A TCM Case: Managing Mr. Wang, an Early Gastric Cancer Patient
Mr. Wang, a 67-year-old farmer from Shanxi province, was a patient with early gastric cancer.
On May 28, 2021, the patient’s daughter first sought my help via video, telling me that her father had suffered from painful swallowing and fatigue for more than three months. Two days earlier (May 26, 2021), he was examined at the local county hospital (Shouyang County People’s Hospital, Shanxi). Gastroscopy (electronic gastroscopy no. 2021530, Shouyang County People’s Hospital) showed: near the cardia at the gastric fundus, the mucosa was pale in color and the folds were stiff; on the posterior wall an irregular ulcer of 2.5 cm × 2.5 cm was visible, its surface covered with a thick yellow coat and filth, blood scabs, and a little oozing of fresh blood. The ulcer infiltrated outward, and the surrounding mucosa showed nodular elevated hyperplasia. The six biopsy specimens taken were extremely poor in elasticity. Pathology showed: (gastric fundus) high-grade intraepithelial neoplasia of the mucosal glands, with focal carcinomatous change. The doctor diagnosed early gastric cancer and varioliform gastritis, and recommended further treatment.
The patient also had mildly elevated triglycerides and blood glucose; the rest was basically normal. His daughter hoped I could give the family some treatment advice. Judging from my experience, this was likely early gastric cancer, the depth of infiltration was not yet great, and the surgical cure rate was high; the optimal treatment was surgery. I therefore advised the family not to rush into using anti-cancer Chinese medicine, but to quickly choose a good hospital and surgeon and arrange the operation. During surgery they should try to choose good-quality imported staplers rather than cheaper, lower-quality ones, to avoid later postoperative complications such as anastomotic inflammation. Further decisions could wait until the postoperative pathology report came out.
After learning that the patient might have gastric cancer, the family’s anxiety and fear were understandable; they were terrified that while waiting for surgery the cancer would progress rapidly and they would lose the window of treatment. I therefore explained the relevant facts about gastric cancer to them, telling them that early gastric cancer does not progress as fast as they imagined, that using anti-cancer Chinese medicine before surgery is of little benefit, and moreover that taking anti-cancer herbs with blood-activating and stasis-resolving action carries the risk of promoting hematogenous spread of the cancer. If they insisted on taking Chinese medicine, they could consider some symptomatic, supportive herbs to address the patient’s clinical symptoms.
To avoid frightening the patient, the family decided to conceal his condition from him for the time being, and asked me to prescribe some medicine via video call to treat him before surgery. I felt that in this situation what the patient and family needed most was psychological counseling and professional advice; moreover, to prevent poor treatment compliance later when the patient was kept entirely in the dark about his condition, it was necessary to have a talk with him. I therefore agreed to the video consultation.
During the video consultation, I learned further details: pain in both shoulders for over half a year, chest pain for more than two months, cough for over half a month with yellow sputum. Long-term dry mouth, but no bitter taste. He had smoked and drunk for decades, and was especially fond of alcohol, frequently binge-drinking when young. Stool occasionally dry and hard, mostly normal; urine clear in color. Not averse to cold, not afraid of heat; able to sweat, but not profusely. Aching soreness in the left hip for about a year. Diet average; no particular craving for salty food. He ate few pickled vegetables, but over the last four or five years he had taken up fishing, kept irregular meals, and lived on instant noodles and ham sausages while fishing away from home. Recently he had a sensation of obstruction when swallowing food.
The family described the patient as extroverted, cheerful, emotionally expressive, quick-tempered and easily irritated. He liked playing mahjong and gathering with friends to chat and drink; he had been hot-tempered when young, but was much better now. His father had died at 62 of an undiagnosed lung disease; most of his father’s direct relatives had respiratory diseases. His mother had passed away at 82 without illness. His younger sister had died of uterine cancer at 48; his second elder sister had heart problems and had undergone three cardiac stents; his eldest sister was in good health.
