Now vs Later

We informed Dr D that my dad decided to undergo radiotherapy for his leg at that hospital ("MM Hospital"). The quoted fee was RM500 cheaper than that at Dr A's hospital ("Adv Hospital") i.e. RM7500 vs RM8000.

So recently, we arrived there in the morning where they took a "planning scan" of his leg as well as some blood for tumour marker tests. Surprisingly the total fee, including the tests, was just over RM3k. Much cheaper than quoted. Something about using only a "fraction", rather than a few fractions @@.

We also requested to speak with Dr D because we were not clear about why she suggested doing chemo later rather than now. Despite her busy schedule, she managed to squeeze us in, patiently explained to us till we were satisfied, and did not even charge us for that! My dad is comfortable with her because not only is her explanation is detailed, it is also clear to him.

To summarise, her points are as follows:

(1) My dad's cancer is mucinous adenocarcinoma, which is quite rare. There's also few studies on this cancer. So in terms of treatment, specialists based on what they know of adenocarcinoma pancreas. In short, efficacy of treatment is a guess.

(2) Condition of patient is usually stable initially ("flat line") for a while before it gets worse exponentially ("exponential part"). Since for the past 6 months, the only notable development is suspected cancer on his left leg and a small dot of suspected cancer in the lymph node, it's her opinion that my dad's condition still lies in the early stage i.e. the early part of the flat line. Hence, having chemo now would not improve the current condition. Moreover, it's hard to determine the success of the chemo treatment as it's only a small dot to begin with.

(3) If undergo chemo now to treat that small dot (left leg is treated with radiotherapy), the cancer cells may develop resistance to the preferred chemo drugs when chemo is really needed (the start of the exponential part).

(4) So her aim is to catch the inflexion point i.e. condition about to worsen exponentially and then recommend chemo to treat the (expected) several spots of cancer.

(5) Throughout the discussion, she regularly goes back to her aim of treating stage 4 cancer patients i.e. prolong life, quality of life and control/manage symptoms.
6 Responses
  1. Twilight Man Says:

    I have been a volunteer with the Hospis for many years and seen many cases. It is true that mucinous adenocarcinoma is very rare. I have so much to share and write in this comment box. Maybe we should email or PM each other. Please be strong yeah.


  2. Jaded Jeremy Says:

    Twilight Man,
    Thanks for your offer. I've e-mailed you.


  3. William Says:

    Hope the treatment plan will be suitable for your dad.



  4. Anonymous Says:

    Thank you for your very clear explanation. Is mucinous adenocarcinoma the source of your Dad's cancer, that had metastasized to his kidney? Why didn't earlier PET scans show the tumor in his leg? Thanks for sharing. (IL)


  5. Jaded Jeremy Says:

    IL,
    Because it wasn't there earlier. None of the oncologists expressed surprise that it wasn't picked up 6 months ago and so I surmised that that has to be the reason.