GGOD AND BAD NEWS

    When we see doctor, many a times people say that there is a good news and bad news . Like " you have diabetes is the bad news , but it's mild and we can treat it easily is the good news '. But sometimes we see patient who has cancer it's impossible fond much good other that may be that we can operate and cut it out . This story is something like that but much different. 

   I saw this 68 years old female in my office . She had some cough and had been going on for 2-3 months and then had a chest x-ray and that showed abnormality and so she had CT scan and she came to me She had not smoked for many years and she had no weight loss or fever or shortness of breath. She was little overweight and came with her friend. She had clear lungs and her oxygen saturation was good. I saw her CT scan and she had a mass in the left middle part of the chest and it was very large almost 7-8 cm . The location was such that she could not have been operated and also the lymph nodes in the center of the chest called hilum were also involved. This makes it inoperable stage. I told her like I tell every patient with suspected cancer that we have to answer 3 questions . IS IT CANCER - HAS IT SPREAD - WHAT CAN WE DO - TREATMENT CHOICES . The surgery was out of question due to location and the lymph node involvement . That left us with chemo and radiation. But we needed the diagnosis . Any time we exclude surgery as treatment choice, that is not a good news as the radiation and chemotherapy are not 'curative ' treatments. But we needed a diagnosis . So we proceeded with biopsy  and PET SCAN . The GOOD News was that the cancer was limited to LUNGS  (though inoperable) At least I told her that that was the good News. The biopsy was done and that showed the cancer to be what is called 'SMALL CELL CANCER'.

    The thought that bothers many patients is that if they would have the diagnosis SOONER - EARLIER ,then it would be smaller an the surgery to give CURE would be there. So what would be the good news in the diagnosis of inoperable cancer ? The answer is the SMALL CELL CANCER CANNOT BE OPERATED and the treatment of choice is chemotherapy. So even if I had seen her 2-3 months earlier when the tumor was sat 2 cm , it still would be treated with chemotherapy . So in this case the BAD NEWS is that she has cancer  and the GOOD NEWS is that it is  type OF A CANCER THAT IS ALWAYS TREATED WITH CHEMO AND NOT SURGERY !!