MANILA, Philippines - The battle with cancer is too often a losing struggle, but when both science and the human spirit prevail, the result is a triumphant story of overcoming the odds.
Statistics gathered by the Department of Health (DOH) and Philippine Cancer Society show that liver cancer is the third most common form of the disease among Filipino men and sixth among women.
In the Philippines, the factors that contribute to the development of the disease include alcohol abuse, high incidence of hepatitis A and B, and cirrhosis, a late-stage liver disease. Liver cells may also become temporarily inflamed or permanently damaged by exposure to certain medications as well as exposure to certain chemicals, including some common ones used for cleaning.
A major reason why liver cancer is so deadly is it usually presents no symptoms until the tumor has already spread and is in an advanced stage, making a cure unlikely and treatment only palliative. Initial symptoms like abdominal pain and enlargement, feeling of fullness, loss of appetite, weight loss, weakness and, occasionally, vomiting and jaundice can be easily dismissed as signs of less serious health problems. Thus, most cases of liver cancer are diagnosed late and, consequently, chances of survival are significantly reduced.
But like other forms of cancer, when diagnosed early and treated aggressively, the five-year survival rate for the liver disease improves dramatically by about 30 percent. Recent scientific advances in the field of medicine have considerably improved the prospects of survival for liver cancer patients.
In November 2007, Guan Huan Ang was told he had only three to six months to live. Worse, the doctors could not even tell him what was killing him.
Ang was brought to the hospital, suffering from continuous vomiting, diarrhea, weight loss and pain. Although he underwent a battery of tests, the doctors could not give a definite diagnosis and yet they told Ang, who did not drink or smoke, he would be dead in a few months.
Devastated by the doctors’ pronouncement, Ang started to put his affairs in order, giving away his assets to prepare for the end. He was resigned to his fate until a relative suggested he should seek a second opinion and see if they could at least tell him what the problem was.
The relative recommended Dr. Juliet Gopez-Cervantes, head of St. Luke’s Center for Liver Diseases. With little to lose, Ang entered St. Luke’s in January 2008 in a very weakened state.
Cervantes administered a series of tests and discovered that the patient had a tumor in his right chest and hepatobiliary tuberculosis or liver TB. The physician immediately started treatment and prescribed nutritional supplements to build up the patient’s strength.
Ang was discharged a few months later, way past the limited period that his first doctors told him would be his remaining time on earth.
After three years – eons away from the three months that doctors first said he would last – Ang is a robust 59-year-old looking forward to more years ahead to spend with his grandchildren. His last ultrasound showed that his liver was functioning well and the tumor was gone.
Taking time to give back, Ang was one of the 20 liver patients who shared their inspiring stories of survival in a liver cancer forum held recently, spreading a message of hope to many others.
Another success story is that of young Lauren Therese Maxino who, at only 16 years of age, underwent surgery and chemotherapy in Zamboanga after the doctors found that her ovarian cancer had spread to the liver. But, despite the procedures, the size of the liver tumor remained unchanged.
The doctors in Zamboanga had given up, but Lauren’s mother, also a doctor, did not. The hopeful mother brought her daughter to Dr. Cervantes.
Cervantes suggested radiofrequency ablation (RFA) of liver tumors, a minimally invasive treatment for cancer, although she made it clear to both mother and daughter that the procedure would be very risky, as the tumor was located between the vein and artery.
Dr. Maxino decided she would rather give her daughter a chance to live a relatively normal life than give up. After three months, the girl’s CT scan revealed that the tumor had not recurred.
In the past, radical surgery was the only treatment for liver cancer. RFA is among the latest technologies for treating primary and metastatic (spreading cancer) liver tumors and is now a well-established and safe procedure with very few complications. The versatile image-guided treatment heats and destroys cancer cells, thus making surgery optional. It can be performed in various ways, sometimes even allowing out-patient application.
When used in the liver, RFA specifically targets malignancy like hepatocellular carcinoma, a primary liver cancer, and metastatic tumors such as those from colon cancer. It is both a curative treatment and a palliative option that can prolong survival. The procedure causes only minimal discomfort and may be done with local anesthesia or conscious sedation. Based on records at St. Luke’s, the survival rate of patients who underwent RFA appeared to have improved to about three years, compared to just six to 12 months without the procedure.
Cervantes, who trained abroad in the application of the new mode of treatment, explained, “RFA’s mode of action is similar to that of a microwave oven – heating from the inside out. The liver reabsorbs the destroyed cells over a period of time.”
But the physician, who has performed the most number of RFA procedures in the country, stressed, “Not all patients are candidates for RFA treatment.” She said every patient’s case has to be studied thoroughly to see if RFA or some other procedure was appropriate.
Until a few years ago, cases like Ang’s and Maxino’s would have offered very little hope. Liver cancer is one of the deadliest of all cancers, with most patients dying within a year after diagnosis. Without treatment, the five-year survival rate from the disease is less than five percent. Now, with the improvements in science and technology that are being offered and with trained specialists practicing in the country, the light of hope is brighter and stories of cancer patients can have a happy ending.