There was a sixty-something man who was diagnosed with brain cancer. He and his wife were apart because he works abroad while his wife took care of their family. One day, he was brought home because he had been experiencing some symptoms which led to his being diagnosed with brain cancer.

The patient went through a rather turbulent course. His symptoms made him debilitated to the point that he was bedridden. His wife unselfishly and patiently took care of him. Every time I would see the patient, his wife was always at his side feeding him, changing his clothes, adjusting whatever needs to be to make him comfortable. Many many times I had to tell her that she needed to sleep, rest and relax because her body was showing signs of exhaustion. But despite this, she always managed to draw the energy to attend to his needs. I was amazed to see how dedicated she was. I don’t know how to accurately describe it but her love for her husband was so palpable and heartwarming every time I visited them.

One day, I had really terrible news to deliver. It was one of the most difficult breaking of bad news that I had to do because I couldn’t bear how this woman might receive the news. As I told her, she calmly listened and naturally, tears started rolling down her cheeks. She was not hysterical but was quite calm. Later on, she broke down into a sob. She told me that she was an adopted child. Her adoptive parents took really good care of her but it was only with her husband that she truly experienced being loved. At that moment, I could sense all her emotions, sincerity and pain as she spoke those words. She told me that it would be extremely painful but that she will try to accept.

Several weeks after our conversation, her husband succumbed and that was the last time I saw her.

Six months later, while I was at the emergency room, a lady approached me whom I couldn’t remember at first. She introduced herself and told me that she was one of the relatives of the couple above. So I naturally asked her how the wife was doing. Her face changed and she told me that a few months after her husband died, she was diagnosed with a terrible illness and died within a few months of being diagnosed. I froze in shock because despite her exhaustion, she did not manifest any sign of being ill at the time that she was taking care of her husband.

She has defied their vow and joined her husband soon after he left.

I have encountered this phenomenon a few times in my practice. The spouse who was left behind often would follow within a year or two of the other spouse’s death. Same thing happened to Christopher and Dana Reeves. Who would have thought that she will be diagnosed with lung cancer?

Their love have defied all odds.

Around 99% of patients with cancer will require a sample of the tumor to be analyzed by a pathologist before a final diagnosis of is made. Even when we highly suspect that cancer is present, we still need confirmation by a pathologist before we can initiate treatment.

The method of obtaining the tumor sample is known as BIOPSY. There are different ways of performing a biopsy namely:

1. Fine needle aspiration biopsy (FNAB) – This is performed on tumors that are easily accessible from the surface of the body such as on the neck or breasts. The physician simply palpates (touches or feels) the tumor then pokes a small gauge needle attached to a syringe and aspirates cells to be sent for analysis. This is a very easy and convenient method of obtaining a sample of the tumor; the pain from the procedure is very minimal. However, the disadvantage is that it may not yield an adequate amount of cells for analysis.

2. Core Needle Biopsy – This is performed almost similar to an FNAB except that a larger needle is used and this procedure obtains a greater amount of tumor sample. It can produce a little more pain that an FNAB but is still very tolerable.

3. Excision Biopsy – This type of biopsy requires a small surgical incision over the area of the tumor. After the incision is made, the entire mass is removed. However, this is only applicable for small tumors.

4. Incision Biopsy – Similar to an excision biopsy, a small incision is also made. However, only a segment of the tumor is removed not the entire piece. This is usually done for larger tumors that cannot be easily removed.

All of the above procedures can be done on an outpatient basis. The patient does not have to be confined in the hospital. The procedure can be done in 30 minutes or less. These four techniques are the most common but may not be applicable to all cases especially when the tumor is located inside the body. There are instances when patients need to undergo major surgery to be able to confirm the diagnosis.

The study found that individuals who did not drink green tea had a five-fold higher risk of developing lung cancer. Smokers who did not drink green tea had a 12-fold higher risk of developing lung cancer. Whether smoker or non-smoker, this study shows that there is a benefit to drinking green tea. This, however, does not give us an excuse to continue with the smoking habit. Intake of any form of supplement, maintaining a healthy diet and lifestyle will never eliminate the cancer-causing effects of smoking on the body.

