Returning to Malaysia is not the end of treatment. Once you land, three separate jobs begin: deciding which local doctor carries the clinical decisions, keeping the medicine uninterrupted, and making sure follow-up scans can actually be compared with the scans taken in China. This article sets out all three in order, so none of them depends on luck.
1. Three jobs that are often mistaken for one
The most common confusion is treating “follow-up” as a single thing. It is three, and each is judged on different evidence.
| Job | Who decides | What it depends on | Common mistake |
|---|---|---|---|
| The next clinical decision | The treating doctor in Malaysia | An English handover memo plus a treatment summary | Handing over a pathology report only, with no treatment summary or doses |
| Keeping the medicine going | The treating doctor, based on the Chinese hospital’s prescription | A stamped medication list with dose, cycle and dates | Turning up at a pharmacy with an empty box |
| Comparing scans | The local radiologist, re-read by the original team in China | The original DICOM files and the scanning protocol | Sending phone screenshots or photos of printed film |
One boundary needs to be stated plainly: the platform does not make medical decisions. Our service ends once the handover and scheduling at the hospital are complete. Follow-up after return is carried out by the treating doctor in Malaysia, working from the written guidance issued by the receiving hospital team. The service boundary is set out on the follow-up page.
2. Who is responsible for what after landing
| Party | Responsibility | Not their responsibility |
|---|---|---|
| The treating doctor in Malaysia | Assessing the current condition, ordering follow-up tests and medication, accepting or rejecting suggestions from the Chinese team | Cannot know what happened in China unless given the documents |
| The Chinese hospital team | Issuing the handover memo, the written follow-up calendar, the imaging comparison reading and written opinions | Cannot examine the patient remotely, and does not replace the local doctor |
| The platform | Organising English records, passing requests to the hospital team, helping connect the patient with the local doctor | Does not accompany the patient after return, does not make clinical decisions |
| The family | Keeping the file, keeping the appointment dates, storing discs and reports | Do not need to interpret scan results themselves |
3. Documents you must hold before discharge
Everything below should be requested before discharge, not after you get home. Adding documents from Malaysia later means a cross-border errand for something that could have been settled in a day.
| Document | Language | What it is for during follow-up |
|---|---|---|
| Referral-back handover memo | English | The basis for the Malaysian doctor to accept the case and open a follow-up file |
| Written follow-up calendar | English | Sets when imaging and blood tests are due |
| Discharge summary | English | Regimen, doses, start and stop dates, and complications while admitted |
| Full pathology report (including IHC) | English | The baseline for comparison if treatment has to change later |
| Original DICOM files (CT / MRI / PET-CT) | Files, not printouts | Before-and-after comparison |
| Stamped medication list plus prescription | Bilingual | Prescription renewal and customs checks |
| Last blood results before discharge | English | The baseline for judging change at the first visit |
The rules for carrying medicine home are a separate subject, covered in bringing discharge medication home; the list above is only about continuity of follow-up.
4. The 12-month calendar: what each visit covers
The table below is the usual frame. The written instructions issued at discharge remain the authority — some conditions need scans more often, or extra tests.
| Visit | Focus | Usual tests | Who reads it |
|---|---|---|---|
| Month 1 | Drug tolerance and recovery after treatment | Full blood count, biochemistry, liver and kidney function | The local doctor |
| Month 3 | The first effectiveness assessment | Contrast CT or MRI for the tumour site, tumour markers | Local radiology; comparison by the original team in China |
| Month 6 | Continuity and longer-term side effects | The same imaging plus blood tests | As above |
| Month 12 | Deciding the next phase | Imaging, and whether maintenance treatment continues | The local doctor, with a written opinion from the Chinese team |
The visit most often missed is month 1. It feels unnecessary because the patient feels well, but it is the visit that establishes the baseline for every comparison that follows.
5. How two scans from two countries are compared
A comparison is only meaningful if the technique is close to identical. Two scans taken with different protocols can produce the wrong conclusion even when both are “normal”.
| What needs to match | Why it matters |
|---|---|
| Modality (CT or MRI) | CT and MRI cannot be compared directly for the same lesion |
| Contrast phase | Non-contrast, arterial and venous phases show different things |
| Slice thickness and spacing | A small lesion can “disappear” or “appear” only because the cuts differ |
| Field of view | A whole-body scan and a single-region scan cannot be overlaid |
| Date and interval | Change must be judged against time, not only size |
This is why the original DICOM files are requested rather than film printouts or screenshots: the specialist can adjust window settings, measure lesions, and reconstruct slices in the same plane as the original scan.
