Saturday, October 21, 2017


      I am always amazed with the new inventions and new techniques in medicine. But some of them are so good and may be an advantage for the patient and for the physicians. But sometimes it adds to the problems . So few years ago I was talking to some one  who happened to little older . She had tried to get pregnant and was not successful . She had test tube baby - fertilization done out side the body , then selected embryos implanted in the uterus. Due to the advanced age of the mother, they were doing blood tests from the mother starting at age 10 weeks . The blood tests were done again done at periodic time . The mother's blood is tested for fetal DNA. This can help detect the Down's  syndrome and some other fetal abnormality . The amount of the DNA is increased as the pregnancy advances. So the mother's blood gets fetal DNA even though the two bloods don't mix. While I was thinking about this , i looked in to it and realize that similar thing could be done for cancer or tumors. So I looked in to it and was surprised that there were some scratchy studies done in the past .

     And then I came across the study where blood tests are being done for very small nodules in the lungs and some as small as 3 mm and some much larger as much as 30 mm . This is called 'liquid biopsy" The studies are being done for breast cancer and the lung cancer and urine for bladder cancer. So I now know local physician involved in this study. I am not sure what would come out , but I was excited to know that some one was doing the study .

     But then I came across a study which was published recently and the lung cancer . They did the blood test in patients who were treated for the lung cancer and had NO EVIDENCE of the cancer. Those who had the positive blood test for ??tumor marker- had higher incidence of the recurrence of the cancer.But here is my problem . So if the blood test is positive and one has no evidence of the cancer , should we treat it with more chemotherapy or just watch it . The problem is that even though the blood test may suggest that some cancer cells are still in the body , not everyone comes with the recurrence , may be the body's immunity takes care of small tumor load. So treating everyone , we may be over treating , and that adds to the cost and the side effects .This problem was much worst when in past some did similar blood tests in high risk patient , who had no evidence of the cancer anywhere in the body, and the tests came back as positive . So now what do you do . Without the actual tumor , one can nor select appropriate chemotherapy and what kind of follow up can we done to see if patient is Responding or not. So when these tests are done we need something more or better to help patients and doctors to make these decisions. Otherwise we have tests and the reports , and no answers or treatment plan . And on top of that it adds to the anxiety on part of the patients and the family . It also may create problems with getting Health insurance and Life insurance .

       I know this blog is not a patient story , but I think it tells the real dilemma that will be added to medical decisions , when medicine is Art and Science combined in my opinion.  

No comments:

Post a Comment