"Warm humanity blooming from the tip of a cold scalpel." Medical Human Story is a space for vivid hospital narratives and web novel series told by a practicing medical expert. It captures the fierce struggles at the boundary between life and death, along with hidden messages of love and hope. We invite you to this unique space where visions of AI healthcare and future medicine meet creative imagination.
[Medical Human Story]-Time Hidden Beneath the Skin(Episode 51) Red Blooms on the Peritoneum(2)
Get link
Facebook
X
Pinterest
Email
Other Apps
A Record of Adenocarcinoma of the Appendix and Krukenberg Tumour
Part II: A Small Shadow Cast Upon the Liver Surface
The morning of the CT scan, the hospital
corridors were unusually quiet. As I headed toward the
radiology reading room, my steps felt strangely heavy.
Three months ago, a small shade had appeared on the
surface of the liver. Medically, it was labeled
an "indeterminate
lesion," but a doctor’s intuition already knew its name:
Recurrence.
The image flashed onto the monitor.
·Location:
Surface of the right lobe of the liver, 1.3cm nodule.
·Characteristics:
Contrast enhancement pattern, continuity with the peritoneum.
The radiology professor spoke quietly, "It appears to be metastasis. The probability of
recurrent appendix adenocarcinoma is high". I took a slow, deep breath. Her chart still bore
the bold letters:
Appendix adenocarcinoma with peritoneal metastasis,Status
post HIPEC,History
of Krukenberg Tumor
And now, suspected liver surface metastasis.
The Moment of Explanation
In the
outpatient clinic, she looked calmer than before, almost as if she had already
known. "You saw it,
didn't you?" I
nodded. "There is a
small lesion on the surface of the liver. The likelihood of metastasis is high". Her husband asked,
"Is surgery possible?" "Resection
is possible given the location. However, we must also consider the possibility
of accompanying peritoneal recurrence". She spoke slowly,
"So, it’s surgery again". I cautiously added,
"But this decision is a bit different".
🩺
Medical Insight: Characteristics of Liver Metastasis in Appendix Adenocarcinoma
Mucinous adenocarcinoma often presents
as surface metastasis rather than within the liver parenchyma.
It is frequently accompanied by
peritoneal metastasis.
Local resection, when possible, has been
reported to have survival extension effects.
The decision for repeated surgery must
consider the patient's condition and quality of life.
The Multidisciplinary Meeting
Surgery, Medical Oncology, Radiology, and OB/GYN. I presented the case:
"45-year-old female, appendix adenocarcinoma, 6 months post-HIPEC, single
lesion on the liver surface".
The medical oncologist noted, "Observation while
maintaining systemic chemotherapy is an option". Radiology shook their
head: "It is growing". Silence fell. Finally, I said,
"She wants aggressive treatment". The conclusion: Surgical resection + Change in
chemotherapy regimen. But I knew—this was
not a curative surgery. This was a
negotiation with time.
Her Question
"Doctor, do I have to be opened up again?" "Yes. This time, it’s to resect the lesion on the
liver surface". "Is it
dangerous?" "The
scope is smaller than before, but the risk of recurrence remains". She was silent for a
moment. "If I keep
having surgeries... where does it eventually end?" Instead
of answering, I asked, "How far do you want to go?" She
looked out the window. "I want to make
it to my son’s graduation".
The Graduation
The
surgery was postponed until after the graduation. Before meeting her at
the hospital, I happened to pass by the school playground. She had her hat off. Her hair was short
and regrowing; her face was bright. I watched from a
distance. She was smiling—not
as a cancer patient, but as a mother.
🩺
Medical Insight : Quality of Life (QoL) and Aggressive Treatment
Repeated surgeries can potentially
extend survival.
However, complications and recovery time
must be considered.
Decisions centered on the Goal of Care are vital.
Shared decision-making
between the medical team and the patient is essential.
The Second Laparotomy
The operating room lights turned on once more. I entered through the
previous incision line. The peritoneum looked
cleaner than before.
Liver surface lesion confirmed.
·Resection completed.
·Exploration of the surrounding area.
·Two additional small nodules were discovered and
resected.
"I hope this is the last one," I muttered to
myself.
The Pathology Result
·Diagnosis:
Metastatic mucinous adenocarcinoma on the liver surface.
