77-year-old Zambian man with triple cancers gets new lease of life at Jaslok Hospital

Mumbai: Jaslok Hospital and Research Centre in Mumbai recently treated Mr George, a 77-year-old gentleman from Zambia, who was presented with symptoms of rectal bleeding and constipation. 

Prior to this had undergone a surgery for benign prostatic hyperplasia in 2015, which revealed prostatic malignancy. Due to the complexity of his case, involving multiple overlapping issues, he was referred to Jaslok Hospital for comprehensive management. At Jaslok Prompt evaluation revealed a growth in his large intestine that was diagnosed as a cancer of the sigmoid colon.

During a metastatic workup he was found to have high-grade metabolic activity with circumferential wall thickening in the sigmoid colon, moderately increased metabolic activity in a pericolonic lymph node, and metastasis in a solitary pulmonary nodule in the left upper lung.

At Jaslok Hospital, a multidisciplinary team comprising gastrointestinal surgeons, head and neck cancer surgeons, medical oncologists, urologists, and a nuclear medicine specialist evaluated Mr George. The central question revolved around whether aggressive treatment of the colon cancer in the presence of advanced prostate cancer would benefit him or not? Imaging studies, including a PET scan revealed localised sigmoid colon tumor, localised thyroid cancer and prostate cancer with extensive bone metastasis.

On Prostate-specific Membrane Antigen (PSMA) scan for prostate cancer indicated potential responsiveness to Lu-PSMA radiation therapy despite of extensive bony metastasis with good long term survival. At length on discussion in an Institutional Tumour Board comprising of Dr Shailesh Raina, Director Urology, Dr Mehul Bhansali, Director Surgical Oncology, Dr Vikram Lele, Director Nuclear Medicine, Dr Pravin Agrawal, Sr Consultant GI & HPB Surgery, Dr Vivek Shetty, Consultant GI & HPB Surgery, Dr Ganapathy Bhatt, Consultant Medical Oncology, Dr Rahul Chhabria, Consultant Cardiology and Dr Savi Kapila, Consultant Anaesthesiology a comprehensive plan was devised. It was surgical intervention for Colon cancer and Thyroid Cancer followed by Lutetium PSMA Radiation therapy for Prostate cancer.

On January 6, 2024, Mr. George underwent two major surgeries simultaneously under single anaesthesia monitored by Dr Savi Kapila. A right hemithyroidectomy was performed by Dr Mehul Bhansali, Director Surgical Oncology and Dr Snehal Bhange, Consultant General Surgery, followed by a laparoscopy-assisted sigmoid colectomy by Dr Pravin Agrawal, Senior GI & HPB Surgeon and Dr Vivek Shetty GI & HPB Surgeon.

Despite the lengthy duration of approximately 7 to 8 hours surgery, he demonstrated remarkable tolerance to the procedures. Subsequent to surgery, he was closely monitored in the ICU for any signs of complications. He was mobilized and started on solid diets as per the protocol.

Dr Mehul Bhansali, Director Surgical Oncology opined that “since the patient had a guarded prognosis in view of the extensive skeletal metastasis and lung metastasis from the primary prostatic malignancy as well as a second sigmoid malignancy a consensus decision was taken not to subject the patient for second neck surgery for a completion thyroidectomy. The final histopathology after the hemi thyroidectomy revealed low grade follicular thyroid carcinoma, minimally invasive type.”

Speaking about George, Dr Vikram Lele, Director Nuclear Medicine at Jaslok Hospital said “This patient had 3 malignancies: Of the colon, thyroid and prostate at the same time. PET CT scans with different isotopes helped to characterize these 3 malignancies and map out their spread in the body and to decide which malignancy had spread .

Treatment was also given for the metastatic prostate cancer with Nuclear medicine isotope 177Lu- PSMA. The thyroid cancer will be treated with radioactive Iodine later. Nuclear medicine is thus playing the major part in diagnosis and therapy of this patient”

GI & HPB Surgeons Dr Pravin Agraval & Dr Vivek Shetty said, “Between all three malignancies survival of colon cancer is lesser without treatment followed by Thyroid cancer followed by Prostate cancer. Hence he was subjected to aggressive surgical treatment for colon cancer and thyroid cancer”. George Namakando, was overwhelmed with his treatment and mentioned” I have survived this only because of the complete team of well-experienced doctors at Jaslok Hospital.

They always kept my family updated about every minute detail. I am grateful to all the doctors and nurses who looked after me like a family”. Dr. Milind Khadke, Director at Jaslok Hospital & Research Centre, emphasized the significance of adopting a multidisciplinary approach in managing complex cases like Mr. George's. “Our team of physicians and surgeons collaborated seamlessly, pooling their expertise to formulate a meticulously tailored treatment strategy. This commitment to synergy and comprehensive care underscores our unwavering dedication to meeting the diverse needs of our patients.”

The patient’s departure from the hospital occurred under stable conditions, marking an important milestone in his treatment journey as he prepared to continue his comprehensive care regimen.