During the conversation I told the patient that his reports suggested a possible precancerous state, that the ulcerative lesion in the stomach could very likely lead to gastric cancer, that surgery was needed, and that after surgery he would still need a longer course of integrated Chinese-Western internal-medicine treatment to prevent carcinogenesis. I hoped this talk would make the patient take his condition seriously and lay some groundwork for later, when it might be necessary to tell him the truth.
The patient’s whole family was highly receptive to TCM and wanted to begin Chinese medicine treatment immediately. I agreed to treat him, but told him that after taking the herbs all his clinical symptoms might well disappear—yet the disappearance of symptoms would not mean the disease was cured; he still had to undergo surgery to remove the lesion and follow up with me for a period afterward.
Based on his symptoms, I prescribed: Dangshen (Codonopsis) 18 g, Tiandong (Asparagus root) 12 g, Sheng Zheshi (Raw Hematite) 24 g (decoct in a bag), Xuanfuhua (Inula flower) 10 g (decoct in a bag), Fabanxia (Processed Pinellia) 10 g, Roucongrong (Cistanche) 12 g, Zhimu (Anemarrhena) 15 g, Dangguishen (Angelica body) 10 g, Shidi (Persimmon calyx) 10 g, Zhuru (Bamboo shavings) 10 g, Dingxiang (Clove) 6 g, Gegen (Pueraria) 30 g, Xuanshen (Scrophularia) 12 g, Zhebeimu (Fritillaria thunbergii) 12 g, Sheng Muli (Raw Oyster shell) 30 g (decoct first), Xianhecao (Agrimonia) 50 g, Banzhilian (Scutellaria barbata) 30 g, Baihuasheshecao (Oldenlandia) 30 g, Shandougen (Sophora tonkinensis root) 10 g, Chao Maiya (Fried barley sprout) 30 g, Shihu (Dendrobium) 15 g, Huangjing (Polygonatum) 15 g, Xiaoji (Cirsium) 20 g, Shiwei (Pyrrosia) 30 g, Tengligen (Actinidia root) 30 g.
Three doses, one dose daily, decocted in water, taken about one hour before breakfast, lunch and dinner. Avoid spicy, greasy food, tobacco and alcohol, grilled food, hotpot, beef and mutton, scalding-hot food, and hard, difficult-to-digest food. I advised a meat-to-vegetable ratio of 2:8 to 3:7.
After three doses, sure enough, all clinical symptoms eased, and there was no longer a noticeable obstructive sensation when eating—this is where symptomatic Chinese medicine shows its strength. Because the initial visit was effective, the patient and his family built confidence in me. Confidence in a doctor built on actual therapeutic effect plays a very important role throughout treatment, because it gives the patient high adherence to the doctor’s future plans. This is why so-called “doctor-patient affinity” often hinges on the effect of the first prescription.
Because before prescribing I had already told the patient that his symptoms might quickly ease or even disappear, but that symptom relief would not mean cure of the disease, he did not, after the herbs eased his symptoms, abandon the idea of surgery. Such advance warning is crucial, because I have also encountered patients who, after Chinese medicine improved their symptoms, wrongly concluded that their cancer could be cured easily and then refused surgery.
Oncologists must constantly refine their art of consultation in order to serve patients better. That is why I write this article: the emphasis here is not on how to use drugs, but on how to counsel patients and give them correct treatment advice. Some inexperienced TCM physicians, when receiving cancer patients, often fail to think things through, causing many thorny problems later in diagnosis and treatment. These issues must be anticipated at the initial encounter; we need the patient’s understanding and cooperation throughout the course of care, so communication during the first consultation is extremely important.
Cancer is a special kind of disease. Many people collapse mentally upon learning that they or a family member has cancer. In the course of diagnosis and treatment, the oncologist must take the psychological factors of the patient and family into account and offer appropriate emotional comfort and correct guidance.