​What kinds of symptoms do patients experience before receiving treatment?

Patients often present with abnormal growth or lumps located on the head, neck, or face. This could be due to various reasons, including benign (non-cancerous) or malignant (cancerous) tumors, cysts, lipomas, or other abnormal tissue growths. The size of the tumor or mass can limit vision, speaking, breathing, or the ability to swallow. Some patients may not have any symptoms except for neck lump.

​What is the impact on patients’ lives of living with these conditions?

These tumors can have a profound impact on the lives of patients, affecting both their physical and emotional well-being. These can be due to difficulty swallowing, breathing, pain, and discomfort. The presence of a neck lump often leads to significant anxiety.

What cultural or regional factors affect the treatment of these conditions?

Often the Cambodian preference is to first visit traditional medicine practitioners or spiritual healers, delaying their eventual diagnosis. For the management of neck lumps (often thyroid tumours), an ultrasound scan and guide biopsy (often a fine needle aspirate) is recommended to guide diagnosis. Unfortunately, the fine needle aspirate is not easily available in Cambodia and patients rely on surgery to obtain definitive diagnosis. Some benign tumours (pleomorphic adenoma) are best removed early because in the long run, they can become cancerous.

What does the treatment process look like?

The patient will be seen pre-operatively in the clinic. They will be admitted for at least one night to ensure there are no post-operative complications and relevant blood tests will be taken if required. They will then be discharged home following surgery with pain medication, and antibiotics and followed up as per their diagnosis. For most patients who require excision of a lump for diagnosis, it would require an incision through the skin and identification of important surrounding structures (nerves and vessels) to ensure they are not damaged (unless they are stuck to the lump which sometimes may require either leaving part of the lump behind or sacrificing the said structure), the lump is then removed and sent for histology. The wound is then closed and a drain is inserted to avoid accumulation of blood in the event of bleeding. The drain would then be removed in 24 to 48 hours. Once the drain is removed the patient can be discharged and would come back for removal of sutures in one week and further follow-up once the histology results are obtained.

What is the impact of this treatment on the patient’s life?

The histology from the excision will provide the patient with a definite diagnosis for excluding/including cancer. If it is benign, the patient will be reassured and not require further treatment. If the histology shows cancer, they can be guided and informed about further treatment in the form of further surgery/radiation/chemotherapy if indicated. If the cancer found is still in its early stages, they may not require any further treatment except for regular monitoring and follow up.

What potential side effects or risks come with this treatment?

Risks of surgery include bleeding, infection, pain, damage to surrounding structures such as nerves, and scarring.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

The treatment is offered at other hospitals but the patients often cannot afford the cost of the operation. The patients can present themselves to the hospital, or be referred by previous patients or by other hospitals.

What are the alternatives to this treatment?

The alternative would be a watch-and-wait policy and repeat investigations to check for disease progression but the only way to get a definitive diagnosis is through surgery. Often the Cambodian preference is to first visit traditional medicine practitioners or spiritual healers, delaying their eventual diagnosis. Patients with money and resources may choose to go elsewhere (e.g., Thailand or VietNam) to receive private treatment, often at a much higher cost than CSC.