It's quite tough to break the news. I won't ever forget Mr. P, a 55 year old white male with no previous medical history, a totally healthy guy who came to me with swelling of the face and neck. He had been experiencing for the last month or so increased swelling of his face and neck, particularly when leaning over e.g. when he would tie his shoes. He had also noticed some new intermittent shortness of breath. He came to the hospital to check it out and we did imaging which showed a significant "soft tissue" mass in his right lung. This mass had been likely growing for quite some time and was now almost totally occluding the Superior Vena Cava (SVC), one of the major veins that returns blood to the heart. He actually had significant "collateralization", which means that small accessory veins around the SVC had picked up the slack from the occluded big vein over time. This "SVC Syndrome" clearly accounted for his neck/face swelling and shortness of breath symptoms.
I recognized the possibility of cancer right away and had the tough job of breaking the news to this patient and his wife, who is a health care worker herself. This patient as I mentioned was totally healthy before. Had smoked cigarettes for 30 years but had totally quit 5 years ago. I explained to them sensitively and clearly what I thought was going on and what further testing we needed to do -- in this case we proceeded with a bronchoscopic biopsy of the lung mass. I got to know the patient and his wife quite well over the next several days, and was with them as they learned that the mass was in fact Adenocarcinoma of the Lung, spoke to specialists in Hematology / Oncology and Radiation Oncology, and set them up for all their future care needs. The prognosis is not good, but it was very fulfilling to be able to be there with these very pleasant people, answering their questions and helping to ease their very difficult transition into dealing with a new diagnosis of cancer. The wife gave me a big hug on the patient's discharge day, and I have been continuing to follow the patient's progress via the electronic charting. I hope his available chemotherapy and radiation therapy options, while not likely curative treatments, will at least allow this patient to lengthen his amount of quality life left and allow him to die with dignity and on his own terms. Oncology is a tough field, I'm glad that I didn't go into it, as I think that I do have a pretty high degree of sensitivity (though I can be kind of cold sometimes) and the weight of sharing in people's new cancer diagnoses over years and years would be pretty tough. I was glad though to have had the opportunity to participate in this gentleman's care and to have made a positive difference in his life.
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