Cancer of the rectum,and prostate Holep

[al007]

I am currently in India having just had prostate Holep surgery, this week,  I am awaiting biopsy report from prostate to check for cancer

 

At the same time I had a colonoscopy ( previously a year ago in KhonKaen I also had this done and no apparent problem) but my sixth sense told me to repeat it, the result showed virulent cancer in the rectum, about 14cms length right round the lower intestine in the rectum

 

Unlike the prostate where I had done 18mths research here I know nothing

 

I need to hear from anyone who might be able to advise Bangkok hospitals that can deal with this and what they would do, also cost issues

 

I have a doctor checking out options here in india, probably either Delhi or Bombay

 

I have already this week had a PET CT scan and it has been confirmed at present there is no evidence the  cancer  has spread, it can invade all the body organs, if untreated pretty quickly

 

I consider myself very lucky to have found this at an early stage, for two years plus I had been telling my hospital in KhonKaen I had blood in my stools, and was told not to worry

 

I am 71, and self insure, have some savings but not wealthy so cost is important, SPEED IS ALSO ADVISED ON THIS ONE, and I am  aiming at making and doing what needs to be done in the next week or ten days

 

Prostrate cancer generally is pretty slow growing but this one is NOT

 

I am having a second colonoscopy today, in a couple of hours time

 

I will write more later about my experience and learning on the holep prostate procedures, I have a lot of knowledge to share

 

Thai visa medical forum has provided me excellent advice and information in the past, especially Sheryl

Edited September 24, 2016 by al007

[lopburi3]

Can only provide cost for basic colonoscopy this week at Bangkok Hospital in Bangkok was 19k plus 4k for anesthesiologist and total price for wife without anything needing to be removed was 26k.  This is one of the most expensive facilities.

 

 

[TerryLH]

"...my hospital in KhonKaen ..."

 

Can you tell us which hospital this is?

 

Good luck.

 

Terry

[Sheryl]

Treatment of rectal cancer depends on the stage. You indicate there is no spread to other organs but it is important to also know if it has penetrated beyond the lining of the rectum and if it has spread to adjacent lymph nodes.

 

Stage 0 = has not gone beyond the inner lining of the rectum (i.e. does not invade the rectal wall itself). In that case only removal of the tumor is required with of course close follow up thereafter. The surgery can usually be done via rectal approach without need for abdominal incision.

 

Stage 1 = has grown into the rectal wall but not gone beyond the rectum itself, no lymph node involvement. In this case treatment is also just surgery, with the nature and extent of the surgery depending on the exact location and size of the tumor. Sometimes abdominal incision is needed and other times it can be done via the anus. Usually no other treatment bit with a very virulent grade (which seems to be your case) some doctors might advice post-op chemo. .

 

Stage 2 = the tumor has grown through the rectal wall, may or may not have extended to adjacent tissue, not  yet in the lymph nodes. In that case treatment is a combination of surgery, chemo and radiation, not necessarily in that order (and chemo sometimes twice, before & after the surgery). As with Stage I, type of surgical approach depends on size and location, but unlike Stage I size , since the tumor has grown through the rectal wall it will definitely be necessary to cut out a segment of the rectum/lower intestine. If the anal sphincter was not compromised then this can be followed by what is called an anastamosis, i.e. sewing the lower intestine back onto what remains of the rectum, preserving normal bowel function. If the sphincter was compromised then colostomy can be necessary. Frankly if there is any sphincter involvement and I were you I'd head straight back to your native country as there are some state of the art surgical approaches that can sometimes make the difference between preserving normal bowel function and having a colostomy for life.

 

Stage 3 is same as stage II except that nearby lymph nodes have been invaded, This is often not known until after surgery. Treatment is similar to stage 2 (chemo, radiation, surgery) but the surgery will be more extensive, also removing the adjacent lymph nodes.

 

Here is a good overview  http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-treating-by-stage-rectum

 

I can't tell you anything about treatment options in India. In Thailand, there is an excellent, US-trained colorectal surgeon on faculty at Chulalongkhorn Hospital who has hours at Bangkok Christian Hospital. He is also at Bumrungrad but as you are paying out of pocket you don't want to go there; and, he is also at Chulalongkhorn but seeing him through their after hours clinic, while the least expensive route, might entail waiting time you cannot afford -though no harm in trying that route first to see if you can get a quick appointment.  He is at BCH only on Mondays.

