Tuesday, June 28, 2016

Living with cancer: my thought (the second part)

The inspiration from an academician
                                                           
                                                  By Xu Kecheng, Chief President of Fuda Cancer Hospital

In 2008, I met with a long-separated friend, academician Wang Zhenyi, who is the founder of the induction of differentiation therapy. He succeed in treating promyelocytic leukemia with retinoic acid, opened a new chapter in the history of cancer treatment. He said, “We need to make innovations in cancer treatment. Many therapies are novel, unique and scientific but the therapeutic effect is not that good. Why? The point is that the whole body and the immune system are not taken good care of. ” He asked me to seek advice from his student, Dr. Kong.

In May of that year, Dr. Kong and I ran through the streets of Shanghai by a rented car and visited 38 patients who once received a kind of vaccine injection in 1990s. They were advanced cancer patients who were once claimed to be hopeless. We were amazed to find that only 5 out of the 38 patients died of cancer itself and the rest of cancer patients all survived more than 5 years. It’s really difficult to spot each and every patient in such a big city of Shanghai. To find a nasopharyngeal melanoma patient, we managed to check his medical records at a major hospital in Shanghai. The medical record of his first hospitalization in 1991 showed that patient was hospitalized due to nosebleed. Operation record showed that the tumor that was adhered with surrounding structure was 7 cm in diameter. Only 70% of the tumor was resected. He received 32 sessions of chemotherapy but tumor remained the same size. The medical record of his second hospitalization showed that,”After discharge, patient received a kind of immunotherapy. In recent years, patient has been in normal condition until one month ago when patient had nosebleed again. Patient received relevant examinations upon admission and was found to have tumor recurrence.” The New England Journal of Medicine once covered a cancer patient who survived 2 years after receiving T cell-based immunotherapy, which has drawn the world’s attention. It was amazing that the patient we mentioned above should had had survived 12 years with cancer. As academician Wang Zhenyi has said it was the immune vaccine that has played an important role in his long-term survival.  

My visit to Indonesia

In May 2010, Ms. Lin, an ovarian cancer patient from Indonesia wrote to me and shared with me her joy of being able to survive for 7 years after receiving treatment. In 2002, she came to our hospital with her brother who is the owner of a factory in Zhuhai. At that time, her abdomen was distended and the lower abdomen was hardened like rock. She had undergone operation in Indonesian National Cancer Center. During the operation, the tumor was found to be located at the base of the pelvis and had metastasized to ovary, uterus, surrounding lymph nodes and intestines. She refused to receive chemotherapy as she did not want to suffer any more in her 60s. Later, she underwent percutaneous cryoablation and then surgical operation. After treatment, the tumor and metastases were almost completely removed. 
After read Ms. Lin’s letter, my colleague and I could not wait any more to fly to Jakarta and went to Ms. Lin’s home located at the western suburbs of Jakarta. She showed me her latest CT scan report and blood routine test, which showed that all indicators were within normal range.

Later on, I started my 10-day visit that covered a course of 5,000 kilometers in Indonesia. I paid visits to 27 cancer patients who had been treated at our hospital and tried to figure out the secret behind their long-term survival. There were still tumor present but none of them was confined to bed. As most of them are Chinese Indonesian, they hold great enthusiasm and gratitude to me. In a small town that is more than 300 kilometers away from Bandung, an 81-year-old lady who suffered from lung cancer insisted to accompany me to visit 7 patients one by one regardless of the fact that there were still two 
masses in her lung.


          My colleague and I paid follow-up visit to cancer patients who had been treated at our hospital

An old man from Jiangmen

I hold such beliefs that people can live with cancer and cancer is a controllable chronic disease. In August 2012, I led my team to pay follow-up visit to 145 advanced cancer patients, among which 98 were suffering from non-small cell lung cancer (NSCL), 37 were suffering from hepatocellular cancer and 10 were suffering from pancreatic cancer. There were 11, 12 and 1 patients respectively who have gained 3 year or more than 3 years survival time; 5-year survival rate was 7%, 22% and 10% respectively. One lung cancer patient and 2 liver cancer patients gained over 10-year-survival. Though the survival time seemed to be relatively short, all these patients were once claimed to have less half a year’s life expectancy.

