Finding the Right Cancer Doctor

There are many good doctors one can consult for cancer treatment but Helen made sure she had one with whom she was happy and comfortable with. It took a lot of work to find him but the result is that Helen is now cancer-free...

Helen Layshan McIntosh

My General Practitioner

The first doctor I saw was my family’s General Practitioner. I was going once a year with my family to Florida to get a general check-up and to get tested, as I had a family history of hepatitis and liver cancer.  The doctor kept telling me that my virus level was going up and up but he wasn’t a specialist in gastro-intestinal disease so he kept telling me that I looked good and we didn’t do anything. Then when the viral load was getting higher and higher, he suggested doing an ultra-sound. By that time, they found that my tumour was very big already.

My GP’s advice to me was that there were a lot of liver cancer cases in Asia and the doctors there would have a better understanding of the disease. But we were in America, and so I asked him that if any other American patients came to him, would he suggest they come all the way to Asia? He just scratched his head. I had been going to him for 10 years and, when he did a manual examination, he didn’t spot my tumour because it was at the back of my liver. It was about 6cm and I was wondering how he never spotted it.

I dropped that doctor because he wasn’t a specialist in the field I needed and wasn’t up-to-date. A doctor needs to go to conferences and meetings to keep up with the latest treatments. After that, I consulted the son of a family friend. He was the chief of children’s liver transplants and told me that I should stay in America for treatment. He recommended a liver surgeon who specialised in liver cancer at the University of Florida whom he had recruited when he was a professor at the University of Florida hospital. This surgeon my friend recommended had studied and practiced in Canada where there was a large Asian population and he had much experience in treating primary liver cancer.

The Surgeon

Within two days I had a meeting with this liver surgeon after I went for an additional MRI which he ordered. The surgeon was 45 years of age, I guess, and very direct. He told me my five year survival probability was less than 30%. When you hear you have cancer, you don’t want a doctor who is too old but then you don’t want one who is too young. He told me after he examined my MRI test that the tumour was large and was close to a vein. He made a drawing of my tumour and liver, and to this day I have it framed on my desk. There were two options, we could use embolizations to reduce the size and extend my life or we could do a complicated liver resection and attempt a cure. He recommended the surgery and that is what I did.

Let me say I now know how talented this surgeon is. He is one of the few surgeons in the United States to do both resections and transplants, one of the few surgeons qualified to do transplants on both adults and children, and one of only three surgeons in the world to have successfully done an in-vivo liver transplant.

Eight days later my tumour was removed in a surgery which required seven hours to accomplish. Afterwards the doctor told me he got the whole tumour and there was no evidence of the cancer having spread. He predicted a full recovery.

After that initial surgery, I went back to get tested every six months. But after only one year during a routine MRI scan, two pinpoint-sized suspicious areas were spotted and again I found myself consulting with my liver surgeon. Knowing my case, he recommended a liver transplant as the only way to possibly have a cure. There were other methods, but those would be aimed at life extension, and never offer the possibility of a cure.

To qualify for a transplant, with cancer as the reason for the transplant required a battery of tests to ensure the cancer had not spread outside the liver, and to ensure I was mentally able to accept a transplant. These tests took a month to complete and to my relief, I was declared cancer free in all parts of my body except the liver.

The Head of Radiology

At that time, I wasn’t sure whether I should get the transplant or not. It was a huge turning point in my life. I decided to get a second opinion. My good friend HSH Princess Vudhichalerm Vudhijaya suggested I go to the MD Anderson Centre in Houston where there is a Thai doctor who is the head of radiology. This doctor told me that, for the best result, I should get a transplant. This was the same advice that I got from my doctor in Florida.

I really liked the Thai doctor a lot but I didn’t feel I had a good connection with the liver specialist in Houston. He told me that I wasn’t entitled to get a liver transplant because, according to his tests, I had too many emerging tumours in the liver. He wanted to take it slowly, step-by-step. He suggested I get chemo-embolization through the groin which would target the spots and slow their growth. But I had that done before and although they got rid of the spots I had, they came back nonetheless.

Doctors are very important, even when they are associated to world-renowned medical centres. The doctor at MD Anderson ordered the MRI, but he failed to order the contrast (injecting dye into the liver to highlight tumours). When he read the MRI scan, scaring from my previous surgery showed up as small tumours. I was devastated as I felt I had waited too long for the approval of my wanting a transplant. Upon arrival back in Florida I told my surgeon I had made a mistake in waiting and that I now had too many tumours to qualify — I had the MRI pictures to show him. He shut the door, smiled at me, and asked — did they run the contrast? I said no and he said they made a mistake, I had three very small tumours and I did qualify. I immediately agreed and that afternoon I was put on the liver transplant waiting list. Within two months a healthy liver became available and was successfully transplanted in place of my cancerous liver.

It’s not just luck but by the mercy of God that a liver appropriate for me became available. As an Asian, I was smaller and I got one that fit me from a teenage boy who had an accident. I was able to get one because my body is not that big and the donor’s liver was just right.

The Follow Up

My doctor in Thailand who does the follow-up is a young doctor as well, only about 48 years old. I cannot judge from age but I really like this doctor. I found him through internet research and he works very well with my team in Florida. They agreed on the course of treatment for me and that is very important.

It took only three months and fifteen days from the time they found the three pinpoints to my getting a transplant, but I had to see many doctors.

I dedicate this article to all my doctors:
1. Dr. Max
2. Dr. Alan
3. Dr. David
4. Dr. Souldevilla
5. Dr. Cheng
6. Dr. Sinn
7. Dr. Surasuk

20/01/2011 - 10:11

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