 

http://cop.car.chula.ac.th/chucheep.sa

https://www.bumrungrad.com/doctors/Chucheep-Sahakitrungruang

http://www.bch.in.th/en/doctor-th-4/surgery/item/584-doc22.html

 

Prof. Chucheep is really excellent and you would be in good hands with him.

 

I can't tell you too much about costs other than that BCH would be about half what a place like Bumrungrad would be, and Chula maybe half that again, but the issue is whether you can get a quick appointment with him at Chula. Surgery at a guess, something in the range of 150,000 baht at BCH. Chemo and radiation would depend on exactly what drugs and how many times, and at this stage we do not know if either are necessary for you.

 

If you do need chemo and/or radiation as well as surgery then again, might want to consider returning to your home country for it, especially if you have access to free care there.

[rodknock]

just reading and knowing all the information from sheryl has no price tag and i commend for all the help given!!!!!

[al007]

7 hours ago, lopburi3 said:

Can only provide cost for basic colonoscopy this week at Bangkok Hospital in Bangkok was 19k plus 4k for anesthesiologist and total price for wife without anything needing to be removed was 26k.  This is one of the most expensive facilities.

 

 

Interesting, had second colonoscopy here today, cost ind rupees 3500, or 1700 thai batt, very high quality images and good assessment, however despite local anaesthetic he got me screaming, in Delhi for the same thing but not such a  lear result I paid 8,000 batt

Man who did second one reviewed the one I had done in KhonKaen a year ago, and pointed out very clearly it showed cancer, only problem in Khonkaen they told me no problem do not worry

When I have time I will ask some questions

[al007]

7 hours ago, lopburi3 said:

Can only provide cost for basic colonoscopy this week at Bangkok Hospital in Bangkok was 19k plus 4k for anesthesiologist and total price for wife without anything needing to be removed was 26k.  This is one of the most expensive facilities.

 

 

Bangkok hospital in khonkaen wanted 60,000 batt two weeks ago for prostrate biopsy, did not go there

[Sheryl]

The best medical facility in Khom Kaen is KKU Univeristy hospital (Srindakarind). Though in your case, at this point, I would stick to Bangkok and the surgeon I mentioned.

 

In my experience upcountry private hospitals are best avoided unless a particular doctor you want to see (and are sure of) happens to have hours there.

[al007]

Thanks Sheryl

 

PET CT scan this week i Delhi cost US 300, showed between stage 0 and 1 per , and no migration

 

Sheryls notes

A year ago it was probably stage 0 but they missed it !!

 

Problem now is it very close to rectum so may not be able to cut and join

 

Likely to involve major surgery closing off anus and taking to colomostony bag

 

I an being told major surgery,two surgeons and two anaesthetists, on of them worked in UK for 15 yrs and I think I trust him, also hospital GM seems honest and fair, at RG Stone Goa, big chain small hospital, and two weeks in hospital, I am being assessed on Monday to see if I am strong enough to survive the surgery, I am 71

 

I am told I will be cut from chest to pelvis

 

I am examining Dehli, and Bombay

 

I could go to UK but have no home there or family there, my friends are all dead, so air fares , hotel bills and NHS waiting lists make it an unlikely option

 

In india I may well be able to do at similar cost as going to UK even thought medical free in UK, also in India done on my time scale

 

Have made no decisions just exploring options

[Sheryl]

Again, if it were me - I'd go back to the UK...at least for a consultation to see if colostomy is avoidable.

 

NHS waiting lists should not be an issue in your situation, with a documented aggressive cancer.

 

If colostomy is inevitable then so be it, but if there is a chance that it can be avoided that is worth exploring.

 

I can think of no reason why incision should include the chest. This should be abdominal surgery only.

[lopburi3]

As Sheryl said above and in her post before with even stage 2 to check options in home country and if there is a chance to avoid the colostomy stoma option.  I just had surgery to remove bladder with stage 2 cancer and cut intestine for urine stoma which was over 5 hours on operating table so probably similar major surgery but cut was only up to belly button.   

[al007]

18 hours ago, lopburi3 said:

As Sheryl said above and in her post before with even stage 2 to check options in home country and if there is a chance to avoid the colostomy stoma option.  I just had surgery to remove bladder with stage 2 cancer and cut intestine for urine stoma which was over 5 hours on operating table so probably similar major surgery but cut was only up to belly button.   

Lopburi thanks I will PM you later on the way to another hospital appointment

[al007]

thanks everyone, have followed Sheryls advice and now contacted a couple of her recommendations in BKK also contacted a couple in the UK, on way to another hospital appointment

 

Mayo in USA will only advise after consultation