Sunday, November 20, 2016


    I have often said that medicine is nothing but statistics, at least on day to day diagnosis and treatment. When we tell patients that you have bronchitis or pneumonia or even for that matters high blood pressure and we will treat 'it' this way or that way, we are using statistics. We don't know if the antibiotic that we are using is going to work in EVERY CASE or the blood pressure medicine that we selected is going to be the 'right' one for him or her . But we know that in 'majority ' of the cases 'it works' and so we use it. But there are exception to the rules or the statistics.These are the patients or the conditions that defies the all the odds.This is one of those stories.

        I saw this patient who was 75 years old. He never smoked and had no major problems other than high blood pressure. He had history of renal stones and so when he had pain in the belly, he went to ER.He had CT scan of the belly and it showed the stone, but somehow he passed it. But in doing the CT scan of the belly we include some lower part of the lungs and vise verse. So in the lower part of the lungs they saw a nodule. This was at the edge of the lung. So then he was sent to me . He then had a dedicated CT chest and it confirmed the nodule. There were no additional nodules or any other abnormalities.
     I saw him . His had no complaints and his lungs sounded clear. He had no swollen glands. So He had PET scan and it showed very low uptake. This meant the chance of cancer was quite low. He was quite concerned. So I did bronchoscopy. It was negative and no infection was there and  no cancer cells were seen. But I did not expect it to be positive as the nodule was way out of my bronchoscope reach. But there was about 6weeks between the Ct scan of the belly and the PET scan. The size of the nodule had gone down by 2 mm. He was quite concerned. So I sent him to a chest surgeon. The chest surgeon saw all the scans and the reports and felt that the possibility of cancer was very very low and advised to repeat the CT scan in 3 months. He came to me for follow up after the visit with the surgeon. He was quite anxious. I told him the criteria that we us and the chance of cancer in nonsmoker and with slight decrease in the size and negative PET scan uptake ---which is extremely low. But I realize that he was still concerned.
    So I spoke to radiologist . The radiologist told me the same thing , the chance of cancer was low and we should do follow up CT scan . But with the patient's anxiety , I asked him to do the needle biopsy. He agreed. So he had the biopsy.

     So here is a guy . who never smoked which makes his 'chance' of getting lung cancer 20 times less than smoker. He had slight decrease in size , again making the chance of lung cancer less likely. The PET scan was negative ,making chance of cancer may be less than 12 or 15%.But he still had lung cancer.

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