ONE AFTER OTHER

    In medicine we have some of theses saying that is true in majority of cases , but there are exception. The patients have not heard them and so sometimes we have problem . What may be true in many patients or cases , may not apply for one  of the patients. We in medicine go by probability  and that is statistics The 2 words that we talk are 'probable' and 'possible'. Anything and everything is possible , but not everything is probable. The probable is what can happen in majority of cases - say more that 50%. But possible means it can happen but not more than 50 % . So if it can happen 1 in a million it is still called possible though not probable. That brings me to the story for today. 

  I saw this patient in my office . She had a lung nodule and that was less than an inch in size. We did the work up and she had bronchoscopy and PET scan and also breathing tests. She was a smoker and has some shortness of breath, The CT scan had shown the nodule and it also had shown another nodule of 6 mm in size. 25 mm make an inch . The PET scan showed that the larger nodule was positive and the smaller one was not picking up any activity. Certainly that could be a scar or cancer , but with not enough number of cells it was negative on the PET scan. The lungs functions were showing some compromise  and she still had enough reserve to have part of the lung taken out . 

  She did have lung surgery and the nodule was cancerous and all the other things - like lymph nodes, margins and covering of the lung etc. were ok and so she had a high chance of having 'cure. 'She was sent to an oncologist and he told her no need for any additional treatment and she had her family were happy. She was happy . He did new CT scan in 3 months  and that was OK but the smaller nodule had grown by 2-3 mm , So the oncologist wanted to do PET SCAN in 3 months . She saw me and I saw the CT scan and the growth though only by 2 mm was bothersome . So I called the surgeon and pushed for having new PET SCAN done sooner . The PET scan was done  and she had pick up in the nodule though faint. I talked to the surgeon. Interestingly enough her lung function had not gone down much in spite of having a part of the lung removed . So the surgeon did do second surgery and took out the nodule that had grown  and IT WAS CANCER . The good part -if there is anything good about having cancer - was that it was a different  type of cancer . If it was of same type then that means she had a spread of a cancer in first place and that would not have been a good news . So she seems to have had 2 separate independent lung cancer starting at the same time - something that we don't see commonly . Or to state it differently, it is possible but not probable to have 2 lung cancers in the same lung at the same time . But she did !!