Madam T was a 78 year old Chinese lady who was referred to me with blood in her stools. She also had diabetes, high blood pressure and had previously suffered a stroke.
When I met her, I advised her to undergo a colonoscopy. During this procedure I found she had small polyps in her rectum and left colon which I removed with the colonoscope.
However, this was not the last of her problems.
Cancer In The Colon
The colonoscopy also showed a cancer of the left colon as well as a huge polyp in the right colon which looked very suspicious. The right colon polyp was too large to remove safely with the colonoscope and could only be removed surgically.
I decided to do a CT scan of the chest, abdomen and pelvis just to be sure the cancer had not spread elsewhere.
As polyps can become cancerous over time, I could not leave the polyp alone especially as she had already developed a cancer in the left colon.
To remove the cancer in the left colon as well as the polyp on the opposite side, undergoing open surgery would have meant a long incision from the upper to lower abdomen.
I recommended laparoscopic surgery as this would mean a much smaller scar, less pain and faster healing. Nevertheless, the operation still had some risks due to her age, diabetes, high blood pressure and previous stroke.
She was also on blood thinning medication (antiplatelet drugs) which would increase the risk of bleeding during surgery.
But the biggest obstacle was yet to come.
She Refused Surgery
Madam T was completely against surgery. She was understandably worried and frightened.
She firmly refused surgery although I told her that this could be an early cancer. Her best hope was to remove the cancer through surgery. Untreated, it would most certainly progress, possibly to obstruction or spread elsewhere beyond the reach of any medical help.
Sensing her fear, I decided to keep my silence as I completed her tests including a thorough cardiac assessment.
Finally, I drew her family aside and explained the situation clearly to them. Yes, there were risks including leaks, bleeding and another stroke.
No, I could not promise to deliver an operation without complications but I did promise I would leave no stone unturned and would try my very best to make it as safe as humanly possible. It helped that the daughter had seen me as a patient on an earlier occasion and I had already won her trust.
Madam T finally agreed to proceed after much cajoling from her family, signing the consent form dejectedly.
The laparoscopic surgery was a success. We managed to remove both the cancer and polyp using just a 6 cm long incision. During the operation, we noticed there was no visible spread of the cancer which was a relief!
Soon after, Madam T had a good recovery post-operation without any complications. She was relieved that her surgery went well and was glad she was persuaded to undergo it, despite her earlier misgivings.
She is presently on chemotherapy and there are presently no signs of recurrent cancer.