a miserable young patient with advanced colon cancer

 

Miss D was miserable all her life. She developed epilepsy when she was five, then she had an accident around 12, which significantly impacted her left side. As a result, she lumped and her left arm was slightly twisted, and she cannot completely extend her left arm. Although her epilepsy only caused mild episodes, it was never fully controlled, and she usually had an episode every two weeks. As a disabled child, she only finished elementary school in China. 

 

She has one older brother, who was healthy. He got married and moved out a long time ago. Around 2010, her parents got a chance to immigrate to the USA because of a sibling on her father’s side, and a few years later, she was brought to the USA by her parents.  

 

Although at that time, already in her 30s, she was single, never worked and did not speak English at all, she was elated. Her life was full of hope now, and she had so many plans. She wanted to start learning English online first, and then take a free English class for adults speaking other languages. After she improved her English skills, she would get training, and begin to work, which was something she was unable to do in China.

 

Her parents only had limited English skills, knew nothing about computers, and worked in grocery stores stacking shelves. Although their income was low, they had an apartment and a fair life. As long as the three of them are together, their life will get better and better. 

 

However, fate struck again in her miserable life. She was diagnosed with stage IV colon cancer about one and a half years after she arrived in the USA. When it was first found, the tumor was already the size of an orange and had spread to her rectum, ovaries, uterus and retroperitoneum and caused ascites. Since there was no point to do surgery, her oncologist tried chemotherapy. After 8 rounds of chemo, it was found that her tumor did not respond well to the chemotherapy. Nevertheless, her oncologist did not give up and prescribed radiotherapy. This time, her tumor shrunk after 26 times of radiation treatment. Her response to the radiotherapy was so great, she was qualified for a surgery one year after the beginning of her treatment. 

 

It was a formidable surgery, which took her surgeon 4-5 hours. At the end, the surgeon cut off a large piece of her colon, rectum,  both ovaries and uterus, thus more than 95% of the tumor was removed. In addition, the pathology results showed that the majority (over 90%) of the removed tumor was dead. Although the surgery was considered to be an enormous success, her life after the surgery was still challenging.  

 

First, the surgery left a huge incision in her abdomen, which was infected after the surgery. So a wound vacuum was used to help with the healing, and the dressing  needed to be changed every week by a nurse. It took 8 weeks before the wound vacuum could be removed, and still two unhealed holes were left in her abdomen, but now she could change the dressing herself. Second, since a large piece of colon as well as the rectum were removed from her body, Miss D was required to use an ostomy bag to collect her feces, and this bag will be with her in all her remaining life. Third, her reproductive organs were cut off in the surgery, which of course meant that it was impossible for her to become a mother. Although it was a small sacrifice compared to her life, her mother who did not completely understand the procedure before the surgery was very upset, and cried for it a couple of times.

 

After removal of the wound vacuum, it was time for more rounds of chemotherapy. Although the surgery had already removed more than 95% of the cancer, it could not be completely removed once it spread to retroperitoneum. Consequently, it was impossible for Miss D to be cancer free, but she needed to live with her cancer. To achieve that, she was in need of continuous treatment for the rest of her life.   

 

This time, her oncologist prescribed two drugs. One was a chemo drug and another an EGFR antibody, and the expected side effect was skin rash from the EGFR antibody. Miss D will have one infusion with these drugs every three weeks for a year. The doctor also wanted to cooperate with a biotech company to develop an antibody which could specifically recognize her cancer cells, and a reagent generated from this antibody could be utilized to detect circulating cancer cells from her blood samples, therefore she only need to do a blood test to determine her cancer load instead of a CAT scan every three months. The doctor mentioned if everything was good after this course of treatment, she can be off chemo for a while, such as three to six months. Afterward, they can discuss what to do next again. Her oncologist also referred a neurologist for her epilepsy.

 

Miss D’s parents could not fully understand what living with cancer meant. They eagerly wanted to know when Miss D could begin to work. Fortunately, her oncologist thought Miss D’s condition should qualify for disability benefit, and arranged to have a social worker talking to them. In addition, Miss D has Medicaid which covers all her treatment costs.   

 

At this time, Miss D has gone through multiple treatments for her cancer for more than two years. She suffered so much. However, she never complained and just endured her agony quietly.  She still looked forward to learning more. I really admired her. Life treated her cruelly and she can still have a smile on her face. Her oncologist was also wonderful. He never gave up and did his best to save this miserable, young woman from a poor Chinese immigrant family.