THINGS ARE UNUSUAL - BUT MAY BE NOT THAT MUCH

    I have been in medicine for many years and have seen things that are very very common like asthma or COPD , pneumonia and may be even cancer. But sometimes even common diseases can present as very interesting presentation, though anything that is interesting for for health care professionals is bad news for patients . That brings me to today's story.

  I have been seeing this patient for a while , She has been ex smoker -quit many years ago and had some COPD . She has had routine x- ray - CT scan in past and that was ok . But this time she had sputum tinged with blood. So I did new CT scan and the report was very sketchy, There was mention of some abnormality in right bronchus , but no mention of any tumor.  I had planned bronchoscopy any way and  then with the abnormal findings on CT scan, i also ordered PET scan. In PET scan glucose pick up of normal tissues / organ is compared to the abnormal areas seen on CT scan and if the pick up is increased that indicated cancer - infection etc. . The accuracy of picking up cancer is about 80%.The bronchoscopy was done before the PET scan was done and that showed that the main bronchus - was narrowed and that looked like external pressure. There was no mass as such that I could biopsy. I did do some brushings - pap smear from  the bronchus. The PET scan was done and that showed that there was a mass and that was making the right bronchus narrowed and there was greatly increased in that mass suggesting that it was cancer. But the scan also showed that she had increased uptake in thyroid .She had seen thyroid specialist less than one year and had biopsy and that was OK. But the PET scan was abnormal and so I asked interventional radiologist to do biopsy of the thyroid . The lung mass was there too and so I called interventional pulmonary doctor and he did do ultrasound guided biopsy and he called me that preliminary report was that it was thyroid cancer . The thyroid biopsy was done before the lung biopsy and that also showed thyroid cancer. 

  So I called patient and told her that she seems to have thyroid cancer that has spread to lungs . I also called oncologist too and ask him to see her. But the story did not end there . I checked the final report on the lung biopsy and that was not a thyroid cancer but it was usual lung cancer !!So she had 2 different cancers -one thyroid and other lung cancer . Due to location and spread  to the central lymph nodes , that was not resectable or operable and so we will need chemo and may be radiation . I am not sure what would be best for thyroid cancer - ? surgery or some different chemo or both ? I will let oncologist decide on that.