Two very long weeks

05/09/2009 at 5:00 AM Leave a comment

Upon the inital diagnosis of something that may well be cancer, I hear the bell of a long two week process. It may be a bit less or in some cases a few weeks more, but the point is that from that first xray or scan that shows the offending lesions to the time where we KNOW what we are dealing with is a non inconsequential amount of time. And a not inconsequential verbal dance for me.

A year ago a  59 yr old patient who could be a Malboro man: Tall, lanky, weatherbeaten face,  smoked unfiltereds since the world started, has what is probably lung cancer. He goes to the hospital for a bad aggravation of his headaches and during the usual work-up a regular chest XRay shows three lesions, one in each lobe of the right lung. Whoa! Forget about the friggin  headache, we need to get this lung thing figured out.

The process is slightly different depending on where the lesions are. The more accessible the quicker and easier. The breast for example is accessible, not critical to daily function, easy to biopsy. The pancreas on the other hand requires an expedition.

For this man the next step is a trip to the pulmonologist who will put a scope down his trachea ( windpipe) and look for the tumors. If one of the tumors is close enough to an airway, he will put a tool through the bore of the scope and voila, we have our biopsy, with minimal intervention. Actually a good number of lung cancers succumb to this procedure.

If that fails then the next thing is a CT guided needle biopsy. Using sequential images as a needle is introduced into the lung, they manage to get it into the biggest, closest tumor. The CT is important for several reasons: you need to avoid critical organs as you are aiming for the tumor, you need to make sure that the tissue you got was not ‘close’ to the tumor, but part of the tumor. Life altering decisions will be made from those few bits of tissue.

Then more waiting occurs. The tissue has to be processed. I dont know how automated it is now but the process of staining the tissue and slicing it into viewable strips used to take quite a bit of time. Mostly because the dyes had to set in the tissue for a while.

So between 3 and 7 days later the results are back and then we know what you have, not only the organ that the tumor originated, but what kind of cell type. For the lung this is very important, it could be one of several types of cells that occur in the lung. They act differently and respond differently to various chemotherapies and radiotherapies.

For me the issues are what to tell them before we know for sure. Like in this man, my suspision may be very high, but I dont know for certain. I allow hope to remain. Not so much that he needs hope now. Hope that it isnt cancer. But that he will need hope for the long haul, to get through the chemo, the radiation, depression, the haunting unknowing of the uncertain future.

I find it important to talk in what I know, not what I suspect. It does not mean that I paint a rosy picture, for I do not, but it does mean that my statements are about known facts and what needs to happen, my implications and inferences are about getting ready to hear bad news. By the time the results are back, we had talked about what we will do if the results are bad, what the process of dealing with cancer looks like and how and when to tell the family ( now!) and what we will do for any symptoms until then.

( more on this tomorrow)


Entry filed under: How things work.

Lost in technology two very long weeks part 2

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