keeping your hope alive is of utmost importance. If you give up on treatment because you feel there is no hope, you have no chance at all to cure or improve your quality of life. So don't give up hope, because you only live once." Dr John Low said.
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