Retinoblastoma: Ugly like hell

Thursday, September 25, 2008

Neoplasm/cancer or an abnormal growth of cells is longer unfamiliar in this society. It instills fear in anyone who knows how deadly it is, crushing every of your hopes that you have left for this hostile world. Some people would rather have a radical double mastectomy after knowing that they have a high risk of developing breast cancer due to the inheritance of the mutated BRCA1 and BRCA 2 genes, giving up their sex life, begging for survival as helpless as a baby. Have anyone of you all actually thought about how cancer cells look like? For me, if you are speaking in terms of microscopic views, it is gorgeous, captivating. Somehow I find that abnormal cell growth either benign or malignant represents a parasite that has long been residing inside your body, waiting for the right chance and the right time to be released from the surveillance of the body's immune system, and thus ending a life by proliferating out of control.

It all happens in chronological order. First the patient will present to you with an emanciated condition, loosing weight, fatigue, reduced physiological function and etc. Then, as the cells starts to proliferate by having a shorter cell cycles, it denotes the start of a loosing battle. The body's effort to kill off the cells seems futile, day by day, the expansion occurs. Practically till the last breath you could probably gasp.

Yes, cancer cells, you are undoubtedly beautiful and attrative to me. For those that does not catch what I mean, below is a histological cross section of an adenocarcinoma at 10x taken from one of the slide from the histopathology lab.
The irregular architecture of the cells, with features of dysplasia,enlarged/darker nuclei and bizzare rate of mitosis together with a high N-C ratio is bringing out the message that : the battle has just began. Look at it..Isnt it wonderful? Microscopicly i mean, ugly like hell if you consider the consequences of its presence.

Recently, I have the opportunity to meet a patient who is diagnosed with retinablastoma in one of the private hospital in KL. Jason* a 27 year old male presented with distorted facial features is diagnosed with retinoblastoma when he was at the age of 2 ( if i am not mistaken ). Asymmetry of the face was noted with prominent atrophy of the muscles on the left side of his face due to the fact that he undergone a series of chemotheraphy and radiation treatment to kill that cells that apparantly had destroyed one of his eyes causing complete loss of vision on the right eye. Series of chemotheraphy and radiotheraphy have severely damaged the vascularization of the left side of the face resulting in asymmetry and delayed facial bone development. Back at that time, the surgeon removed the eye and arranged plans for him that include a few different modalities of treatment. From then, his life has been totally different from the normal children.

Name of the patient has been de-identified to protect confidentiality.

"Retinoblastoma - (Reh-tin-oh-blast-oma) is a cancer of one or both eyes which occurs in young children. There are approximately 350 new diagnosed cases per year in the United States. Retinoblastoma affects one in every 15,000 to 30,000 live babies that are born in the United States. Retinoblastoma affects children of all races and both boys and girls.

The retinoblastoma tumor(s) originate in the retina, the light sensitive layer of the eye which enables the eye to see. When the tumors are present in one eye, it is referred to as unilateral retinoblastoma, and when it occurs in both eyes it is referred to as bilateral retinoblastoma."

I am here not to talk about the pathophysiology of retinoblastoma but instead to tell you how I feel after i met and talked to him personally. Well, to give a clearer picture, shown below is the actual CT scan of the patient. The scan denotes the deformity suffered by the patient well.

Being a retinoblastoma patient, he did not have the chance to further his education to the tertiary level. From the way he talks, I probably think that he is in denial as he did not even know that he suffered from retinoblastoma after years of theraphies and treatment. The mother who was the one who is doing the talking all the time. From the mother's look, I could understand the feelings that she is going through. Although I did not go through what she has gone through, being placed in a situation like this is unbearable for me. The uncertainty of his future would be the matter that worries her the most I guess.

As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many different emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions, and are part of the process that many parents go through at such a difficult time.

(Retinoblastoma, white color in the center circle of the eye (pupil) when light is shined in the eye, such as when taking a flash photograph)

As a first year meddie, this case do really widen my horizons. Being a doctor or a surgeon does not involve only slicing and cutting. They deal with the quality of life of the patients as well. Jason is completely cured I would say. What he needs is a facial reconstruction to help him regain his self esteem.

When the surgeon asked him what are his current wishes, he said:

"I just want to put on a spec, thats all"

Simple thing like this do touched me. Right till the bottom of my heart I would say. Looking at the doctor and then at the patient. Even as an observer, I am satisfied. Satisfied spiritually. Now I know, medicine is really satisfying. As a doctor, you have a pair of hand that is capable of healing, putting things back into their order. Isnt that a noble thing to do?

Anyway, I am looking forward to the reconstructive surgery that will be held maybe next week. Hope to see him regaining his self esteem after being given a new "face".

Well, this post is getting kinda long and boring. So i think I better put an end to it.

Anyway, I saw a patient with footdrop when I was on my way to uni yesterday morning. He was waddling as he was trying his best to make his foot clear the ground. I suspected it was due to a common peroneal nerve injury. Went to the old folks home today, did a neurological examination on a patient with parkinson. Saw what is pill rolling and shuffling gait all about.

It is so satisfying to tie what you have learnt with what you see.

Seriously, "What you dont know, your eyes wont see", thats rule number one in the world of medicine.

Signing off,


Terence said...

i read this post from top to bottom and i must say... i'm seriously impressed! the way u relate what u've learnt to what u actually see makes me think that u're a meganerd but then again, i wish i could do the same.

hashie said...

"The eyes don't see what the mind doesn't know"

That was the lesson taught to me by Dr Liew, and i try my best to keep to it. =P