Breakfast: 1 cup coffee, 3 pcs pan de sal with hotdog and fried egg
Snack: 1 small bag of chips with tetra pack orange juice
Lunch: ½ cup of rice, bangus sinigang
Snack: pancit bihon
Dinner: 1 cup of soup, ½ cup of rice, chicken adobo with 1 glass of iced tea
This type of diet is very common among Filipinos. It is complete with carbohydrates, proteins and fats but very much devoid of healthy fruits and vegetables.

We have all been exposed to the concept of antioxidants. They have been advertised as anti-cancer but they mostly come in pills or supplements.

Fruits and vegetables are nature’s health gift to man. They are packed with so many vitamins, minerals, antioxidants and other substances that are beneficial to the body. Man has been very good at identifying, isolating and synthesizing these antioxidants and packaging them as supplements.

Unfortunately, these supplements will never work in the same way as when they are derived from their original source. Fruits and vegetables, in their natural form contain different kinds of good substances that we have not yet all identified. Taking these antioxidants as individual substances in the form of supplements will never completely take the place of eating fruits and vegetables in their natural form (not the canned variety which is very high in sugar). Taking these supplements will also not undo very poor dietary habits.

The diet above provides calories, the major components of the basic food groups but it is sorely lacking in healthy nutrients and fiber. It also contains a lot of sugar (in coffee, tetra pack juice, pan de sal, iced tea) and refined carbohydrates (pan de sal, rice, chips, pancit) which can cause blood sugar to suddenly spike.

So how can we makeover this diet?

Breakfast: 1 cup coffee, 3 pcs pan de sal with hotdog and fried egg. Add ½ cup tomato and cucumber
Snack: 1 small bag of chips with tetra pack orange juice. Add 1 piece of fruit
Lunch: ½ cup of rice, bangus sinigang. Add 1 pc banana and 1/2 cup vegetables to sinigang.
Snack: pancit bihon. Add 1/2 cup mixed vegetables
Dinner: 1 cup of soup, ½ cup of rice, chicken adobo with 1 glass of iced tea. Add 1 cup lettuce and 1 piece of fruit

Making the above additions to one’s diet increases the servings of fruits and vegetables from 1 serving in the previous menu to 6 servings.

A study done in Finland showed that men who exercised for at least 30 minutes a day decreased their risk of prematurely dying from cancer. The study is published in the British Journal of Sports Medicine.

The subjects were queried about their leisure-time physical activities over a period of 1 year and were subsequently followed up for the occurrence of cancer over a 16 year period.

The reduction in the risk for premature death from cancer was seen in men who exercised for more than 30 minutes every day, and with an intensity that was moderate to high. Examples of activities that can produce this effect are jogging, swimming, rowing, cycling, brisk walking, hiking, dancing, boxing, etc.

What is important to remember is that these activities should be done consistently and should form part of our lifestyle. Exercising regularly should be as essential as eating our meals and not to be done only “when we have time”.

I have been asked several times how we can prevent cancer with expectations that I will be able to tell them with all certainty the answer. Because it is part of human nature to expect certainty, it is no different whenever I am asked about cancer prevention.

We have not yet identified definitively how we can PREVENT CANCER. What we have identified are “Risk Factors” or those things that may increase a person’s likelihood of developing cancer. The evolution of cancer is so complex that it entails many many factors that are beyond our control. Our genes/inheritance, age, gender and certain environmental factors are beyond our reach. However, our lifestyle is one of those risk factors that is well within our control and should be the focus of our risk reduction strategies.

By saying that we have not yet identified how to prevent cancer is not the same as saying that we can’t do anything. Nor should we just live as we please because we will all die anyway. There is a lot that we can do but we have to always keep at the back of our minds, that in the end, whatever happens, a good dose of surrender and serenity is very important.

The choice is ours. As a doctor, I have seen what can happen and I’m telling you that it is very unpleasant. The outcome for all of us if we continue in our current ways is very very ugly, very very uncomfortable and can be very emotionally and financially devastating, not only to the patient but the entire family.

