Unresectable

              Cancer stinks. No matter what form or what stage, there is nothing nice about it. We see plenty of cancer here in the highlands of Papua New Guinea: oral cancer from chewing betel nut, rampant cervical cancer, childhood leukemias, lymphomas, breast cancer, colon cancer, pancreatic cancer, and the list goes on. There are many people who we can help, but unfortunately, many of our patients come too late. Sometimes we can identify metastatic disease during the medical work-up, but due to our limited diagnostic capabilities, we often don’t discover it until surgery. The past few weeks have been a discouraging litany of such cases. Our current series started with an elderly woman who presented with an incarcerated umbilical hernia and bowel obstruction. We fixed the hernia through a small incision, but her obstruction did not improve. On re-exploration, she had metastatic pancreatic cancer that involved several loops of intestine.  

              Later in the week, we attempted resection of a large kidney cancer (Wilm’s tumor) in a 10-year-old boy. Unfortunately, the tumor involved the major blood vessels and after a three-hour struggle, we had to abort the surgery. With limited chemotherapy and no radiation therapy options, we were very discouraged that we could not surgically remove his disease. 

The next case was an exploration for a right upper quadrant abdominal mass of suspected gallbladder origin. Instead, we found colon cancer that had widely metastasized throughout the abdomen. 

             This week, I performed a pelvic exploration for complex ovarian cysts and uterine mass, only to find ovarian cancer coating all the pelvic organs including the rectum. 

Most recently, I was consulted on an elderly woman with history of gastric ulcer disease who presented with symptoms of a perforated ulcer. At surgery, we discovered gastric cancer that had perforated through the mesentery of the transverse colon. 

              Even more discouraging than finding unremovable cancer is the conversation with the family and the patient once they wake up from anesthesia. There is no easy way to break the news that the patient has a terminal illness. Palliative care is all but nonexistent here. Fortunately, we know that death is not the end. We can point patients to the hope found in Jesus and help them prepare for eternity.