THE GOOD AND THE BAD NEWS

      In medicine we often say there is a good news and a bad news. Many a times when I see patient who has abnormal CT scan and then we do the work to get diagnosis, and then the biopsy shows cancer, i sometimes say that there is a good news and a bad news . The bad news is that he has cancer but the good news is that it has not spread anywhere and we can do surgery. But sometimes the situation is different. That brings me to the story for today. 

    I saw this patient who has been a smoker in past and had chronic lung disease, COPD. She was doing good. She had routine Chest x- ray and that was abnormal and so we did do a CT scan of the chest done and that showed a mass . We did usual work up . She had PET SCAN and had  breathing test and also Biopsy. The PET scan showed activity in the central mass on right side and also some in thyroid . We did do the biopsy of the lung mass and that was lung cancer . The thyroid biopsy was also positive for cancer. The tumor in the lung was such that it had spread to nodes in the center of the lung  and so there was no way we could do the surgery. So we decided to do radiation and chemotherapy. The tumor was blocking the bronchial tube and so I we asked for radiation treatment . She had both and did well . 

    The new scan showed that the mass was smaller  and uptake was also reduced . So she was doing good , but she had cough and that was bothering her. She was treated with steroids and she felt better but still had cough. So, I decided to do bronchoscopy  and that was to see if she still had tumor.. What I saw was a significant narrowing of the bronchus which was blocked by tumor. The opening was so much narrowed that I could not see beyond it . It was inflamed  and that probably was the cause of her cough , So, the cancer was not there but the radiation had  killed caner , but also caused narrowing  and so she had cough . 

    There was no medical treatment for such mechanical blockage. I am not sure if we could dilate  it and open it.

 SO THE GOOD NEWS WAS THAT THERE WAS NO CANCER , BAD NEWS WAS R=THAT SHE HAD POST RADAIATION NARROWING WHICH MAY NOT BE IN POSITION TO OPEN UP.