Rare Disease: Sweat Gland Cancer

Sweat gland cancer, a rare disease, was reported in global medical literature to have only 48 cases worldwide as of 1976, but it has now emerged in Vietnam. In the southern region alone, there are currently 4-5 reported cases, with the initial symptom being a “hard lump in the skin“.

Currently, besides common cancers such as lung, liver, nasopharyngeal, esophageal, colorectal, and gastric cancers, sweat gland cancer (SGC) may sound unfamiliar! However, in recent years, a very small number of unfortunate patients have been diagnosed with this disease in Southern provinces and cities. If not detected early and treated with appropriate protocols, the risk of death is very high.

Sweat gland cancer is so rare that even some oncologists are surprised when this disease is mentioned…

From a “hard lump in the skin“…

To help understand this condition, Dr. Bui Chi Viet, Deputy Head of the Surgery Department 2 at Ho Chi Minh City Oncology Hospital, has actively helped review the medical records of hundreds of patients over the years.

The stored records show that from 2002 until now, there have only been 4 cases of diagnosed sweat gland cancer. In 2002, there was Ms. Ngo Thi Luong (born 1977, Phung Hiep, Can Tho); in 2003, Mrs. Tran Thi Duc (born 1945, District 4, Ho Chi Minh City); in 2006, there were two cases: Mr. Tran Hong Tho (born 1969, Mang Thit, Vinh Long) and Mr. To Mao (born 1937, Phan Thiet, Binh Thuan).

All 4 cases mentioned above had a “hard lump in the skin” located on the lower leg, thigh (right or left), and shoulder. Among them, patient Tran Hong Tho initially only had a lump on his left lower leg, but after 5 surgeries and 10 rounds of radiation therapy, he finally stabilized during a follow-up visit in March 2007.

For instance, let’s consider the case of a female patient named Nguyen Thi Thuong (born 1952, Tan Thien, Ham Tan, Binh Thuan) who has since passed away and does not appear in the stored medical records of the Surgery Department at Ho Chi Minh City Oncology Hospital. The author of this article sought information about her case from the treating physician and the patient’s family.

Despite treatment, the recurrence rate remains high: 59%

A patient receiving treatment at Department 1 – Ho Chi Minh City Oncology Hospital (Photo: H. Cat)

In September 2001, at the age of 49, Ms. Thuong visited the Ho Chi Minh City Oncology Center (now Ho Chi Minh City Oncology Hospital) with initial symptoms of a lump behind her neck causing pain. Previously, as it was not painful, Ms. Thuong did not pay attention, but shortly after, when the lump swelled to nearly the size of an egg, she began to feel discomfort and severe back pain.

After diagnosis through histopathology, which confirmed the malignancy through biopsy, doctors determined that Ms. Thuong had sweat gland cancer in the back region.

Her family was devastated upon receiving this news, as they had long thought it was just a simple “lump” on the skin and questioned how a “sweat gland” could develop cancer. When they asked the treating physician, they were explained that it was a “rare disease“.

Ms. Thuong was then recommended for surgery followed by radiation therapy. After approximately 4 months of treatment, she was discharged and completely recovered. With her health restored and the tumor fully removed, she felt secure living without it.

Unfortunately, she fell within the 59% recurrence rate… Just three years later, in 2005, she suddenly felt fatigued, lost her appetite, had frequent insomnia, and experienced severe pain in her spine. Ms. Thuong suspected she had spinal spurs but did not find any results upon examination.

What Ms. Thuong did not anticipate was that the earlier tumor, although removed, had recurred and metastasized to the bones. As Dr. Bui Chi Viet noted, once all abnormal tissue is removed, the margins of the specimen must also be carefully examined to confirm that malignant tissue has indeed been entirely excised. If cancer spreads to other crucial body areas (metastasis), surgery at this stage could merely be a “first aid” attempt, if not entirely futile.

Indeed, after returning for a follow-up at Ho Chi Minh City Oncology Hospital, the doctors were still uncertain whether Ms. Thuong still had sweat gland cancer. It was only after conducting a CT scan of the back, costing 1,000,000 VND per session at Cho Ray Hospital, that it was confirmed she had metastatic sweat gland cancer in the bones. At this point, the family requested the hospital to perform surgery in hopes of prolonging her life, but it seemed all too late.

Initially, it was merely a small lump on her back that she paid little attention to, but when it recurred and invaded the bones, Ms. Thuong suffered excruciating pain, completely lost her sleep, and had to rely on strong painkillers like Cyclohexanol 50 mg or Tramadol, a narcotic containing Morphine. This medication is only used under a doctor’s prescription to alleviate severe pain.

At that time, Western medicine seemed to be at a loss… Ms. Thuong was compelled to seek out traditional remedies in hopes of finding a miracle.

However, after more than six months of searching for doctors, trying medications, and outpatient treatment at Cho Ray Hospital and Ho Chi Minh City Oncology Hospital, Nguyen Thi Thuong passed away in May 2006. At that time, her body weight was less than 37 kg!

Nguyen Thi Thuong is noted as the first patient to have died in at least the past five years due to sweat gland cancer in the back region.

Do Quyen