Five years ago when I was giving a lesion in Jiangmen, I, at the invitation of the head of the Science and Technology Bureau, went to visit his 87-year-old father in Xinhui that was 5 kilometers away from Jiangmen. Being diagnosed with lung cancer, his father was recuperating at home after being claimed to be untreatable. At that time, I suggested him to receive cryosurgery at our hospital. The tumor was too big to be completely ablated. This time when I was making follow-up visits in Jiangmen, I was told that the old man is still alive. I immediately decided to visit him. He was very happy to see me and showed me his latest imaging slides, which showed there were still few masses in the left lung. But he told me he was very happy to see his great-grandson. The old man, who once served as the director of Jiangmen Pharmatheutical Factory, said with a smile, “I’m a cancer survivor who is able to live with cancer.”

The appreciation from Indonesian health minister

In November 2010, to practice the concept of living with cancer, we accepted a patient whose treatment had a bearing on our national honor. One Sunday, I got a phone call from Indonesia, telling me “to prepare to admit a patient tomorrow afternoon”. The next day, the patient, then health minister of Indonesia, was admitted into our hospital. We wondered why a minister who was in charge of the health undertakings of 300 million populations decided to come to our hospital for treatment. She said, “I’m diagnosed with advanced lung cancer. Time is a luxury for me now. But I still have missions to be accomplished. I want to live with cancer and to make doctors reachable at all villages in Indonesia. ”
The power of will is boundless. The health minister from a foreign land underwent “3C+P” treatment.
With the residual tumor in her body, she never stopped working. In the subsequent WHO conference, she extended her appreciation to Chen Zu, then health minister of China. Hence, health minister Chen Zu praised us for having “created a brand name” and “won honor for the country”. In my opinion, the brand name he mentioned is the concept of living with cancer.

On February 8, 2013, I received an email from academician Tang Zhaoyou, who sent me his New Year greetings to me. He said in the email, “After my visit to your hospital, I have been feeling more strongly that you have blazed a new trail in cancer diagnosis and treatment. In the past, we emphasized that development is of great importance. Now, we would say, transformation is also of great importance. In fact, only by making transformation can we make breakthrough in the cause of cancer treatment. However, there is no end in making transformations. You have broken a new path in clinical research of tumor, which, I believe, will bring benefits to more cancer patients…” Also attached in the email was a photo of academician Tang and his wife Prof. Li Qisong. Prof. Li, my mentor in digestive disease, was diagnosed with breast cancer few years ago. I missed her so much at the sight of the photo.

From left to right: academician Tang Zhaoyou, his wife Prof. Li Qisong, my wife Prof. Ruan Rongling and me

That year, I celebrated the Spring Festival at my home in Shanghai. On the second day of the Chinese lunar year, I visited academician Tang’s home located at Yuyuan Road. The couple who are in their 70s were happy to meet me and offered me tea. Academician Tang introduced to me Prof. Li’s condition: she received lumpectomy; immunhistochemistry showed ER (-), PR (-), HER (+); she received no chemotherapy but two times of Herceptin, which had to be stopped due to severe side effects it had caused. As an expert in traditional Chinese medicine and western medicine, Prof. Li prescribed Chinese herbs for herself. Academician Tang give me a book Clinical Oncology edited by him. Holding the 1987-page great work, I jokingly asked, “Are you treating yourself with each and every method mentioned in the book?” They laughed upon hearing me asking that. Academician Tang said, “Just like the path of transformation I have mentioned, she can be counted as a case of living with cancer.”

