GUT FEELING

    I have talked about some of the new things in diagnosis of cancer . I have also done that in my YOU TUBE  video . If you are interested it's under the name JUST A TALK . But sometimes all the tests that one can do may not going to give diagnosis  and sometimes one has to go by old GUT FEELING. So this is one of the stories where I did that . 

   I saw this female patient who had  an auto accident and then she went to ER. They did do some spine X- ray and scans  and that showed a small pulmonary nodule like 10 mm . She was told to see primary care doctor  and she had no insurance and so she decided to wait for 3 - 4 months till she got insurance . She saw PCP and then she was sent to me .She was less than 60 years old  and she had not smoked for 28 years  and had no pulmonary symptoms. The new CT scan had shown that the nodule had increased by few mm . This was in 4-5 months. I did the work up I did the TET scan and also the bronchoscopy  and I also did breathing test. 

   The  Bronchoscopy was negative  and it was not expected to give me the diagnosis but I wanted to make sure that there was no other cause for the nodule. The Breathing test was OK  and the PET  scan showed mild uptake  and radiologist felt that it could be inflammatory . But in addition to that I also did a new blood test called NODIFY . This is a new blood test  and I think it was approved last year . It tests certain proteins in blood and certain other things and that can give a probability of cancer . So One can calculate the probability based on several characteristics of the nodule -like size , location, spiculation, age , sex of the patient and the history of smoking etc. Then  based on the the blood test reports the probability is recalculated  and it may be increased or decreased. Or the test may not change it at all. So this is a new test and it is more than 95 % sensitive. The test was done in this patient. and it was  reported as reduced probability . 

  So we had low uptake on PET SCAN nd reduced probability on this new blood test  and she was not a smoker . So now we had several options. One was to do a needle biopsy which may or may not give diagnosis. The other option was to wait and watch the CT scan in 3 months  and if it grows then do surgery  and lastly do surgery now . I decided to tell patient to do open biopsy or surgery. It was not based on TESTS that we did but it was based on my Gut feeling  and the fact that the nodule has increased and in my mind ANYTHING THAT INCREASES MUST COME OUT.

  She saw a surgeon  and he decided to do needle biopsy and that showed high suspicion for cancer  and so she had surgery and the surgery did confirm Lung Cancer  and she did very well .