One afternoon in 2007 post lunch, I had a knock on the door. It is a common practice for patients, patients relatives to seek consultation at doctor's residence. They normally would be from nearby village and the need to catch bus/train back home compels them to disturb doctor during his personal/private time.
This time it was a bunch of people with MRI scan and other reports in hand. The MRI showed mass in the cervical region extending into the bladder. MRI is not a part of FIGO staging but widely done scan. There is a learning curve to interpret MRI's and I had to rely on the report given by Radiologist to get more out of the MRI report. The description mentioned cervical mass invading the bladder. The histopathology report had confirmed it as squamous cell carcinoma. They had consulted a gynecologist who based on the reports had counselled them that it was Stage 4 cervical cancer and the best treatment would be symptomatic care. Looking at the reports, I also opined that it is Stage 4, Surgery and Radiation both would cause more harm. Benefit from chemotherapy is doubtful. One of the relative insisted on getting the patient examined by me. I reluctantly agreed.
The same day evening I examined the patient. On pelvic examination, to my surprise, found the anterior fornix completely free. You cannot have the bladder invaded with the tumor without the anterior fornix being involved. The physical examination did not match the MRI report. The clinical diagnosis was Cervical cancer stage II B. This was potentially treatable and curable. But what was that in the bladder?
CT scan and Urology opinion made us realize that it was a big stone in the urinary bladder.
The patient had surgery for the removal of the stone. When the wound had healed she received Radiation both external and brachytherapy. During external radiation she also received weekly Cisplatin chemotherapy.
It is five years now since she got treated. She has occasional urinary tract infection has subcutaneous fibrosis. Probably she can be considered cured of her cancer. Last year her third son got married and he was quite emotional.
The patient and her family hail from the rice growing region in Karnataka. They have constantly shown their gratitude by supplying me with free rice. I call her lucky and i am even more lucky!
Learning:
1. Clinical examination is a must. Scans cannot substitute clinical examination.
2. It is a good idea to get second opinion.
3. PAP Smear screening will reduce/eliminate diagnosis at late stage. Early stage diagnosis or pre malignant lesions are completely curable.
"Cancer is curable, if treated early".
Godspeed!
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