Let’s choose wisely.

There is a stigma attached to patients who are diagnosed with cancer. People automatically think that a diagnosis of cancer is equivalent to being sentenced to die soon even if some patients have better prognoses than patients who have moderate to severe forms of heart disease. People experience fear just by hearing the word cancer.

Cancer is no longer a death sentence. However, the psychological impact of being diagnosed with cancer can still be devastating. Having to go through the long period of treatment can be traumatic and can exert its toll on the physical, social, emotional, psychological, spiritual and financial well-being of the patient and family.

Much of the focus on cancer (and most of the common diseases) now has been on treating the cancer after it is diagnosed. Considerable efforts have also been placed on early detection. However, so much more emphasis should be given to raise awareness about CANCER PREVENTION through changes in lifestyle and we, physicians and patients, should pay very close attention and take the matter more seriously.

Answer the following questions to give you an idea of how detrimental our lifestyles are

1. Do your meals consist mainly of processed carbs (white rice, white bread, white flour) and protein (chicken, fish, beef or pork) without vegetables or only traces of vegetables serving as garnish?

2. Do you lack recommended servings (5 or more) of fruits and vegetables in your diet?

3. Do you consume a lot of cured or smoked meats or fish?

4. Do you consume a lot of sugar on a regular basis?

5. Do you live a sedentary lifestyle without any form of exercise or only very occasionally?

6. Do you smoke?

7. Do you consume more than 1 serving of alcohol per day for women, more than 2 servings for men?

8. Is your diet very high in fat or fried foods?

9. Are you sexually promiscuous especially without protection?

10. Are you always stressed out and harbor a lot of negative emotions?

11. Are you overweight?

12. Do you stay under the sun for long periods without protection?

13. Do you have a family history of cancer?

If you answer yes to any of the above questions then perhaps you need to seriously consider about changing paradigms.

Screening Tests for Breast Cancer

There are different ways involved in our quest to detect breast cancer very early. There is the Self-Breast Exam wherein a woman is adviced to examine her own breasts for the purpose to checking whether a mass is growing but more so that the woman is able to know the feel of her breasts. This makes it easier to detect changes, especially for any new growth.

There is also the annual breast exam by a physician (Clinical Breast Exam). The assumption here is that a physician is more knowledgeable than the patient as to how the growing mass feels during palpation and he is better able to distinguish this new growth from the rest of the breast tissue.

The current gold standard among all the tests for breast cancer screening is the Mammography. This test uses low dose x-ray to examine the breasts in more detail. During this procedure, the entire breast is pressed against 2 opposing plates then radiation is applied. The purpose of this is to evenly distribute breast tissue for proper visualization. The image produced is then captured on a film (conventional mammography) or by detectors before being recorded on a film (digital mammography).

For the general population, the current recommendation is for women to undergo mammography every year once she reaches the age of 40. If there is a family history of breast cancer especially in a first degree relative (mother, daughter, sibling), the patient should undergo breast cancer screening 10 years earlier than the age of the index case (Ex. A mother was diagnosed with breast cancer at the age of 44. Her daughter will be advised to undergo screening at the age of 34).

Expectedly, the group was distraught but something caught my attention which I found truly amazing.

The patient’s daughter’s face was covered by extreme sadness. Tears were running down her cheeks. She was not sobbing but anybody who passed by our space would know that what we were talking about was not very good.

As I was talking to them, the two year old son was as usual playful initially. However, as our conversation went on, the child started to calm down. He suddenly noticed the sadness on her mother’s face. He started kissing her. He gave her one kiss then backed down a little to see the effect it would have on her mother. Then he gave her another one and another one and another one and every time he kissed her, he would look at her response hoping that his gesture would make his mother’s face light up. When he couldn’t achieve that, he looked around with a face that said “Help me! What can I do to make my mother happy again?”.

Up to this day, I can still clearly see the look on the child’s face. I cannot help but be amazed by what I saw. A truly awesome and unforgettable experience!