Thursday, February 19, 2015


    It is often stated that the third time is the charm . So when I see some patient who has been married 3 times , and the last marriage has lasted longer than first two, then they say that third time is the charm . Or in many other cases , when first two times there was no success , then trying third time it is said the the third time is charm . But sometimes it is not a charm first or third or may be fourth time . So this a story of my patients  where there was a 'good ' news fourth time in one case and 'not so good' news in other case,.
      I saw this patient sometimes ago for a follow up . He was seen by me for last 10 years or so . About 12 or so years ago was the first time when I saw him He had a mass in his right upper lobe . We did the work up and then he was diagnosed to have a lung cancer. Luckily he was operable and the cancer was resectable . He underwent surgery and the good news was that he did not need any additional radiation therapy or chemotherapy. So we continued to do follow him up and he had no recurrence. But in  2009, he had routine chest X-ray, It was abnormal and so we did CT scan and then it turned out that he had a another cancer of the lung . So 12 years ago we took out right upper third of the lung and now in 2009, we had to take out left upper third of the lung . Again the good part was that we diagnose the cancer early enough that he did not need any additional treatment. So I continued to do the follow up . In 2013 he had some urinary problem and then the work up showed that now he had kidney cancer. He was getting old. He also had some other issues and the renal tumour was small. So the decision was made to treat it with Radio frequency ablation.He did good and the follow up in 2014 , a year down the road, there was no recurrence of the kidney cancer.So he had THREE CANCERS and each time we were successful in 'curring' the cancers.
      But the story does not end there . I did chest X-ray in late 2014 and it was OK . So we decided to do follow up in 6 months . He was having some shoulder pain and so he was referred to an orthopedic surgeon . He did MRI of the spine and shoulder MRI .The MRI showed MASS IN THE LUNG , NOT SEEN ON CHEST X-RAY done 3 months ago . The PET scan was positive and he has new cancer of the lung. He is not a candidate for surgery . So we will end up with radiation and may be chemotherapy . So three times  he had cancer that was cured , but the fourth time ??? not a charm !! 

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