 The road of transformation of the academician

In May 2013, academician Wu Mengchao attended the 2nd International Forum on Cancer treatment hosted by our hospital. As a great master in the field of cancer treatment, he is reputed as the father of hepatobiliary surgery in China. He has been paying great attention to the development of Fuda Cancer Hospital as the honorary president of FUDA. He went to visit patients as soon as he arrived at the hospital. He met with an Indonesian patient who was suffering from nasopharynx cancer with tens of metastases all over. In the past 10 years, he has been hospitalized at FUDA for treatment for 28 times. Last year, the hospital held a “Birthday Party” to celebrate his living with cancer for 8 years. As a Malaysian Chinese, Wu Mengchao has special feelings to patients from Southeast Asia. After learned the patient’s anti-cancer treatment experience, he hold his hands tightly, saying “How nice it would be if all advanced cancer patients would live with cancer like you!” The next day, Wu Mengchao, in his 90s, delivered a 40-minute speech with the theme on “making innovations and treating cancer as a chronic disease”.
              In May 2015, academician Wu Mengchao is delivering speech on the 2nd International Forum on Cancer Treatment organized by FUDA

Bill claimed FUDA to be the No. 1 in the world

On April 11, 2015, experts at home and abroad gathered at FUDA for the 2nd (Guangzhou) International Forum on Minimally Invasive Treatment for Pancreatic Cancer. As the organizer of the forum, Guangzhou Fuda Cancer Hospital invited Prof. Vay Liang W. Go (Bill) of UCLA. He is an internationally renowned digestive disease expert who specializes in pancreatic cancer. He is also the only Asian expert in the President's Council on Fitness, Sports & Nutrition in America. We have been acquainted with each other for over 20 years. As an old friend, he always brought me black chocolate, saying eating black chocolate could prevent heart disease. However, his academic persistence has made me realize his rigorousness.

Five years ago when he attended a conference in Guangzhou, I seized the opportunity to present him a paper on cryosurgery for pancreatic cancer, hoping to get it published on the magazine Pancreas, for which he served as the editor-in-chief. He refused my request politely, saying that “Let’s talk about it three years later.” He is a man of his word. Since 2013, 4 of our papers on cryosurgery have been accepted and published in the magazine he serves for. This time, he came to Guangzhou for a conference and paid a visit to our hospital one day early. He visited Huang Guangwen who suffered from multiple endocrine neoplasia, whose case was reported on the magazine Pancreas. Huang Guangwen is a young man from Malaysia and at that time he was serving as a volunteer in the hospital. His case was similar to but seemed to be more complicated than that of Steve Jobs. In 2010, his blood glucose was 1.4 mEq and convulsions and coma attacked him almost every day. After received cryosurgery, he had increased blood glucose instantly and had it maintained within normal range as of today. Though no pancreatic tumor recurrence is noted, masses are still present in the liver, adrenal gland, abdominal cavity and thoracic cavity.

Prof. Bill had been very excited during these days. He checked the medical record of Gurli Gregerson, a pancreatic cancer patient from Denmark. As of now, the patient has survived for 7 years after received treatment at FUDA. He also checked the medical report of a British patient who had pancreatic cancer with liver metastases. The lady was admitted into the hospital in 2013. She suffered from WDHA syndrome which was very rare. She had watery diarrhea for more than 20 times a day. When he was told that the patient was to come back for re-examination, Prof. Bill asked us to arrange thorough examinations for her and write an article about her treatment experience so as to get it published on the magazine Pancreas.

Prof. Bill went to the CT room and watched the process of cryosurgery on pancreatic cancer again before he left Guangzhou. He signaled me to sit down and said to me, “In recent years, I have been keeping a close eye on this hospital. Now, it’s fair to say that the concept of living with cancer you have been advocating is correct.” He also approached Prof. Korpan, a cryoablation expert from Austria and asked him to sit down. He said to me, “You have done an incredible job to do cryosurgery for pancreatic cancer patients and prolong their lifespan. Neither America nor Japan has made it. Your hospital can be said to be the No.1 in the world in this regard.”

As an old saying goes in China, the patterns of shoes don’t have to be the same as long as the shoes fit the feet. The concept of living with cancer takes not only the patient into consideration but also the tumor itself. The concept not only accords with the nature and evolvement of cancer but also meets the expectations and appeal of patients. In the fight against cancer, living with cancer should be the main melody.
                                                                                                    ——Extracted from Living with Cancer  
Xu Kecheng: chief physician, doctoral supervisor, chief president of Fuda Cancer Hospital, former president of International Society of Cryosurgery, laureate of Norman Bethune Medal, laureate of Role Model of the Times, chairman of Guangdong Provincial Light of Life Society for Cancer Rehabilitation, the 5th National Moral Model Award Nominee.


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