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Blogs by the online BMJ respiratory medicine champion
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New hope for Sputum Cytology? *cough cough*
One perusing 'the paper' in the Drs Mess this morning, following the ward round, I found a small article entitled "I coughed up my incurable cancer". It turns out that a woman of 37 had a severe coughing fit, and coughed up a 2cm "heart shaped" lump. She took it to her GP, who sent it to the path lab, to be told it was an "aggresive tumour". She was then told to save for her funeral!
CT scanning revealed - nothing. So she's been told that "It is very uncommon to cough up cancer, but she did". Of course, I want to know more! What was the pathology? Was this likely to be an oropharyngeal mass, or lung? Or oesophageal? The Sun doesn't reveal the juicy details. The wee photo on the page describes the lady as "Lucky...." I should say so. Quick straw poll of the Mess: no-one recalls anyone coughing up a tumour, although I have had patients cough up tracheal stents I spent so long carefully inserting. I was teaching the students yesterday about screening for lung cancer, and the Fleischner guidence on SPNs - they asked me about sputum cytology, so I proclaimed it to be essentially useless. I suspect the cytology on this occasion might have been positive. Not sure if I can start advocating sputum *histology*....
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In the antipodeans we spit in a clockwise direction like our cyclones and water down the bath plug. I have yet to see a tumour like this with a left hand thread.