Possible cancer and fast-track

[Simpo Two]

90 y/o relative in a care home had a cough for weeks and went for a chest X-Ray on 16 November. GP has called to say there's an opacity on the X-Ray which might be cancer. However they only suggested she go back for another X-Ray in six weeks...

I had an idea that there was a fast-track for cancer suspects - or is six weeks the 'fast track'? Wouldn't the next step be biopsy for proper and quick diagnosis?

[anonymous-user]

Sorry to hear this, a story like this is never nice.

The development of cancer in a 90yo is very slow due to the cell regeneration rate at old age, so 6 weeks is not necessarily as bad as when a bit younger. Biopsy (depending on where it is) may actually be quite a serious option for a 90yo.

Doctor probably has a motive and probably knows best. :-(

[jbudgie]

Fast track is much quicker than 6 weeks.

[Simpo Two]

bulldong said:

Sorry to hear this, a story like this is never nice.

The development of cancer in a 90yo is very slow due to the cell regeneration rate at old age, so 6 weeks is not necessarily as bad as when a bit younger. Biopsy (depending on where it is) may actually be quite a serious option for a 90yo.

Doctor probably has a motive and probably knows best. :-(

Sound points - sometimes these things are best left to run because the risk of treatment is greater. I will give her a (polite) grilling tomorrow, but wanted to have some background of what I can and can't expect. But I don't see any point in waiting six weeks for another X-Ray - what will it prove? Perhaps they think the opacity is something else and might clear up anyway?

jbudgie said:

Fast track is much quicker than 6 weeks.

Indeed, I thought more like 14 days. I'll get the gen tomorrow and let you know what she says.

Thanks for the replies.

[Simpo Two]

OK, just to conclude - Doc says: X-Ray showed ill-defined 3cm opacity, probably secondary infection, so she's staying on antibiotics. If it was cancer, no treatment is possible at that age - apparently lung tumours aren't treatable and the test (bronchoscopy) would kill her anyway. So whatever it is, it will have to take its course.

The only gap in the chain is that a month ago, when she had a bad cough, the care home was not allowed to do what seems perfectly simple and obvious - give her some cough mixture. No, it has to get worse for a couple of weeks until the doctor is called and goes straight to ABs. Crazy.

[Granville]

My other half had a suspicious mole on his head which we'd been keeping an eye on as it was growing quickly. He saw the doctor, received a phone call from the consultant the following day and had it removed at the hospital within a week of seeing his doctor.

He returned 3 weeks later for a further removal of his scalp and lymph node trace to check ithe cancer had not spread to his face or neck. He now has an 8cm diameter graft on his scalp. 3 monthly checks for the next 3 years, 6 monthly to 5 yrs, 1 yearly to 10 years.

Can't fault the Churchill & John Radcliffe in Oxford or the Macmillan Cancer Nurses.

Oh, he's 28.

[dgb00]

anonymous said:

[redacted]

That isn't true. If you have "red flag" symptoms you automatically are referred under 2 week wait.

Usual procedure with a chest X ray and infection is to repeat it in 6 weeks to make sure that the shadow (that might be infection or a cancer) is resolving. If not then more investigations would be ordered if appropriate.

[Simpo Two]

dgb00 said:

Usual procedure with a chest X ray and infection is to repeat it in 6 weeks to make sure that the shadow (that might be infection or a cancer) is resolving. If not then more investigations would be ordered if appropriate.

Thanks, that's a bit reassuring.

Take it 'gasman' means anaesthetist?

[dgb00]

Yes. I used to do clinical research in novel chemotherapy agents though. Found cancer a bit depressing though, unsurprisingly!

Good luck to your friend.

[K77 CTR]

Simpo Two said:

OK, just to conclude - Doc says: X-Ray showed ill-defined 3cm opacity, probably secondary infection, so she's staying on antibiotics. If it was cancer, no treatment is possible at that age - apparently lung tumours aren't treatable and the test (bronchoscopy) would kill her anyway. So whatever it is, it will have to take its course.

The only gap in the chain is that a month ago, when she had a bad cough, the care home was not allowed to do what seems perfectly simple and obvious - give her some cough mixture. No, it has to get worse for a couple of weeks until the doctor is called and goes straight to ABs. Crazy.

At the age of 90 many people just wouldn't want the prodding and poking needed to diagnose lung cancer and if diagnosed any surgery/ chemo/ radiotherapy would really take it's toll. The reason for taking a repeat xray is to see how things have changed, as has been suggested if it's an infection it should be resolving in 6 weeks. I'm also guessing that there are no other symptoms like sudden weight loss.

As for cough mixture, it is a waste of time, would not help the patient unless it contains codeine but all that does is suppress the cough but at 90 is likely to make them confused and constipated.