Blood in the stools: Just piles?

No, it was cancer, as one patient found out after dismissing what seemed like symptoms of piles

When Mr Tony Uy went on a business trip to China in 2005, he found that he had blood in the stools. He was surprised but not worried.

“I thought I just had piles, it was no big deal,” he said.

He felt a little faint, a little tired, but continued with the trip, and returned home uneventfully.

A year later, he again found blood in his stools but this time, there was a lot more blood. He had also lost his appetite and his vision was blurring.

That was when he went for a colonoscopy – and found out he had a malignant tumour.

More accurately, his wife and children did – but he was not told of the diagnosis.

His daughter, Mary Jane said: “We were not sure how he would take the news. We didn’t want to be the ones to tell him because we thought it would affect him too much.”

Mr Uy went for surgery to remove the tumour and five days later, he walked out of the hospital. He felt fine and was eager to get on with life. His family, meanwhile, had gotten a second opinion, and knew he needed chemotherapy.

Mary Jane said: “We had to tell him then.”

When he heard the news, the first reaction was fear.

“I was really scared because many of my classmates had died from cancer. I was exploring different options about where to go for treatment – people told me that China was a possibility but I knew a few people who had gone there and did not do well.”

So the family decided on Singapore, on the advice of another Filipino cancer patient, who also had colon cancer.

Dr Ang Peng Tiam, the Medical Director of Parkway Cancer Centre, saw Mr Uy. He said: “Mr Uy presented with stage IV cancer of the colon which spread to the liver. He was brought to see me by his daughter, who heard about me from another Filipino patient. She had been told about the seriousness of his condition by his doctor in the Philippines.” “As there was extensive liver involvement, she was told that he did not have long to live.”

In fact, one of her relatives, a doctor, had told her that her father only had a few months to live. He should remain in the Philippines and spend his time with the family rather than going abroad. She decided otherwise.

Mr Uy had stage IV cancer, a fact which his family kept from him. They asked Dr Ang to tell him.

Dr Ang explained what he did. “The best time to tell patients the actual stage is after they are comfortable with you as their doctor. You must win their trust that you will look after them and that you are capable of handling the problem,” he said.

“When Mr Uy responded to the chemotherapy, I casually mentioned that his cancer was stage IV at the time of presentation. He did not seem to be perturbed by the ‘bad news’ as he was so happy to see his cancer melt away and disappear on the PET-CT scan. I’m not even sure if he remembers or cares that he is stage IV as he is doing so well.”

The front-line programme for stage IV colon cancer, which uses Oxaliplatin with 5-Fluorouracil, has very minimal side effects. Except for some numbness of the fingers and toes, this programme has no other significant side effects.

Mr Uy responded well to treatment with marked resolution of the liver metastases.

Today, he has resumed his normal working schedule, running his family business. The only difference is that he no longer spends late nights out, and does not make so many overseas trips.

He is also teaching his children the skills needed to take over the family business – he has five daughters aged 20 to 31.

Dr Ang said that Mr Uy’s initial dismissal of his symptom as piles is not surprising. “Most patients attribute blood in the stools to be due to piles. I was not surprised that he did not seek immediate medical attention for his problem because there are many who have made the same mistake,” he said.

“My advice for anyone who has blood in his or her stools to always see a doctor for evaluation to rule out colorectal cancer.”

Mr Uy’s last PET-CT scan showed that he was in remission. However, Dr Ang said that at some time in the future, his cancer will develop drug resistance and may progress despite treatment.

“Hopefully, there will be new cancer drugs discovered by then which can offer him another reprieve,” he said.