Ladder fall leads patient down unexpected path
Lung cancer can sometimes be detected in unexpected ways, says Dr Barton Jennings, Cabrini Respiratory and Sleep Physician.
Take the story of a 70 year old man who fell off a ladder and went to the hospital with a fractured left wrist.
As part of the trauma series a CT chest scan was performed. He was known to have severe underlying diffuse parenchymal lung disease (DPLD). However, the scan also revealed a lung nodule measuring 2.5cm, which was concerning for the possibility of a cancer.
The patient had suffered pneumonia two and a half years earlier. He was treated for infection at that time and made a very good recovery.
A CT scan taken at this time showed a small nodule which measured two millimetres in diameter in the exact position where the current incidental nodule was found now to measure 2.5cm.
This indicated that the nodule had slowly increased over time, and was most likely a slow growing lung cancer.
“It’s always useful after the incidental finding of a lung nodule to review previous imaging,” Dr Jennings says.
A biopsy confirmed that it was a small cell lung cancer.
The case was discussed in a lung multi-disciplinary team meeting and it was decided that this patient should be treated with surgical resection given that the tumour behaviour was of a slow growing cancer rather than the typical fast growing nature of small cell carcinoma. Surgery is not the usual treatment for a small cell cancer.
The patient’s lung function was good, consistent with his very good exercise tolerance, although this was surprising based on the CT appearance showing severe lung disease. It was decided that he would tolerate surgery, despite concerns regarding to the severity of his underlying cystic lung disease.
Dr Jennings says the whole tumor was analysed histologically post-surgery.
“It was confirmed to be predominantly adenocarcinoma, and the best treatment for a solitary early stage adenocarcinoma of the lung is certainly surgical resection,” he says.
“Hopefully this will achieve a cure for this patient, which is an excellent outcome.”
To learn more about Cabrini Cancer services, visit www.cabrini.com.au/lung-cancer/