Friday, April 19, 2013


    I see patients with cancer quite frequently . Unfortunately, most of the patients that I see are not resectable .This may be due to various reasons . Sometimes when patients present to the doctor , the cancer has already spread to other organs , making it inoperable . Sometimes patients may have poor lung capacity , so even though the tumor may be resectable , patients may not be in position to tolerate the surgery or resection of the part of the lung . When the patients are  not candidate for the resection , the chance of 'cure ' is very small . The radiation therapy or chemotherapy can not cure the cancer in most cases . I do know some patients that got cured with either radiation or chemotherapy .So many a times patients ask me as to the prognosis . They want to know as to 'how much time ' they have . I am lost for the words . I don't want to take away the hope but at the same time I don't want to lie . And frankly I really can't predict the out come in specific patient, though I am fully aware of the statistic and can easily state what happens to majority of the patients . So I often make a statement . I say that that the cancer is like a family name . They all have similar characteristics . The are bad and they spread and will kill . But as is the case of family name , even though there are common character , not all the family members are same in their behavior . But then in some cases you turn out to be completely wrong .The case that I am going to tell is one such case .
        I knew Mary for long time . She was a smoker and had emphysema . Every time she came to office , she would promise me that she was quitting the smoking .One day she had some belly pain and it got worse . She saw gastroenterologist and he ordered ultrasound of the belly and did endoscopy . The endoscopy was OK but the ultrasound showed that she had masses in the liver highly suspicious for cancer . Her pain was quite severe and she was admitted to the hospital for the pain control .I was asked to see her . Further work up showed that she had multiple nodules in the lung , not seen on plain x-ray , but seen on CT scan , highly likely to be due to spread of cancer . The liver biopsy was done and it confirmed the cancer . They had hard time deciding as to where the cancer originated . But it looked most likely to be from pancreas . She was seen by the oncologist , cancer specialist . She had a port put in for giving chemotherapy . From the complaint of pain to the time that we got diagnosis was less than 2 weeks .She was discharged

       She was readmitted in less than one week , with multiple complaints . When I saw her , her belly looked bigger and she was mildly confused . I did MRI of the brain , and it was OK .She was given fluid and she did get better . Due to the increase in belly sise I did new CT scan of the belly . IT showed fluid in the belly and the liver tumors had increased in  size. This was in less than 3 weeks .  I knew that nothing was going to help . I talked to the daughter and the patient and decided to refer her to Hospice . There was nothing that we could do ,that could change her prognosis .
      She died in next 4 days , less than 5 weeks after the 1st complaint.


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