A Blip on the Radar

It was easy to see the spot. When the doctor showed me the chest X-ray, he didn’t really need to point it out to me. And that’s why it was all the more difficult to understand how it had been missed the first time…

I’d already had an X-ray the year before as part of a routine medical examination when I was living in Austria. (My husband worked for the Embassy, and the medical coverage was good – one of the benefits). Although in retrospect the spot was clearly visible, the local physician told me that there were no abnormalities.

A year later, we moved back to Canada and I resumed my work as a nurse. A routine medical examination was a prerequisite for employment, so – among other things – I was given another chest X-ray. The spot was seen immediately – but this time, it was flagged and discussed with me. What was it? Why hadn’t it been addressed previously? One possibility the doctors considered was tuberculosis, which meant that my employment was immediately suspended to prevent its potential spread. Further testing ruled out that disease, so we began to investigate other possibilities.

Eventually, I was told that the spot was likely a tumor. My options were “watchful waiting” (monitoring the spot to see whether or not it would develop further) or to have a biopsy, with surgery to follow if needed. I was in good general health and fairly fit, and the spot itself was small (about the size of a dime) and discrete, so I opted to have an X-ray guided biopsy performed under sedation.

As a nurse, I knew what would happen to my sample next; it would be sent to pathology, where a diagnostic professional would take a close look and determine my next steps. Would I need watchful waiting? Surgery? Additional treatment? Thankfully, as a healthcare professional, I knew I could rely on my laboratory-based colleagues to guide my medical care.

In this case, the pathologist speedily diagnosed a carcinoid tumor – a rare, slow-growing cancer that was unlikely to spread, but that would need to be removed as soon as possible. Armed with this information, a surgeon proceeded to remove the tumor under full anesthetic. He cut out a generous wedge of my right lung as well – so generous, in fact, that no follow-up radiation was required. The result was a single afternoon of surgery and a few weeks of concern and recuperation, after which I was able to resume being a wife, the mother of two young children – and a nurse. Of course, I still had several years of follow-up appointments for scans, tests and check-ups, but my cancer no longer had the power to disrupt my life or prevent me from living it fully.

It’s the ideal outcome – a long and happy life after a potentially devastating diagnosis. But something was missing: as both a patient and a professional, I would have appreciated the opportunity to speak to my pathologist directly. It would probably have made no difference to my treatment, but I would like to have learned more about my tumor. The surgeon was a bit inarticulate and only felt he had to tell me it was “a type of cancer”; evidently, he felt I didn’t need to know more. However, I would have liked to know what tests were used to identify the tumor and what my other treatment options might have been. It would also have been good for the pathologist to receive credit for the work; my surgeon never mentioned pathology – I suppose he fancied himself as the star of the show!

Thanks to the pathologist’s speedy diagnosis and the quick action the surgeon was able to take as a result, I can now look back on a potentially life-threatening situation as nothing more than a blip on my personal radar. I only wish all patients were as familiar with the contributions pathology makes to their care. Hopefully, as pathologists begin interacting more frequently with patients and doctors in the clinic, they will be.

For more patient-eye views of pathology, read our December cover feature, “Hello, My Name Is…”