The modern day medicine is complicated.The things were simple when we used stethoscope and did not have Ct scan, PET SCAN and many more cardiac tests and so on.In the past we used to diagnose cancer and there were limited therapy and we did it. Now a days we have tumor markers and specific chemo for different types of markers and mutation and so we need more tissue to diagnose and then we use different treatments . I do believe that the treatments are more specific for particular type of cancer and certainly that is much better . But how much it has changed the final outcome is to be seen. ( I know that patients are living longer for sure but not sure how much longer NOW with inoperable cancer than they did in PAST) That brings me to the story for today.
I had seen this male patient may be 16 months ago.He had chest pain and he was worked up and I saw him and my work up showed that he had cancer of the lung. Based on the PET SCAN and other things he was thought to be not operable candidate and I would not go in to the details of the reasons why he was not operable. But he was sent to radiation doctor and also oncologist.He was treated and he did OK . He did not see me for almost a year . Then he showed up as he was short of breath. I asked him as to what was the status of his cancer . He told me that the doctors have told him it is gone. I had hard time believing that as he had fairly large tumor and the chance that he would be cured was small. But he and his wife were convinced that he had no cancer now. I did the work up and treatments . He had wheezing and so I started him on steroids and also inhalers and neb. treatments. I also asked him as to when was the last CT SCAN or Pet scan and he had last CT scan 5 or 6 months ago. So I decided to do new CT scan. He came for the follow up and he was feeling much better , still some shortness of breath, but much better . I had also tested oxygen level and he was started on oxygen and overall he was better .But the CT scan had shown that the mass had grown . So he had mass or cancer when I saw him and then he had treatment and the new scan had shown the mass to be smaller . Now the new scan showed it to be bigger . I told him to see the cancer doctors and did not do any new biopsy. He went to see them and then he had an episode of coughing up blood . It was small amount and cleared without any treatment. The radiation doctor called me and wanted me to do bronchoscopy. I did it and he had significant abnormality but that I thought was due to radiation and may be treatment. I did do biopsy and all came back negative for the cancer . But the SCAN was definitely showing increasing in mass.
He came to me for follow up and I told him that even though the biopsy was not showing cancer, I was convinced that he had recurrence of the cancer. Certainly most of the time people don/t want to believe that they have recurrence without the proof. For me the increase in size of the mass was indicative of the cancer and in this patient who had inoperable cancer, this was easy to see.He went to his cancer doctors and they wanted more proof . With radiation given to the area where the cancer was diagnosed, the needle biopsy may not get tissue as there will be changes related to radiation and so we may not get the diagnosis by such biopsy. The open biopsy in my mind is futile as the surgery is not curative surgery and will not add to the treatment of cancer. So I would consider treatment for the cancer which was treated and not taken out, under presumption of recurrence .
SO SIMPLE FOR ME BUT COMPLICATED !!
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