Fighting the odds to win

Doctors beat the odds to find the root of Ms Gulieva Tatiana’s cancer

All Ms Gulieva Tatiana wanted was a health check at a hospital. Instead, she received a shocking diagnosis – advanced lung cancer with only months to live.

That was in 2006. The homemaker from Russia had accompanied her teenage son to Singapore for English courses during his summer vacations. They were his yearly study trips, and while he sat in classes, she had time to kill.

So, she decided to take a comprehensive health examination, which included a heart scan and a routine chest X-ray. It would be money well-spent, she thought, as quality healthcare was expensive back home.

Ms Tatiana’s X-ray unexpectedly showed two abnormal shadows, one in each of her lungs, prompting doctors to recommend a CT-scan on the chest.

The initial diagnosis was that Ms Tatiana had advanced cancer involving both lungs, where treatment was usually used to slow the spread of cancer, not cure it. She was started on chemotherapy.

An intrepid Ms Tatiana said she retrieved her medical files and returned to Russia to seek a second opinion from specialists there. She also sought advice from doctors in Japan. One by one, however, the consultations reaffirmed her incurable disease.

Then, a friend, Dr Anjula Thomas, stepped in to recommend her colleagues at Mount Elizabeth Hospital. Desperate, Ms Tatiana returned to Singapore once again.

Dr Lim Hong Liang, Senior Consultant Medical Oncologist, saw the patient first and made the clinical diagnosis of a double primary.

He needed a surgeon who would agree with him about the diagnosis and who was willing to perform the necessary surgical procedures to confirm the diagnosis.

Dr James Wong, a consultant cardiothoracic and vascular surgeon, agreed that Ms Tatiana’s illness was uniquely complicated.

They believed she had two separate lung cancers, arising individually from each lung. Not one cancer spreading to both lungs, as other doctors had earlier concluded.

Dr Lim said: “In situations like this, it is very important to distinguish between a stage IV incurable lung cancer where the cancer arises from one lung and spreads to the other lung via the blood stream, and from two separate early cancers, each arising independently in different lungs.

“Appropriate treatment of the latter can result in cure in a meaningful percentage of patients.”

Now, Dr Wong and Dr Lim decided to re-visit the possibility of a double lung cancer, putting themselves between a rock and a hard place. First, this went against the surgeons and oncologists Ms Tatiana earlier consulted.

Second, their patient would have to undergo invasive procedures for biopsy of the tumours, including a formal open chest surgery under general anaesthesia to obtain tissue to prove she had two different cancers.

At the end of it all, if it turned out that she had the same tumour, Ms Tatiana would have undergone futile procedures and pain.

But Dr Wong, who performed Ms Tatiana’s operations, supported this meticulous approach. For him, this was “proper medicine”.

Surgery was a planned two-stage operation. An open biopsy of the left lung cancer was first performed, and it was sent and examined by the pathologist while the patient was still under anaesthesia.

Once the pathologist reported the cancer cells looked different from what was earlier reported for the right lung tumour, a joint decision was made (again while the patient was under GA) among her husband, Dr Wong and Dr Lim, to proceed to remove the lower lobe of the left lung together with the tumour.

A week later, the cancer from her right lung was removed.

The good news? Both cancers were detected at an early stage.

Three cycles of chemotherapy were given after surgery, to reduce the risk of cancer recurrence.

Today, Ms Tatiana is on a steady road to recovery. She flies here twice a year for health checks and that is not exorbitant, considering she would have spent a similar amount for treatment in Russia.

She recalled: “From the first day, Dr Lim was very concerned. As the tumour was close to the heart, he consulted a heart specialist and warded me on the same day.

“I was very impressed with the way the hospital handled me as a patient and felt my problem was finally understood.”

Most importantly, Ms Tatiana is glad that doctors at Mount Elizabeth Hospital had the confidence to operate on her.

“The verdict changed from a dead end to one that is allowing me to continue my life today.”