Overcoming fibromyxoid sarcoma against all odds

Jun 5, 2023

Neng (4th from left) and his supportive father, Mr Lim (5th from left), with SJMC's multidisciplinary team, from left; Dr Kenny Cheng, Dr Navinsatku Nithianandhan, Dr Liew Ngoh Chin, and Dr Eng Chee in March 2023 post-surgery.

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Neng would feel tickles down his throat, with itching and frequent coughs. He was unable to lie flat. That resulted in weeks of interrupted sleep and the only way was to sleep sideways with his head propped up. That would have been uncomfortable for most of us. Breathing became increasingly difficult, and his voice became hoarse and fainter by the day. That was Neng at the end of 2022. He was only 26 years old.

Neng was eventually referred to Subang Jaya Medical Centre (SJMC) and diagnosed with high-grade Fibromyxoid Sarcoma on his right neck. Fibromyxoid Sarcoma is a rare form of soft tissue cancer that can affect different parts of the body, such as the arms, legs, abdomen, head and neck regions. It is characterised by the formation of solitary firm mass that can be difficult to detect, and it is often misdiagnosed as other types of tumours.

Due to its rarity and complexity, treating this is challenging for both patients and medical professionals. For Neng, the treatment that will offer him the best chance of cure would be surgery to remove the tumour followed by radiotherapy. No other form of treatment by itself can control the disease effectively.

“Advanced imaging showed that the tumour has encased and compressed the carotid artery, which is the main blood supply to the brain. The cancerous tumour in the right neck also displaced and compressed the airway. The tumour had extended down into the chest, reaching the level of the arch of the aorta close to the heart,” said Dr Eng Chee Yean, Consultant ENT, Head and Neck, Thyroid and Parathyroid Surgeon (lead surgeon).

This posed significant risks due to the proximity of the tumour to major nerves, blood vessels, the airway, and the heart. A failed surgery could mean a coma, stroke, dependence on a breathing machine permanently, or even death. Neng's case was further complicated by the rapid growth of the tumour compressing his airway causing difficulty in breathing and therefore requiring urgent surgery. The patient and surgical team were battling against time.

Despite the significant challenges and the inherent risks of treatment, Neng and his family were determined to fight this cancer. After meticulous planning and informed consent, Neng proceeded to have the surgery.

Dr Eng remarked, “I had to make sure that the tumour was removed completely from the neck without damaging the trachea and important nerves. Despite the complex nature of the case, Neng displayed tremendous courage, and we were determined to provide him with the best possible care.”

The multidisciplinary team comprised Dr Eng Chee Yean, Consultant ENT, Head and Neck, Thyroid and Parathyroid Surgeon (lead surgeon), Dr Kenny Cheng, Consultant Cardiothoracic Surgeon, Dr Liew Ngoh Chin, Consultant General and Vascular Surgeon, Dr Navinsatku Nithianandhan, Consultant Cardiac Anaesthesiologist, and Dr Winnie Ng Nyek Ping, Consultant Clinical Oncologist. This, together with a dedicated team of nurses and operating staff took up the challenge to perform the surgery and successfully removed the tumour without causing any complication.

Neng made a smooth and fast recovery. He is now going through post-operative radiotherapy. He shared, “I would not have made it without the love and support of my family and the skills of the doctors. They saved my life. I want to live my life to the fullest and to travel to Japan once I am fully recovered.” Neng hopes that his story can inspire others who might be battling a rare form of cancer.

He added, “For me, the greatest relief was I could lie down flat again. It's the little things that we take for granted, you know? So, if you sense something is wrong with your body, don't wait. Get it checked. You never know how much time you have left.”

It's the little things that we take for granted, you know? I’m going to live my life to the fullest now.
– Neng, Rare Cancer Survivor