Saturday, October 19, 2019


   I have been asked many times as to the cause of cancer. We see have seen it in older  and younger people , we have seen it in fat and skinny people , we have seen it in people who have good habits  and bad habits.We have known some risk factors like smoking  and chewing tobacco, and people with exposure to chronic irritants. The sharp tooth has caused oral cancer and KANGRI the heated burner that people in KASHMIR out around their belly to keep warm has caused the cancer of the skin of belly wall.When radium was invented  and people used radium dial wrist watches , there was increase incidence of cancer of the wrist bone.So we know some causes but we do not have any idea as to why some get cancer  and why some don't.This brings me to the story of the patient for today.
     I saw this young women who has some vague chest pain . She was nonsmoker and had no h/o high blood pressure or diabetes or any cardiac problems. She was OK till then . So the family doctors did a chest X- ray. The chest X- ray was abnormal. and so she had CT scan of the chest  and that showed a large mass  and also a smaller mass. She was sent to me . She was very anxious  and was quite concerned . And rightly so as the mass was reported as as most likely as lung cancer in the report, which she had with her and had read it few times . She had noticed the right sided chest pain only 2 weeks ago  and she had no pain before that .She had no shortness of breath or any significant cough, She had not coughed up any blood . Her appetite was good, but she had lost some weight,but she had thought that due to the the problem that she had with eating . I explained it to her and her family that the possibility of lung cancer was high but may not be 100%. We should answer 3 questions -Is it cancer, Has it spread and lastly the choice if treatment if it is cancer.
   To answer these questions we needed the diagnosis of cancer.So we ordered PET SCAN which is good in detecting spread of cancer or presence of cancer - may be 85%of the time. I also ordered the breathing test. and also bronchoscopy. That showed narrowed bronchus  and so I did biopsy  and then the biopsy did come back showing cancer .
   The PET scan was done a day after the biopsy. So when I saw the PET scan report I was not happy. So I called the patient to see me . She had lung cancer and the PET SCAN showed that the cancer had spread to Liver and bones . The chest pain that she had was due to the spread of the cancer to the ribs . So she was not operable. I had called  chest surgeon to see if there was any chance of doing surgery - though it was before the PET SCAN,  and I had done it in spite of knowing that she would not be based on ct scan .
    She had come with her family and they wanted to know the prognosis  and why she had cancer . I had no answer to both the questions. So the nonsmoker,nonalcoholic lady was having lung cancer and that too had spread to other organs such that the prognosis was not very good .

No comments:

Post a Comment