“Pinagsakluban ng langit at lupa.” A Filipino idiomatic expression used to describe an extremely unfavorable situation; that life is terrible and cruel.
This very phrase captured exactly what small-scale business Rufino (not his real name) felt after finding out that he had stage 4 lung cancer.
Medical and screening tests were commonplace for Rufino. These tests were necessary after suffering his third stroke in two decades—the first was in 1998, the second in 2015, and the latest one in 2016. Being diagnosed with diabetes also meant that hospital visits and diagnostic procedures were quite routine.
“When I was younger,” Rufino shared, “I didn’t have a care in the world. I let myself go. I was rather overweight and I smoked two packs of cigarettes a day.”
“Fast forward to 1998, I had my first stroke. My doctor took very good care of me. He recommended that I change my lifestyle completely to a healthy one. No more vices, no more unhealthy food.” And so he did as his doctor advised.
Nineteen years later, a second stroke hit. The third one attacked him a year after. It was then, in 2016, that the X-ray of his lung showed the finding that would change his life forever.
The X-ray procedure was only meant to supplement his post-stroke check-ups, but his pulmonologist found an unexpected mass in his lung. Upon discovery, he was referred to a cardiologist, then to a medical oncologist. And after a needle biopsy, it was confirmed that he had advanced lung cancer.
“The patient underwent a biopsy of the cervical lymph nodes because it was the least toxic procedure to diagnose the patient,” said Dr. Katherine Hernandez of St. Luke’s Medical Center, Rufino’s medical oncologist.
“Through this procedure, we discovered that it was indeed a metastasis from the lung. A metastasis in lymph nodes is categorically an advanced stage of lung cancer—stage 4. Fortunately, it did not spread yet to other major organs.”
Dr. Hernandez said that Rufino simply had no idea of the existence of the disease because he had no signs and symptoms. If not for the palpable cervical lymph nodes, the disease would not have been discovered since he was asymptomatic, the medical oncologist explained.
Rufino was, needless to say, shocked. “Cancer na agad (already) after two decades of quitting smoking. I didn’t even have the usual cough symptoms!”
The treatment journey
Despite the sleepless nights after his diagnosis, Rufino made it a point to speak to his medical oncologist about his treatment options in moving forward, saying that “instead of feeling sorry for myself, I chose to be thankful that I was still alive and decided that I’m going to fight.”
“After the work-ups and diagnostic confirmation, I made the decision to offer the patient a combination chemotherapy with the least toxic side effects, with high consideration of him being a stroke survivor,” shared Dr. Hernandez.
The chemotherapy was initiated in January 2017. A chest CT scan was done after every three cycles to monitor progression or regression of cancer lesions. These revealed that the patient’s lung mass continued to decrease in size. The combination therapy continued on for nine more cycles, until another re-evaluation scan revealed that the lung mass had progressed instead of regressed.
“We had to change protocol, and I had to offer another type of chemotherapy with a different technology and supposedly manageable side effects,” related his medical oncologist.
However, the new regimen of chemotherapy affected Rufino’s quality of life quite negatively. After receiving just three cycles, he started to experience alopecia (hair loss), fatigue, nausea and vomiting, malaise, difficulty in breathing, and even hemoptysis (coughing of blood). All these factors almost made him want to give up.
Luckily, Dr. Hernandez had another treatment option in mind for her patient.
“Immunotherapy works to enhance the immune system of the patient to help attack and fight the cancer cells,” she explained. “Right after Rufino consented for the treatment, I gave him the first dose in August 2018. After several intravenous infusions of immunotherapy, Rufino then underwent a PET CT scan. As expected, the results were really promising! The pulmonary lesions had decreased in size.”
And for several more infusions, Rufino soldiered on. “For every three cycles, I had to undergo a reevaluation of my condition, and every time I had a scan,” he says quite proudly, “the doctors would tell me that the mass in my lung got significantly smaller and smaller and smaller.”
“And I got my hair back! I was so excited about that, I even decided to grow a moustache to match!”
A new lease on life
“To date, Rufino has received 16 infusions of immunotherapy, and in medical oncology language, that means his condition has indeed stabilized,” Dr. Hernandez explained, citing her patient’s latest PET CT scan results.
She continued, “There were no longer the side effects like weakness, fatigue, alopecia, and others, which he previously experienced. And even as a stroke survivor, he was stronger, and even walking faster than before.”
“It was empowering to see the positive effects of the treatment on me. Instead of thinking about dying, I was thinking about how I was going to live my life again,” Rufino enthused about the novel cancer treatment introduced to him. “Tumatakas na nga ako at pumapasyal! (I can now go out and travel)!”
Rufino said all these things with a huge grin on his face.
“Now that I have a new lease on life, I want to share the fact that there really is hope against advanced lung cancer!”
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