WHEN IS ONE SAFE -??NEVER

         When we talk about the cancer and then say that 'one is cured', we have different time durations that we take in to account to make a statement that the cancer is cured . The melanoma for example ,can come back after many years and so is breast cancer. So when we have someone with breast cancer we talk about 'disease free interval'. But sometimes we have problem. Usually the lung cancer does not come back after disease free interval of 3 years ,but I had seen one coming back after 5 years . This is rare. But then there is a increased incidence of SECOND CANCER when one has one cancer ,which complicates out thinking. 

    This brings me to the story for today. I had seen this male patient several years ago. He was a smoker in past and then quit. He has some COPD and also had Sleep Apnea. He had kidney mass  12 years ago and that was detected and then he had kidney taken out and that was cancerous . The oncologist and urologist did follow up and after 5 years he was told he was fine and 'cured . of renal cancer. Then 7 years ago he had a lung mass and so we did the biopsy and he had lung cancer . At that time when we saw the mass in the lungs ,we had thought of that being related to kidney cancer . But then when we took out the mass ,it was NEW LUNG CANCER and not related to his kidney cancer which was -at that time - taken out 3 years ago. The oncologist followed him and then I continued to do the new scans. After 2 years or 3 years of 'cancer free ' time , we did the scan every year. The last scan was clear and there was no cancer or recurrences of the cancer. AND when we did the new CT scan , I had a shock. On physical examination ,he had some prominence of breast bone that he had noticed few days ago and he had a mass behind the breast bone and also other mass in the lungs. So now he has a cancer - most likely and I am not sure if it is NEW or old - recurrence of the old Cancer. The work is is in progress. 

NOTHING NEW HERE-IN CANCER DETECTION

    The Medicare has approved payment for the Yearly screening CT scan of the chest - so called Low dose  Radiation Ct scan - for early detection of lung cancer .This is done in current smokers or Ex smokers for up to 14 years. So now a days we are seeing many patients that have some abnormality that is detected on these scans . The smaller nodules - like few mm 1-5 or even up to 8 mm are difficult to work up. Many people have come out with different tests to find out if the nodule seen is cancerous or not . The PET scan that I have talked about in many blogs , does not do good job if the nodule is less than 8 mm in size  and even at 8 mm it is difficult. The conventional bronchoscopy or needle biopsy are not good enough to get the tissue diagnosis and then we are left with doing a follow up of the CT scan .There were some blood tests that came out ,one called NODIFY and that detected certain protein and then it is used to calculate 'probability' of cancer  and still does not 'give' the tissue diagnosis. It just tells you if the probability is increased or not. So we are left with only option of OPEN BIOPSY. That brings me to the story for today.

   I had seen this male who was 73 years old and has been a smoker in past . He had COPD and that was mild . But due to history of smoking , he had periodical - yearly CT scan chest One done 1 year ago had shown a nodule and that was small - small for doing PET scan or any other biopsy. This was the low dose radiation CT scan . He had new one a year down the road and this time the nodule had grown . It was 11 mm . So now he was sent to me . We did the routine work up. Did a breathing test  and bronchoscopy . I also ordered a PET scan . The regular bronchoscopy was OK and the breathing test showed he had mild COPD he had no shortness of breath and he had stopped smoking 2-3 years ago. The PET scan showed NO UPTAKE. The no or low uptake means that the cells in the nodule do not have higher than normal metabolism. The increased uptake is related to higher than normal metabolic rate in  cancer cells - that is why they GROW rapidly. Sometimes slow growing cancer may have low pick up as they do not have very high metabolic rate.

   So, we have limited options. The growth in one year indicates - something is happening and I am concerned that it is SLOW GROWING CANCER .But I do not have enough proof that it is cancer or is likely to be cancer like positive PET scan. So now only option I have is to have surgeon take it out - which means surgery .In spite of all the new tests that are developed, we still have to do the surgery to be SURE that it is or it is not CANCER. And not all the nodules that grow are cancerous - may be 2-5 % are not.