When two scans are compared, the categories usually used are:
| Category | Plain-language meaning |
|---|---|
| CR (complete response) | The measured lesions are no longer visible |
| PR (partial response) | The total measurement of lesions falls clearly |
| SD (stable disease) | No fall or rise beyond the defined threshold |
| PD (progressive disease) | Lesions grow, or new lesions appear |
These categories are a comparison tool, not a forecast. The final interpretation rests with the treating doctor, taking account of symptoms, blood tests and the overall picture.
6. Tumour markers are not a substitute for imaging
Markers can move because of inflammation, infection or medication, not only because of the tumour. They are useful as an early signal worth investigating, but a decision to change treatment almost always needs imaging. If markers rise while imaging is unchanged, the sensible step is to repeat the test and discuss it — not to switch regimen on the spot.
7. When the local radiologist and the Chinese team disagree
This happens routinely in radiology and is not a sign that someone made a mistake. Three reasonable steps:
- The local doctor still decides. They are the one examining the patient and carrying responsibility for treatment in Malaysia.
- Ask for a written opinion that references the same images. Make sure both sides are looking at the same DICOM files, not only written reports.
- Repeat the scan on the same protocol if the disagreement would change the treatment decision.
8. Red flags: go to A&E first, do not wait for the appointment
If any of the following happens after you return, get treatment at the nearest accident and emergency (A&E) department first, then notify the Chinese hospital team through the channel you were given:
- Persistent fever, especially with chills or low blood pressure
- Shortness of breath or chest pain
- Continuous vomiting or diarrhoea to the point of being unable to drink
- Bleeding that does not stop, or widespread bruising without a cause
- Widespread rash, blistering, or symptoms resembling an immune reaction after immunotherapy
- Confusion, excessive drowsiness, or reduced consciousness
The order matters: a patient should not wait for a message reply before getting emergency help. Two layers — immediate treatment in Malaysia, then medication guidance from the original team — protect better than relying on a single channel.
9. When the medicine is running out
Renewal needs the original prescription, the medication list and a personal-use statement. It is not something that can be finished in a few days, so stock should be counted a month before it runs out. Never buy through informal channels: medicine of unclear origin cannot be verified, and it can undo continuity of treatment that has already been built.
Frequently asked questions
Can I send only the Malaysian radiology report, without the DICOM disc?
You can, but the strength of the conclusion is lower. If the report is clear and undisputed, it is usually enough. If the decision would change treatment, the original DICOM files are safer.
Do I have to fly back to China every three months?
No. The month-3 scan and those after it can be done in Malaysia, with the results sent to the original team for comparison. A return trip to China is only needed when the treating doctor judges it offers something unavailable locally, such as a procedure.
Will a Malaysian doctor refuse to continue follow-up because I was treated in China?
In our experience, most specialists are willing to continue follow-up when given complete and objective documents. What decides it is not where the treatment happened, but whether the doctor has enough information to make decisions.
How long should the records be kept?
Keep them at least until the first year of follow-up is complete, and longer if maintenance treatment continues. DICOM files should be stored in two separate copies.
This column explains the process, documents and compliance points. It is not advice on diagnosis, and it does not promise any treatment outcome. Decisions on tests, medication and treatment are made by the treating doctor on the basis of an actual examination.
Reference sources
- Ministry of Health Malaysia (institutions and health service information): https://www.moh.gov.my/
- National Pharmaceutical Regulatory Agency of Malaysia, NPRA (medicines and the rules for personal use): https://www.npra.gov.my/
- DICOM standard for medical imaging (DICOM Standards Committee): https://www.dicomstandard.org/
- RECIST criteria for response assessment in solid tumours (RECIST Working Group, EORTC): https://recist.eortc.org/
- National Health Commission of China (medical institutions and clinical technology management): https://en.nhc.gov.cn/