Sunday, June 10, 2012


      I see many patients with abnormal x-ray. Fortunately many of them turn out to be nothing . , at least not cancer . Most of the times patients have same question, is it cancer . It all most common for patients to use term 'cancer ' interchangeably with ' tumour'.I try not to correct it till I know that it is cancer or not .  So this is a case when we suspected a cancer when we saw the x-ray.
       I saw this 65 years old white male in the hospital for the pneumonia . I had known him from before .He was followed by me in the office. He was a smoker and had continued to smoke in spite of the diagnosis of COPD, chronic lung disease. He was quite obese, and had many other health issues . He was disabled from it. HE had fever and had significant cough, and had coughed up blood. His x-ray showed pneumonia in the middle and lower part of the right lung. We started him on the antibiotics and did CAT scan . The CAT scan showed 'obstructing lesion 'i.e. cancer, per radiologist. So I did a bronchoscopy . During the bronchoscopy , he was quite short of breath and I did see the tumour in the middle lobe of the right lung . I did the biopsy, though they were not great as he was quite short of breath and issues with the oxygen saturation . So I did not want to prolong the procedure too long . The biopsy came back 'no cancer '. I knew what I had seen , i.e. blocking tumour , quite red and some bleeding . So I allowed him to get better on his wheezing and fever to come down . His x-ray was nor better. After about 3 days I did another bronchoscopy and saw again the same tumour, did again the biopsy . This time he was better and I was quite satisfied in the procedure and thought that I will get the diagnosis . Again the biopsy came , no cancer .' With his history , CAT scan findings and my bronchoscopy findings I was quite sure that he had cancer , but I was not getting the diagnosis.  So I decided to ask a chest surgeon to see him and do biopsy through a bronchoscopy under anesthesia . The idea was that with control conditions if he has bleeding or any other problems it could be better handled .
       The surgeon did the bronchoscopy and found the same finding of obstruction, but it was not because of cancer , but it was apiece of 'PEACH ' that was obstructing the middle lobe bronchus , giving rise to the appearance of the tumour. Patient had sleep apnea and also had obesity hypo ventilation syndrome , in which patients do fall asleep watching TV or reading or sometimes even during conversation . He must have fallen asleep during eating and aspirated, --the piece of peach went in the lung. The redness fooled me and it was not cancer so no wonder my biopsies came negative twice.
        He still comes to me , has lost 40 lbs on plant based diet , has cut down on smoking and has no cancer.

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