Cancer, Chemotherapy and COVID -19

Cancer patients, Chemotherapy and COVID -19

.  Mr. Yogesh underwent surgery for colon cancer about 6 weeks ago.  He had recovered fairly smoothly and was sent home well before the lockdown.  Now, after a week I had a video-call with him and the first question he asked me is “when do I have to start chemotherapy”?

He was anxious that his therapy should not be delayed.  However, he was looking a bit weak and had not gained weight.  So I had to advised him that he had to wait for a little more time to pick up weight and eat well and defer chemotherapy

Cancer patients are at a higher risk for contracting COVID 19 as cancer itself produces lower immunity.  In addition, many of the patients may  also be on chemotherapy.

So what would be the best option for these patients, particularly in solid tumours (colon, stomach etc)

The precautions of ‘social distancing’ are important and we have to make sure that these patients are given extra precautions particularly when the space itself becomes a constraint in families.  It goes without saying that they should never be exposed to   anything from outside or anyone who has even the mildest of symptoms.

What about chemotherapy?

Many of the patients are on cyclical chemotherapy, may be once in 3 weeks, in solid tumours.

Chemotherapy itself reduces blood counts and normally also they are susceptible to infections. The rational approach would be to shift them on to an oral chemotherapy so that the number of visits to the hospital are less and tide over this period. Many times we find that chemotherapy can be deferred. It is not an absolute time bound period though it is recommended that 6-8 weeks is the time to start chemotherapy after surgery.   This can be pushed to a couple of weeks to give more time for recovery

On the whole we need to balance the benefit of the chemotherapy with a possible risk of a patient making multiple trips and also getting immune-suppressed and also getting more susceptible to the current epidemic.  So it is better to error on the side caution the benefits of the adjuvant chemotherapy are not of that magnitude to risk infection.

So stay home and stay safe and comfortably wait for a couple of weeks or even more before you start your treatment.  Even if there is a gap in between cycles also, it is absolutely fine.

Cancer doesn’t spread in days, Corona does

 

A couple of weeks before the  lockdown, Parul, a 45 year old homemaker consulted me.  She and her husband went for a medical check-up.  She had no symptoms. She was shocked when Ultrasonologist found that she had a mass in her stomach.  Immediately she rushed to me.  It was a peculiar tumour arising from the stomach.  The most common such tumour is  GIST. I assured her that this normally responds to an oral tablet.

Then, as we were investigating, getting biopsies done, we crossed the Sunday Janata curfew followed by the lockdown.

Her histopathology report came while we were in lockdown .   She did not have GIST as I predicted but a different type of tumour. She needed surgery!

Obviously her big question was what would happen in these 3 weeks  under lockdown.

I had a video consultation with her. The conversation went like this:

“Doctor, You told me that I just have to take a tablet, but now recommending surgery ! “

“From day one I wanted surgery immediately as the tumour can keep growing right !”

( I have be honest and agree )

“ Parul, you are right, I did tell you. I was hoping that you would have a lesser option.”

“The pathology shows that it is a very slow growing tumour and has been detected without any symptoms.  Perhaps even if you had waited for the next 1-2 months also it would have not grown big and certainly will not spread”

It is very stressful for a patient diagnosed with cancer to be told to wait.  We all have this feeling that cancer cells multiply quickly and will spread.  This is certainly NOT true.  In fact, cancer cells multiply in weeks and sometimes in months.  This is a common cause for panic..

Can you guess how long a colon cancer will take to spread locally, leave alone spread to the other organs?   It is expected to take at least 4 months to involve ½ a circumference of the colon.  Most of the patients have symptoms for more than 6 months before they come to the doctor. In fact, most of the patients in busy centres wait a couple of months without any adverse impact.

Parul was not particularly convinced, so I offered that I can give her a declaration on a stamp paper that her tumour will not progress in these 3 weeks!

Finally she smiled and accepted.

I do have patients like Parul, who are scheduled for surgery immediately after the lockdown is lifted. Like them, I am waiting to operate and treat cancers.

Till then, I want to tell all not to worry that cancer will be spreading in three weeks.  Cancer cells certainly do not spread as fast as the corona virus which seems to be spreading exponentially at this point of time and poses huge threat to all of us.

Stay home and Stay healthy

 

Saga of a seventeen year old

 

What does a 17 year old normally do?

Hang out with friends, party and look forward to an enjoyable future.

Vishala, a 17 year old bright girl was doing just that, when she suddenly noticed that she had lost her appetite, not relishing her namkeens and snacks as she used to earlier. Slowly she found that her eyes have started turning yellow. Obviously this is a sign for worry and her parents got her investigated with the usual blood tests for jaundice thinking it is ‘hepatitis’. This was not hepatitis as ultrasound showed that the bile ducts were getting dilated (if there is jaundice, get sonography because it differentiates between hepatitis and obstructive jaundice). She was found to have obstructive jaundice and a series of investigations and imaging followed – CT Scan,MRI etc.

She was sent to Mumbai because she was found to have a tumour in the liver hilum a very delicate, complex area. As I tweeted earlier, we really had to plan carefully for this young girl. The team was determined to do our best for the girl and we spent nearly 7 weeks planning out the procedure and consulted a colleague from Japan. The procedure meant that we had to remove three-fourths of the liver from Vishala and the balance 25% would not be sufficient for carrying on the liver functions.

You may be surprised to know that 60% of normal liver can be removed and the liver regrows in just TWO weeks . Amazing !!

I had the privilege of knowing a Japanese surgeon,Prof Makuuchi, who first described a method of enhancing the volume of the liver which we applied in her case. We then proceeded to do the complex procedure which took almost 8 hours.

Things can go right or   horribly wrong especially in such complex surgeries. The family and the patient  had complete faith in us. We also said that we will do everything possible for getting her all right. Fortunately for us the recovery was relatively smooth and now you see that she is ready to go home.

I asked her what she wanted to do now and she said, “I want to learn dancing”, which is natural for a girl of her age. She with her doctor didis post a happy picture.

It is great to have a wonderful team and a faithful patient. Certainly in this case it makes us feel happy that we could save the life of this teenager. Wish and hope she has many years of bright life!

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Life is beautiful but the ‘second chance’ should be a remarkable journey

 

Here is a true inspirational story.

Last week I operated on Nimi for the 3rd time. She insisted that I use her name as she is not worried or scared.   She had undergone 8 surgeries since 2009 in different places including MD Anderson centre earlier. Yes, her morale should have been down and she should have been depressed and dejected. On the contrary she is full of life and keeps joking about her “unwelcome friend’. She has recovered well and rearing to get on with her life in full speed. God bless.

I had a chat with her after a major surgery nearly 4 years ago when we removed a huge mass.

She recovered well from the surgery and said “Doc, you have given me a second chance”.

I said, “It is not me but God who has given you a second chance but this ‘second chance’ should be used to lead a wonderful life”.  That statement seems to have stuck with her because she not only got back with vigour to her career but also enjoyed many trips abroad living life to the fullest.

There are many such remarkable men and women who not only beat cancer but also enjoy their lives without brooding continuously.

Thre is no doubt that positive attitude helps tremendously to cope with cancer and as a matter of fact any adversity. Be it chemotherapy or radiotherapy, its all about the will power. Fortunately we have a great family support system.

But more than any thing “ when you defeat fear, you defeat cancer’.

When I see such people I really feel that none of us have any cause to complain about the bad roads, monsoons and all the so called problems we face in our daily life. The biggest lesson from these patients is ‘Big C can not only be conquered but can be defeated with resounding success’.

The ‘second chance’ should be looked upon as a blessing to lead a remarkable life.