“Adenocarcinoma. All of the upper lobe of the right lung was resected, and the lower lobe was wedge resected. All the lymph nodes that should be cleared were cleared.” I had just woken up from surgery, and my reflexes were still a little slow, and the surgeon’s words seemed to come from far away. After I was sure that it was cancer, my heart was steady: I had lived too much in the past 20 years. I really need to take a break ……
I’m an obstetrician at a specialized obstetrics and gynecology hospital in a prefecture-level city in southwest China. I’ve been in practice for more than 20 years, delivering countless babies and saving countless mothers, and I have a good reputation in the area and am often honored by the hospital. But these honors and achievements are all the result of blood and sweat. In the first ten years of my medical career, I worked many night shifts, from 5:00 p.m. to 11:00 p.m. the next day, and was often too tired to go home and sleep. I think it’s a good idea to have a good time.
Is it inflammation or cancer?
Is it inflammation or cancer?
In the spring of 2015, it was time for the annual physical examination. I had been in good health every year before, so I thought I might as well use the time from the checkup to rest and spend time with my daughter. But my good friends kept urging me to go for medical checkups, “People over 40 should be aware of medical checkups, you are a medical professional, don’t you know the pros and cons? Prevention is better than cure! Besides, the unit gives you free medical checkups, you don’t go, you have to wait until you are not feeling well and pay for it yourself?” I was convinced, and we went to the checkup together. But I was left alone by the head of the imaging department.
“You have a nodule in your right lung, 0.9 cm in size, and it’s not clear whether it’s good or bad for now. Why don’t you go back to the provincial hospital and have it looked at. Or first, get rid of the inflammation to see if it’s inflammation, which can also lead to small nodules in the lungs. There are even some fungal infections that cause similar nodular manifestations.” The director’s words caught me off guard, but being a doctor and used to accidents and life and death, I quickly recovered and said “yes”. The chief talked to me some more and told me that small lung nodules are generally judged by both size and nature. The size of a nodule less than 1 cm is more likely to be benign; the nature of a ground glass nodule is more likely to be malignant.
I know that “frosted glass” nodules, as they are referred to by fellow physicians, are faint nodules in the lungs that are slightly denser than the surrounding lung parenchyma, but the outline of the blood vessels and bronchi within the nodules is still faintly visible, like a piece of “frosted glass. It looked like a piece of “frosted glass”. My nodule was a frosted glass nodule, but it was just smaller than 1 cm, so I needed more precise judgment. In general, about 80% of frosted glass nodules are malignant and only 20% are benign.
“What if I’m in the lucky 20%?”
A week of anti-inflammatory medication and no change in the nodules; another week of antibiotic infusion and the nodules are still there. Then it shouldn’t be inflammation. My classmates helped me find one of the top thoracic surgeons in the capital, who recommended: biopsy and puncture to determine the nature and treat the nodule at the same time. This diagnosis did not break my mental expectations, but I just wanted to wait and see: what if I was in the 20%?
So I started a monthly review. With my knowledge of small lung nodules and lung cancer, I knew that if the nodules were malignant, they should have progressed in a relatively short period of time. The review went on for 4 months without much change in the nodules. When I went back for the review checklist in the 5th month, a young associate physician was surprised to see that I had been reviewed so many times and so frequently. After listening to my case, the doctor opened my file and looked at it a little bit, and finally he said to me, “What are you doing having a review? A look at it is not a good thing, still do not rush to surgery to go?!”
In fact, at this point I was already seriously considering the recommendation of the Beijing specialist for biopsy puncture, and the young doctor’s words were just another boost. But as a peer, I know that doctors speak based on facts, not experience and extrapolation. So I said to the young doctor, “It still depends on the pathology results whether it’s good or not, right?” The young doctor said, “Yes, all judgments have to be based on pathology.”
The subsequent pathology did confirm the young doctor’s judgment, and I learned to use some details to further determine the malignancy of the nodule: a ground glass nodule with a “burr needle” is more likely to be malignant; if there is a subpleural concavity, it is more likely to be malignant; a mixed type of ground glass nodule is also more likely to be malignant. The mixed type of ground glass nodule is also more likely to be malignant. The results of this study are based on the pathology of the nodule, but these are empirical inferences.
The pathology was not good and the nodule was directly removed at biopsy
In early April 2016, I was lying on an operating table in a hospital in Beijing, operated on by the same specialist who had previously advised me to have a puncture biopsy.
“Adenocarcinoma. All of the upper lobe of the right lung was removed, and the lower lobe was wedge-shaped. All the lymph nodes that should be cleared were cleared.” About 3 hours later, I awoke from anesthesia and heard the results of the procedure from the primary surgeon. During the puncture biopsy, my lung tissue cells were quickly sent to the lab for observation and were found to be adenocarcinoma and removed directly. At this point, my lung cancer treatment was all but complete. Since the cancer did not metastasize and was completely removed, there was no need for post-operative treatment and regular follow-ups were maintained.
At that moment, something that had been weighing on my mind suddenly disappeared, and the hard work of studying medicine, the hard work, the twists and turns of life ……40 flashed through my mind. The fact that I am the 20% and not the 80% makes it easy for me.
People often get very sick before they realize a lot of what they should and shouldn’t do, and I’m no exception. I feel both unfortunate and fortunate, even more so than unfortunate: I was unfortunate that the nodule was malignant, but I was fortunate that I was able to overcome the fluke and get it diagnosed and removed early. I also understood that I was so tired that my body was protesting. I know better than to skip medical checkups, and I can’t ignore my health just because I was “fine before”. If you find a problem, you can’t take any chances and ignore the “time bomb” lurking in your body, or just use repeated tests to “comfort yourself”. I think this is also “practice makes perfect”, but it’s not too late.