X ray Report says " It's likely a cancer ". Should I believe ?

หมอวินัย โรคปอด
Apr 9, 2019
2 min read

This is a case of highly suspicious case of cancer from Chest X ray report. A middle age man, non smoker, industrialist, arrived with progressive cough and weight loss for 3 week. Despite an initial treatment as " Pneumonia" , the symptoms became worsening and was referred to me for further management.

Upon reviewing his X ray, I saw a big 4 cm mass with a big cavity inside , surrounded by thick wall (Figure 1) . No doubt it look like a cancer to me but in my experience of having treated over thousands cases of TB , all I can tell him was ...

" Not all Thick Wall Cavity mass is a cancer always.." You Must Prove It.

Fortunately, he decided for a Bronchoscope and the result was Tuberculosis. Cancer was excluded. He was immediately started with anti-Tb meds.

Subsequent follow up showed improvement in symptoms, body weight and Xray mass resolution. (Figure 2)

Figure 2: Resolving Cavitary Mass over time (left to right oriented)

Patient often loose hope and become anxious after reading the X reports. Well, you have to understand that imaging reports are to be interpreted with clinical correlation. That means doctors will have to perform ( STEPWISE)

HISTORY TAKING AND PHYSICAL EXAMINATION, and come up with
a list of possible DIAGNOSIS
Plan for FURTHER INVESTIGATION. Once all the results are available,
Analyse all the reports gather and come up with a FINAL DIAGNOSIS

Unlike Google search : where patients can type in symptoms and you get a list of possible causes, irrespective of physical examination and detail information of how your symptoms have evolve overtime, which symptoms came before and after etc..