7th September 1997

Debulking that growth

The healing cut-9

By Roshan Peiris

The woman was forty-five years old living in the suburbs. The only symptom she had was a back ache for which she had seen many doctors. Finally after many drugs and many doctors, she entered Sri Jayewardenepura Hospital under the care of a physician.

A scan revealed a large tumour on the right side between the liver and the kidney, that was pushing the kidney downwards. It was a very large tumour and when removed it was the size of a husked coconut having spread to the right adrenal gland as a secondary. The adrenal gland is just above the kidney.

The tumour being large the surgeon had to make a big incision vertically from the lower ribs followed by a transverse cut. The incision was T shaped. This type of incision is made, said the surgeon, for large tumours.

Once the abdominal cavity was opened a large lump was detected by the probing hands of the surgeon, lying below the liver and displacing the kidney. It was decided by the surgeon to remove as much as possible of the tumour a procedure which is called Debulking. A tumour deposit was unfortunately seen on the left lobe of the liver and hence that part was removed.

The dyathermy probe was used to burn some of the cancer cells and to make sure that all the bleeding was arrested before he closed the abdomen layer by layer suturing it with nylon sutures.

A drain was kept in the cavity to remove blood which poured into a large glass jar which was more than a quarter full.

Four pints of blood were given to the patient, the blood being contained in a plastic bag and introduced to another large plastic bag and pumped to the body. The large coconut husk like tumour was sent to the pathologist for careful histological examination and to decide on further treatment whether it is to be chemotherapy or radiotherapy. It might even be a combination of both.

The sad part, the surgeon said, is that if this tumour had been diagnosed early the life of the patient would not be in so much danger. When a tumour is large, cure as such is not possible since secondaries arise involving many surrounding organs. Now the surgeon said "we can only relieve symptoms and prolong survival with what is termed palliative treatment.

The operation lasted over two and a half hours. Many of the organs were exposed including the small intestines which lay outside the abdomen.

The primary tumour looking musty lay in a kidney tray and the coconut husk like tumour was the secondary one.

The Sunday Times once again thanks the surgical team led by the Chief Surgeon Dr. Gamini Goonetilleke. The operation was a lesson on the impermanency of life and the possible suffering man is heir to.

It’s cheap and healthy

There is an an cient Chinese proverb "Drinking tea each day will starve the doctor".

Chinese mythology holds that it was the Emperor Shen Nung who discovered the drink - when one day a few tea leaves blew into his bowl of boiling water. The good emperor, having tasted the brew, declared it a considerable improvement over ordinary hot water - but went even further in extolling the beneficial qualities of this new drink that he had discovered.

He imperiously endorsed it as a remedy for fever, chest infection and kidney trouble - and not only the Chinese, but folk all over the world have been drinking and enjoying it ever since. It is the world’s most widely consumed beverage, an estimated one billion cups being drunk each day.

Now a US $4.6 million research study sponsored by the United Nations’ Food and Agriculture Organization is in progress - and the scientists’ preliminary findings seem to agree with the wise one of ancient China. Conclusive proof should be available in 1999, when the scientists submit their final report - but the broad consensus so far is that Tea is going to be proved good for heart diseases and cancers.

Says Dr. John Weisburger of the American Health Foundation, "It appears that some of the components of tea might help reduce the risk of several major chronic diseases such as heart attack, stroke and some cancers." All three types of tea - black tea which we in Sri Lanka drink, green tea which is popular in China and Oolong, a form halfway between green and black tea - contain biochemical compounds called polyphenols. These include the flavinoids, which are a form of antioxidants believed to prevent the cell damage in the human body that contributes to a large number of diseases.

A recent study in Holland showed that men who drank four to five cups of black tea had a 70% reduced risk of getting stroke when compared to those who drank two cups or less. Another study in 1993 showed that higher consumption of black tea was associated with fewer fatal heart attacks.

The key protective factor in tea appears to be the flavinoids. These have been shown to prevent blood platelets from clumping together and forming the dangerous clots which are the cause of most heart attacks and strokes.

Other research on animals has suggested that tea prevents certain cancers, including those of the skin, lung and gut. Here again, polyphenols are thought to be the protective components.

How much tea do you need to drink to get its health benefits? Nobody knows the correct answer, although we may have some guidelines at the end of the FAO’s expensive research project in 1999.

For the present, about four cups per day sounds appropriate.

Scientists are not sure whether adding milk and sugar to one’s cuppa tea reduces the health benefits. Says physician Kevin Jones "One thing that is certain is that the less sugar you take in your tea, the better from the point of view of tooth decay and weight gain. So if it is health benefits that one is after, it is probably better to drink one’s tea "dark and plain" rather than "sweet and blond".

Says Michael de Zoysa, Chairman of the Tea Traders Association, "Today, tea has to compete with a variety of beverages such as beer, coffee and the colas - and it is still the cheapest drink!" So, from the viewpoint not only of cost but also of improving one’s health and longevity, have yourselves a few cups of plain tea each day. The only adverse effect may be, if one believes the old Chinese proverb, that you might end up starving your doctor.

But then - there are quite a few of us doctors who might well benefit by losing a bit of weight!

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