CATCH BEFORE ---

    I n case of many medical conditions, if we catch in time , we have higher success. This is true even with infection . heart disease diabetes etc. . If we treat diabetes or high blood pressure early then we can prevent the complications that are associated with it. This is also true with cancer . In medicine we have tried to  diagnose earliest stage and then hope that we can achieve cure. We have stared  doing tests like DNA pieces of tumor in blood, this is called CTDNA . -Circulating Tumor DNA .But it is not a test that many labs do and even many physicians are not aware of it. It also raises some questions as to what to do if the test is positive. 3-4 years ago Medicare approved CT scan of chest as screening for early diagnosis of lung cancer in patients who recurrent smoker or ex- smoker for 14 years. This has certainly helped , but also has raised some anxiety when the CT scan shows some nonspecific abnormality  and needs follow up. But sometimes I feel that it's not always possible to 'CATCH' cancer early. The story that I am going to tell is one of that kind. 

   I saw this patient who was in mid or late eighties. He had quit smoking many years ago. He had quit smoking many years ago . he had some cough and usual treatment with cough medicines and antibiotics did not help. So, he had chest X- ray and then had more antibiotics . He then had CT scan and that was abnormal and so he came to me. He had some cough and no fever . He had no shortness of breath. There was nothing special in special examination. The CT scan showed  abnormality and had a cavitary area in lung . That could be an infection or cancer. So we decided to do further work up . We did PET scan. The PET scan shows where the glucose is concentrated and that depends upon metabolic activity of the cells. So it picks up in 8- plus % of the cancer. The PET scan showed increased activity in the cavitary area and also some lymph nodes. There was no evidence of any activity in any other areas , We did the EBUS - ultrasound guided biopsy through bronchoscope and that showed lung cancer -highly likely. I had discussion with patient and family and decide to send him for radiation treatment to the lession in lung. . Surgery was not an option and I had called and asked a surgeon to some additional biopsy and he had refused. He and his family did not want any surgery or chemotherapy so, radiation was the only option. I called radiation doctor and he gave him appointment 

  3 weeks had passed and he was admitted with weakness and hospital doctor had admitted. .When I was called in ,he was seen by cancer specialist and infectious disease doctor and also cardiologist. Tests were planned. He had chest pain and that happened to be due to spread of cancer. The cancer doctor had planned ordered bone biopsy . I talked to  patient and family they did not want any biopsy and so I called radiation doctor to consider radiation to bones where cancer  had spread . He agreed . 

   The PET scan done few days - weeks ago had not shown any spread outside the chest and now he had bone spread in many bones. I am sure cancer had spread tat time but out tests are unable to detect as the amount of cells must be bellow needed to be picked up. But with just given few weeks / days it showed on bone scan and CT scan.