Saturday, March 1, 2014


    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.   

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