·Finding:
Positive for microscopic peritoneal nodules.
·Status:
Recurrence confirmed.
I closed the chart. Medically, it was
within the expected range, but for the patient, it was the start of another
battle.
A Husband's Tears
In the consultation room, the husband cried first. "When will this
end?" I
spoke slowly, "There is no clear end to the fight against cancer. However,
we can choose the direction". She quietly took her
husband's hand. "We promised not
to be afraid". Those words shook me.
Changing the Chemotherapy
After
consulting with Medical Oncology, we switched to FOLFIRI. "What are the side
effects?" "Diarrhea,
fatigue, and potential hair loss". She nodded. "The hair will
grow back, right?" "Yes". "Then it’s fine". She was simple. She knew exactly what
she needed to live and what she could afford to give up.
🩺
Medical Insight: Treatment Strategy for Mucinous Appendix Adenocarcinoma
Surgery + HIPEC is the primary treatment.
Repeated resection is possible upon
recurrence.
Concurrent systemic chemotherapy.
Consideration for participation in
clinical trials.
My Night
That night, I reread her surgical records alone. Doctors know the
statistics—median survival, progression-free survival. But I can no longer see
her as just a number. She is the mother
smiling at the graduation, the woman cracking jokes in the chemo lounge, and
the person who said she would stand on the "60% side". Looking out at the
quiet night of Cheongju, I realized:
Medicine treats cancer, but
patients teach us.
Recurrence
is confirmed. Treatment continues. But I felt that this
fight was not just about survival rates. She wasn't just
extending her survival; she was extending her meaning. And I was becoming
the chronicler of that journey.
Two
months after changing the chemo, she leaned against the wall as she entered the
clinic. "Are you alright?" I stood up. "Yes... I'm just a
bit dizzy". Fatigue was etched deeply into her face. Hair loss had started again, and her fingertips were
numb. FOLFIRI was never an
easy choice. Her chart now read: Appendix adenocarcinoma,
recurrent with peritoneal and liver surface metastasis. Medically expected;
humanly, an increasingly heavy burden.
The Shadows of Side Effects
"The
diarrhea is severe". "I've lost 4kg". "My legs tingle so
much at night I can't sleep". Blood tests showed
decreased white blood cells and hemoglobin. Chemotherapy attacks
healthy cells alongside the cancer. She smiled and said,
"Doctor, I feel like the cancer, and I are draining away together". I couldn't bring
myself to smile back.
🩺
Medical Insight: FOLFIRI Side Effect Management
Irinotecan can cause severe diarrhea.
Bone marrow suppression increases
infection risk.
Peripheral neuropathy may persist from
previous Oxaliplatin use.
Dose reduction or a rest period should
be considered.
Response of Tumor Markers
CEA
levels rose slightly. CA 19-9 was also on a
steady increase. I closed the chart
after staring at the monitor. She read my eyes. "It's not good,
is it?" "It's
not a distinct response". She nodded. "What’s next,
then?" I
hesitated before saying, "We could consider a clinical trial".
The Choice of a Clinical Trial
"Will
I be a test subject?" she asked calmly. "It is an option
after standard treatments. It’s a combination immunotherapy". Her husband asked about
the effectiveness. I replied, "Response
rates for immunotherapy in appendix cancer aren't high, but long-term responses
have been reported in some patients". She thought for a
long time. "The odds are
low, but there is a possibility". "Yes". "Then I will
stand on the side of possibility". She always answered
the same way.
🩺
Medical Insight: Appendix Cancer and Immunotherapy
Most are MSS (Microsatellite Stable), resulting in low
immunotherapy response.
Response rates increase in MSI-high patients.
Molecular genetic testing is essential
for trial participation.
A Daughter's Letter
That evening, after the clinic ended, she handed me an
envelope. "Doctor, would you
like to read this?" It
was a letter from her daughter:
Mom,
even though you’re sick, I don’t think you’re weak. You’re the strongest person
in our house. So please, just hold on a little longer.
I stopped reading for a moment. Medicine deals with
numbers, but life leaves behind sentences.
