I AM LOST

    I AM LOST !I have been in medical practice for many years and I often see things that rea not that common and sometimes I am surprised . But sometimes we have a patient that defies all odds . When it happens to be a patient who has say inoperable - wide spread cancer ,that we think will not make 6 months mark with or without treatment, and then something happens and  patient is cured , we are happy. Though in that case we also have surprise - uncommon - unusual outcome. But since the 'ending' is happy' we are happy and no one questions success. Then we have patient in whom the pendulum swings on the other side, when we expect patient to either not have a cancer or cancer that looks like can be cured  and then either it turns out to be cancer or shows spread etc, then we are more stunned. That brings me to the story for today. As always 

    I saw this young lady, who had abnormal CT chest . She was nonsmoker and had h/o positive skin test for TB , Positive test means she was exposed to TB and so the body reacts and has positive skin test . It does not mean one has TB now. She had never smoked and she had minimal cough and no other complaints. The Ct scan did show a small  nodule -less than an inch. She had no old CT scan to know if this was new or old .Since she had exposure to TB, it could have been related to TB . But I did the work up. I did order PET scan , In PET scan glucose uptake is measured and in cancers the uptake is high , as the metabolic activity of the cancer cells is higher that normal cells. The PET scan showed minimal activity. I also did bronchoscopy and that showed no TB or mold. The nodule was too small for me to do any biopsy and I did do brushing and washings and that came back no cancer but showed chronic inflammatory cells. I  decided to do follow up on CT scan in 6 months. The CT scan was done and showed no change in the nodule. But I decided to send her to interventional lung specialist . Since there was no change in nodule they decided to do a new scan. The new one was done in 2 months . It showed no change in 8 months. Normally the cancer will grow and her we have a patient who has never smoked and has history of exposure to TB and bronchoscopy showing inflammatory cell .I do not know the reasoning behind doing a navigational bronchoscopy where a computer helps getting to the nodule . But it was done by the interventional lung specialist . The biopsy showed SHE HAS LUNG CANCER . 

      So a nonsmoker patient , who has no change in nodule in 8 months , no uptake on PET scan and inflammatory cells on first bronchoscopy - defies all odds of being BENIGN and has cancer . That is heart breaking.