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.