Chest X ray found a lung mass in a 82 years old man.. is it worth to proceed further ?

A 82 years old, healthy, tall, Canadian, Former Petroleum Engineer, now retired at Hua-hin and dedicate his time in writing books. Annual Check Up found abnormal elevate CEA ( a tumor marker ). He was sent to me for a lung mass investigation and cancer was suspected. His main concerned was :

" I m 82 and I m not sure is it worth for me to pursuit the diagnosis? "

" I can live with it and pretend as if I m still the same as yesterday. Its too much hassle for me to run around hospital and follow up. Hair loss from chemotherapy would look funny to me... "

Well, doctors dealing with cancer suspect cases usually face these kinds of patients' dilemma. Aging is the main factor that prevents patient and caretaker to take further steps. Most of my denial investigation cases are due to age related factor.

Honestly, I totally respect their decision but here is what my recommendations had always been :

1. No doubt, cancer is aging related i.e. the older you grow, more likely you have " risk" of cancer, yet age alone does not inhibit you from curing as well. If you are healthy, you can perform activity of daily living well, any treatment is possible for any age.

2. With the current advancement in diagnostic instrument, there is a higher probability of rapid diagnosis that can be performed at a lesser invasive ways, with minimal surgical scar and minimal length of hospital stay.

3. Before you decide to terminate the investigation, it is suggested that at least you should confirmed the diagnosis ( whether it is cancer or not) ,know the staging ( did it spread to other region) and get the over all treatment framework.

4. Once you know which type of cancer and the staging , discuss with oncologist ( doctor specialize in cancer treatment) about the following key issues :

• treatment modalities ( surgery, radiation, chemotherapy, target therapy),

• possible side effect and side effects related management ,

• worst case scenario,

• expected survival with or without treatment

• costs of health care

5. Once you have the whole map in hand, it's fair enough if you decided not proceed further. At last, your decision will be based upon the entire framework of facts and data, not only X-ray imaging stating " carcinoma is highly suspected".

After listening to this entire idea, the patient decided ( with a very relax state of mind) to proceed further to confirm the diagnosis.

Further investigate found Left upper lung mass . Lung Cancer was highly suspected from CT scan (Image 1).

Image 1 : Red circle and arrow shows area of the cancer

Fiberoptic bronchoscopy ( put a camera in a lung to obtain the culprit tissue) was done and soon, result confirmed Lung Cancer , Adenocaricinoma type. He was sent for full body PET scan ( Image 2 )to screen for other distant site of cancer spreading and fortunately, the result was negative.

Image 2: WHOLE BODY PET SCAN NOT SEEN CANCER SPREADING

Fortunately, he is now diagnosed as Lung Cancer Stage 2 and surgery for removal of the entire cancer ( Lobectomy ) is the treatment of choice and definitive cure is expected. Currently, he is under treatment with Pulmonologist-Oncologist-Thoracic Surgeon team.

His future plan is to move back to Canada and live peacefully in a a country side farmhouse.

When I asked him how he was handling the issue, his reply was:

" I m so blessed that at the age of 82, my cancer seems curable. I m not worried. I will just have to " take it as it comes ". There is nothing I can do about the cancer though... all I can do is ... Live with it as if nothing ever happened to me. Get it removed. Look forward for this New Year wine gathering with my folks.. hahaha.."

Aging can be a risk for cancer. If you are healthy enough, nor cancer nor aging can stop you from any treatment options. Keep your options opened as time has changed. Best of luck and hope this patient be an example for anyone undergoing similar scenario