1ST DAY ELECTIVE

If in Cork,I had to really focus in order to really understand what the doctors and patients were saying.I thought it would be much easier in Penang,speaking and listening to the mother tongue.I guess I was wrong.The oncology team consists of all chinese and one indian doctors.Sadly,I have to endure listening to some chinglish..no offence,but it is a headache trying to differentiate between R and L.Zelo or zero? And they sometimes communicate in Hokkien to each other,where I only understand bits and pieces.Poor me for not learning the language properly back in school.Fortunately during an audit meeting [which is usually a multidisciplinary meeting in Cork], there were two doctors who don't really speak Hokkien,and they speak English quite well.So the rest of them have to use English as well.And I was grateful for being able to study in Cork,at least my tongue is trained to speak a proper English.

Today, I only knew that head and neck cancer is very common in Malaysia,particularly among the Chinese.They call it NPC [nasopharyngeal cancer].When I first heard of NPC, I thought it was non polyposis coli,a short form of HNPCC...such a terrible thinking =P

Patient with NPC usually presents with nasal bleeding/congestion/discharge,unilateral hearing loss +/- tinnitus and swelling of the neck. When suspecting malignancy,refer to the ENT for FNAC,do not do biopsy as the wound is difficult to heal,plus risk of tumour seeding,especially in salivary gland tumour.FNAC is done using a flexible fibreoptic endoscopy aka nasoscopy? In NPC, the undifferentiated tumour which usually has a worse prognosis,is more radiosensitive.Okay,I have to read more about NPC,that's my homework today.

The most touching scene today was when this 30y/o male Malay patient came in with his wife.He was diagnosed with seminoma 3cm x 3cm but refused to have surgery.His reason - he wanted to wait for his wife to deliver their first baby in October.Dr TAL tried to persuade him by saying that if he undergoes the surgery,he might have the chance to see his child grows up and goes to the university, but if he delays the surgery until it is too late,then he might be seeing his child born but his survival years would not be that long.The man kept on saying that he wanted to postpone the surgery,even after being persuaded by Dr TBS,our head of department.His wife started crying and asked for one more week to decide on this matter.Perhaps that was the way the Malaysian doctors communicate with patients,because if it was me,I'll speak in different way...

Another thing I want to mention here is the Duke staging for colon cancer.A - confined to colonic mucosa, B - breached muscle layers but no spread to lymph nodes, C- spread to nearby lymph nodes and D - distant metastases. For all solid tumours, surgery is the mainstay curative treatment.Chemotherapy follows depending on the tumour residue/outcome of surgery.In Duke A,usually there is no chemo after surgery and there is always chemo for Duke C and D.In the elderly,always check 3 things : anaemia + SOB from PR bleeding, altered bowel habit and reduce amount of stool from obstruction.