Friday, January 10, 2014


     I often see patients with possible lung cancer .Unfortunately only 25 %of cases are operable . Even today 'cure' for the lung cancer is possible with surgery and not with chemotherapy or radiation treatment.There are cases when patients get cured with treatment other than surgery .But these are rare cases . So many a times when I have a patient who has inoperable  cancer ,  I do not make a comment on cure , but I talk about the control of the disease .Invariably I get a response   like 'he is strong ' or 'the God will cure ' or 'he is a fighter ' . Even though I know that the cancer is not curable and the patients and relatives know in their heart that the cancer is not curable , they all don't want to state it . But there are exceptional patients . My next patient is one such  patient
    When I saw this 68 years old patient , he was a having persistent cough .He was ex-smoker He had X -ray done and it was abnormal . So he was referred to me The X-ray was suggestive of the lung mass , or lung cancer . I did CT scan of the chest and did the bronchoscopy and biopsy .It confirmed the diagnosis of the lung cancer . Due to the CT scan findings of the spread to the central nodes , he was inoperable. So I told him about it He was quite calm , may be he expected it .He told me that he had ;trust' in Jesus and HE will take care . I told him that the surgical option was out of question and we could do radiation and or chemo . He was ready for radiation therapy and was not very keen on chemotherapy . I sent him for the radiation treatment .
    He completed the treatment and was followed by me and the radiation doctor .We did the follow up CT scans . There were abnormalities , but they were attributed to the treatment and there  was no evidence of cancer .
     I continued to follow him for his cancer which seemed to have been 'cured ' and the CO PD the smoking related lung problem . After 6 years he had new X-ray and it was reported as abnormal . Due to change of insurance it was done at different place . I did do a CT scan .It was abnormal , but there was no major change . I repeated the scan and it was worse . So I did the PET scan . It was suggestive of a new cancer . The additional biopsy showed that he had NEW cancer . The tissue type was different , so he had new cancer . This time he had a cancer that was called small cell cancer. The primary treatment is chemotherapy . So he was started on the chemo . There was no change in his attitude . He was still calm .
     I did the new scans The CT scan was worse and the PET scan showed new uptake on left side . The original scan had shown cancer in left lower lobe , now there was uptake in upper lobe on left . . So I did the bronchoscopy and the biopsy. I saw narrowing of the lower lobe and did the biopsy from that area . I then looked on the right side . There was no abnormality seen on right side on CT scan or on the PET scan . But I saw a small mass obstructing the right upper lobe . I did the biopsy from it . The biopsy did show a different cancer .
     So this was a patient who had inoperable cancer , that got cured and then got new cancer , that seemed to be getting better or gone , and now has new type of cancer .    .

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