I had written about a case ,where one of my patients had 2 separate lung cancers at the same time . We decided to take them out one at a time . It was felt that she was inoperable as cancer from one side had to go to other side via blood and which means that the cancer will pop up sometimes soon . We did unconventional things and decided to operate one side at a time and we were lucky . The 2 cancers though appear similar in gross way , turned out to be different on tumor markers . The other findings on PET scan were also thought to represent spread of the cancer , but at the time of surgery turned out to be OK . So I was happy .
It has been over 2 years and there was no evidence of recurrence. She was still going to the oncologist . The oncologist decided to to the CT scan . I had done the follow up CT scan on her before and I used to do it without using contrast . This time the oncologist decided to do it with the contrast . Then I had a call from him that it showed nothing new in the lungs , but there was one enlarged lymph node . The location was somewhat odd ,not easy to biopsy. So he did the PET scan . It showed that the node was hot , which meant that it was likely to be due to cancer . I reviewed both the CT scan and the PET scan . There was no question that the node was picked up on PET scan .The previous scans were without the contrast . The contrast does make lymph nodes look more prominent. But in spite of the technical differences I also thought that the node was enlarged. I also could not overlook the high uptake on PET scan .
I discussed this with the patient and her husband . The only option that we had was to do the biopsy.(The other option would be to to do nothing and do follow up CT scan and PET scan in 3 months .)She agreed for the biopsy via bronchoscope . This is somewhat new technique . Through the bronchoscope ultrasound guided biopsy was done . The biopsy showed NO CANCER!
I am pleased with this .But I will do a follow up scan in 3 months . My thinking was simple . The recurrence occurs most of the time in the first year .Some in second year and very few in the 3rd year . It would be very unusual to have the cancer recurrence only in one isolated lymph node without any other areas showing the cancer .
Again I am very happy that the biopsy was OK .But I will continue to do the follow up and hope that logical thinking will pay off rather than looking at the test results as if they are Gospel truth.
It has been over 2 years and there was no evidence of recurrence. She was still going to the oncologist . The oncologist decided to to the CT scan . I had done the follow up CT scan on her before and I used to do it without using contrast . This time the oncologist decided to do it with the contrast . Then I had a call from him that it showed nothing new in the lungs , but there was one enlarged lymph node . The location was somewhat odd ,not easy to biopsy. So he did the PET scan . It showed that the node was hot , which meant that it was likely to be due to cancer . I reviewed both the CT scan and the PET scan . There was no question that the node was picked up on PET scan .The previous scans were without the contrast . The contrast does make lymph nodes look more prominent. But in spite of the technical differences I also thought that the node was enlarged. I also could not overlook the high uptake on PET scan .
I discussed this with the patient and her husband . The only option that we had was to do the biopsy.(The other option would be to to do nothing and do follow up CT scan and PET scan in 3 months .)She agreed for the biopsy via bronchoscope . This is somewhat new technique . Through the bronchoscope ultrasound guided biopsy was done . The biopsy showed NO CANCER!
I am pleased with this .But I will do a follow up scan in 3 months . My thinking was simple . The recurrence occurs most of the time in the first year .Some in second year and very few in the 3rd year . It would be very unusual to have the cancer recurrence only in one isolated lymph node without any other areas showing the cancer .
Again I am very happy that the biopsy was OK .But I will continue to do the follow up and hope that logical thinking will pay off rather than looking at the test results as if they are Gospel truth.
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