The odour of rotting flesh could be smelled as soon as she walked into my consultation room. When she undressed, and after removing the layers of tissue paper, I could clearly see the infected tumour.
Fungus had eaten away most of her right breast and blood oozed out of the fleshy tumour.
'You have very advanced breast cancer and you need to have chemotherapy," I said.
Her head hung down and there was no hint of a response.
'You have seen many doctors and I'm sure they have all said the same thing to you. What are you afraid of? The chemotherapy drugs nowadays are very effective,' I said.
'We have drugs to make sure that you do not suffer. Most of my patients don't even vomit at all," I reassured her.
Still, she sat silently and refused to make eye contact.
'You won't even lose your hair because we have some chemotherapy drugs that do not cause hair loss," I finally said.
Only then did Madam Loh, who is in her 50s, look up. Her response was telling: 'Really? When can I start?"
Some readers may find it hard to believe but this account is true.
Hair loss continues to be one major issue, and reason, why women, and sometimes men, choose not to go for cancer treatment.
Most men, though, are not too bothered about hair loss. The ones who are usually want to keep up appearances or to conceal the diagnosis of cancer from business associates, family or friends.
It is perhaps not the hair loss as such that concerns them but the stigma that is still associated with cancer.
Recently, a 64-year-old Indonesian businessman with advanced lung cancer said to me, 'Who will trust me if they find out that I've cancer? No matter what I tell them, they'll think that I am going to die soon and their money will be gone."
For women, the issue of hair loss is more sensitive. Most would prefer not to lose their hair. They would implore to be put on treatment programmes that do not cause hair loss. There are indeed many chemotherapy drugs that do not cause balding.
(Incidentally this is a question many patients ask: Is it safe to colour and dye hair? My reply: There is no evidence that hair dyes cause cancer.)
In fact, each of the common cancers like breast, lung, colon and rectum have at least one chemotherapy option that does not cause hair loss. This is especially so with the 'targeted therapies" which make use of antibodies to attack certain molecular abnormalities found in these cancer.
Some patients believe that a chemotherapy that does not cause hair loss is less powerful than one that causes hair loss. This is a myth.
Some 'non-hair loss' programmes can be as good as, if not superior to, those that cause hair loss.
Having said that, hair loss is unavoidable in most cancer patients undergoing chemotherapy.
And there are patients who flatly refuse to have any chemotherapy which causes hair loss. We often end up compromising - by using chemotherapy drugs which do not cause hair loss but which may be less effective compared to those that do cause hair loss.
Fortunately, the large majority of patients, despite their initial reluctance, will accept hair loss as part of the inconvenience of treatment once they understand the need for chemotherapy.
My oncology nurses and counsellors often share tips with the patients, such as ways to improve their appearance through the use of wigs, scarves, caps, hats and various headgear. I have even had patients who liked the wig that they used during chemotherapy so much that they refused to give it up even after their hair had grown back.
Hair loss is part of the healing process. I always reassure all my patients that the hair will start to grow back once the chemotherapy is over. And the first crop is often as soft as hair on the head of a newborn baby.
I like to see it as a verdant reminder of new life.
Dr Ang, the medical director of Parkway Cancer Centre, has been treating cancer patients for nearly 20 years. In 1996, he was awarded Singapore's National Science Award for his outstanding contributions to medical research.
This article was first published in Mind Your Body, The Straits Times on Jan 1, 2009.
