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Stomach cancer: after three biopsies he refused medical treatment: where is the logic?

DS-M906, is a 69-year-old woman from Indonesia. Sometime in July 2009, DS had stomach problems. She consulted an internist at a private hospital in Medan. A biopsy was performed and the result indicated an adenocarcinoma, that is, stomach cancer. After this exam, she DS she decided to do nothing. Her problem intensified and she suffered more pain.

In December 2010, DS went to see another doctor at another private hospital in Medan. A biopsy was performed again. The histopathology result indicated a moderately differentiated adenocarcinoma. Not satisfied, in January 2011, DS went to a private hospital in Penang for further consultation. A CT scan did not show any focal lung lesions. Her abdominal organs were normal. A colonoscopy showed simple hemorrhoids while the rest of the intestines were normal. A biopsy of the prepyloric region was performed. The result indicated signet ring type adenocarcinoma. There was also active chronic gastritis associated with Helicobacter pylorias. In short, for the third time DS had been told that he had stomach cancer.

The Penang doctor suggests two options: DS take medicine or have an operation. DS refused further medical treatment and came to us for help on January 21, 2011. Below is the video recording of our conversation.


Since DS and his children had already made the decision not to have surgery, DS had no choice but to drink our herbal teas. We advised you to reconsider your decision to decline surgery. She insisted that she did not want any medical treatment. One of her children said: “After the surgery, she has to undergo chemotherapy. And we know that’s not what we want to do.”

We asked this question of DS and, in fact, of all the patients. If you have already decided not to have surgery after a biopsy, why do you do one biopsy after another? It is understandable if only a biopsy is done, to determine what went wrong. But what do you hope to get by doing three biopsies?

This is a peculiarity that we often notice among Indonesian patients. They come to Penang, they bring all the money they have. They spend their money on blood tests, x-rays, CT scans, PET scans, biopsies, etc. When told they have cancer and need medical treatment, some simply pack up and go home the next day. Isn’t this spending money unnecessarily? Is there any logic in doing such a thing?

This is our message to the patient: if you do not wish to continue with the medical treatments recommended by your doctor, a biopsy is not necessary. A biopsy is done to confirm if you have cancer so you can move on to the next step, whether that be surgery, radiation therapy, or chemotherapy. If he didn’t want to do any of this, why do a biopsy?

Again we say – before doing a biopsy, ask yourself first: If it’s cancer, do I want to have surgery / chemotherapy / or radiotherapy? If you agree to such treatment, proceed with the biopsy to make sure it really is cancer. But if you don’t want to undergo additional medical treatment as in the case of Down syndrome, why spend so much of your money on the biopsy in the first place?

Of course, some patients say that medical treatments are expensive and they cannot afford them. However, some may say that they refuse medical treatments because doctors cannot guarantee a cure. If these are your concerns, why not ask about costs first or ask for a guarantee before doing anything?