The Fork in the Road
CT results: Peritoneal nodules increased slightly;
liver surface lesion remained stable. It wasn't full
progression, but not a clear response either. Medical Oncology
suggested, "At this stage, it's time to discuss stopping chemotherapy and
transitioning to palliative care". I listened quietly. Palliative care. That word is never
about giving up, but to many patients, it sounds like defeat.
Her Decision
"Doctor,
please be honest with me". I took a breath and
said, "The current treatment isn't stopping the disease. It may delay it
slightly, but the side effects will continue". She looked out the
window for a long time. "If I’m only in
pain and only leave behind memories of suffering for my children... I don't
want that". Her husband
whispered, "But... you never know". She took his hand. "We’ve already done so much". Then she looked at me. "Doctor, will you be disappointed if I
stop?" I shook my head. "No. I support
the life you choose".
🩺
Medical Insight: Palliative Care
Stopping treatment Giving up.
The goal is symptom relief, pain
management, and maintaining quality of life.
Concurrent early palliative care
improves QoL.
Stopping Chemotherapy
She stopped the chemo. The hair loss ceased,
and her appetite returned slightly. Though the fatigue
remained, her expression brightened. "Doctor, I’m
going on a trip next month". "Where to?"
"To
see the ocean". I smiled. "That is a
wonderful choice".
The Physician's Turmoil
Left alone in the clinic after she departed, I wondered: How much more aggressively could we have treated
her? Stronger chemo? More trials? Another surgery? But
I was realizing that the goal isn't just to beat the cancer, but to protect the
life. She didn't lose; she
changed direction.
She was no longer a patient being treated, but a
person choosing her time. Yet, I know the cancer
is still there. Another chapter will
eventually come. What will I say
then—as a doctor, and as a fellow human being?
[MHS: Medical Human Story]-Episode 74 Prologue | Part 1 | Part 2 | Part 3 | Part 4 & Epilogue Part I: The Genesis of an Invisible Enemy: When the Body’s Silence Speaks "The human body is a masterpiece of communication, but we are experts at misinterpreting its signals. We call it fatigue. We call it stress. We blame the encroaching years. Yet, beneath the skin, a silent storm can be brewing." We All Think, "It Will Pass" Park Jun-ho, forty-five, was a man who lived by the clock. A routine of morning coffee, the same jazz playlist on his commute, and weekend market walks with his wife defined his existence. His medical history was mundane—a touch of fatty liver, a doctor's recommendation for more fiber. He was a man who rarely saw the inside of a hospital, which made his dismissiveness toward a dull, persistent abdominal ache all the more dangerous. "It’s just a stomachache," he told himself, sipping lukewarm tea. "It will pass by t...
Part I: A Gathering Storm Behind the Silent Peritoneum Cold Night Air and the Mechanical Heartbeat Every time the emergency room’s automatic doors slid open with a harsh, metallic rasp, a gust of sharp night air bit into the room. That chill mingled with the piercing scent of disinfectant and the metallic tang of blood, weaving a strange, palpable tension. The station was a sea of monitors, their screens blinking incessantly with vital signs and spitting out sharp beeps—a cacophony that sounded like the rhythmic heartbeat of a massive, living machine. It was a battlefield where those clinging to the edge of life collided with those determined to pull them back. The Stalker in the Dark: The Radiologist I sat in the deep shadows of the reading room, anchored only by the cool blue glow of the monitors. People often imagine a doctor wielding a scalpel under brilliant surgical lights, but for a radiologist, darkness is the ultimate weapon—the ...
Part II: The Tightening Noose of Time and the Invisible Infiltrator At the End of the Cold Corridor The LED lights in the hallway leading to the Emergency Room felt exceptionally cold and pallid that day. A faint blue glow stretched across the floor, and the entire hospital was enveloped in a dry scent, reminiscent of crisp dawn air. I walked slowly, hands buried deep in my white coat pockets, but my mind was racing. The CT images of Ms. Park Soon-ja that I had just reviewed played on a continuous loop in my mind. It wasn't merely a matter of "inflammation." The real issue was where that inflammation was spreading. Anatomically, the retroperitoneal space is incredibly deep and complex—a labyrinthine tangle of organs, blood vessels, fascia, and adipose tissue. Once bacteria invade this space, they proliferate at lightning speed through invisible channels. I mentally traced the potential paths of infection: Had it descended along the right psoas muscle? Had it...
Comments
Post a Comment