Saturday, May 2, 2020


    All of us know what are the common signs or symptoms of early cancer.Some of warning signs of caner are described by cancer society or  many other institutions. So we know that persistent cough, non healing ulcer in the mouth unexplained weight loss etc are well known to doctors  and even to common public. But some other symptoms are not so well known  and some doctors may not know about it . Sometimes they are treatable  and sometimes they are not and the treatment of cancer it self will be the treatment for them. So these are called 'para-neoplastic syndrome'. They are thought to be related to certain chemicals that the cancer cells secret and their effects on body.I have seen this few times  and my last patient had it.
    So I saw this 60 years old male patient who had persistent  cough and he started loosing weight. He do=id not go to doctor for 3 months  and then when he had lost 30 lbs of weight, he decided to .go a doctor. He had been smoker  and had  had continued to smoke.He had chest x- ray done  and then a CT scan . The chest X- ray showed collapse of left lower lobe  and he had mass in middle of left lung and had some fluid around his left lung . So all the signs were that of Lung Cancer. He came to me , but he had also been sent to cancer specialist and also radiation doctors. But they can  not do anything until the diagnosis is established. I saw him in office . He was a very tall guy and he had lost so much weight that he was weak and had difficulty walking and so he came in a wheel chair . He also had clubbing of nail - changes in nails where the curvature of nails changes  and there is some thickening of skin at nail bed. This change happens in any chronic lung conditions ,but now a days we do not see it often as we have antibiotics  and the diseases that used to be chronic get treated quickly.He had muscle weakness . and also had clubbing and weight loss. He then had PET SCAN  nd that was positive for high uptake in left middle part and so there was high chance of cancer.

   So I did do bronchoscopy  and he had a mass obstructing left main bronchus .It was friable  and I did do biopsy and it came back for suspicious cancer. So I did not have definitive diagnosis  and he was not a surgical candidate  ad so we did needle biopsy and that did give us the diagnosis.He was started on treatments .
     I saw him in office . He had weakness  and also clubbing and also low blood count  and also had LOW sodium . I discussed with him on the para neoplastic syndrome. He HAD  WEIGHT, which is due to chemical secreted by cancer. This one called Cachectin - though no such chemical had been identified . But it cause weight loss. He had ANEMIA   and that is well known  and that is also Indirect effect of cancer. He also had low sodium  and that is due to a hormone secreted by tumor ,which is like hormone called ADH. and lastly is the clubbing which is due to any chronic pulmonary disease. And some patients have elevated calcium  again due to cancer. These  and some other that are not related  directly due to cancer but indirectly from some chemical secretion . 

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