Deep and Dirty Into the Airways | Feb 24 2021

Pulmonology consult: check

EBUS + COVID test: in the process of being organized.

Had a positively lovely hour with the pulmonologist today. Because I wasn’t freaking out and was so curious about the whole thing, he got down deep and dirty into the process of the biopsy and potential ways forward. I’m telling you, in my next lifetime, I am coming back as a doctor– all this stuff is just so interesting. (For example, did you know the cells of the airway are a completely different shape [square] than those of a lymph node? During the procedure, there’s going to be a cytologist in the room who will look at each tissue sample to tell them whether they got the airway or the good stuff, and they’ll just keep going until they hit pay dirt.)

Also, they will go down down my airway with this very cool scope until they can get to the nodes. When the camera is too big to go any further into the breathing tubes, they go to the electromagnetic navigational biopsy gadgets.  If they have to, they will go as far as the mass, which is close to my heart. But he thinks there’s a “very high chance” of getting a good sample of the lymph nodes.

Then that stuff goes to the pathologist. They’ll look for mutations– if there are any, I am instantly a candidate for immunologic/biologic treatments. They’ll also be determining what kind of cancer is growing there. That, plus the info from the PET scan and MRI, will determine the course of treatment we pursue.

He said that the size of the nodes suggests that surgery alone will not be a cure. (It’s amazing they can even use the “cure” word in the same breath as “cancer,” eh? )

Good news (in my book):

• I fit the profile for a good response to a biologic treatment
• Surgery would be a REALLY BIG DEAL. At this very, very, very preliminary point, he doubts I will need it.  (Did you get that very very very preliminary part?)
• There are two categories of cancer: large cell and small cell.
  • If it’s small cell cancer, treatment would be determined by if and how far the cancer has spread. Right now, it looks like all the badness is still contained in the right lung. (Woohoo!) If all the tests show that it is contained, he predicts treatment would lean toward chemo & very targeted radiation. And just think– there are some chemo drugs where you don’t even lose your hair!
  • If it’s large cell cancer, that just leads to more pathways of treatment possibilities.

Anyway, he wanted me to caution you that we really don’t know anything definite yet, so for those of you watching at home, please remember that. Of course, in the next breath, he said, and I quote,”I will be surprised, even shocked, if this is not cancer.” (Shall I go through my notes and count how many times he said that?) So, do with all that information as you wish.

In case you, like me, were so enamored of your high school bio class that you took home your worm for further dissection, here are some images of lungs & EBUS biopsy. Coolest. Thing. Ever.

TTYS

Image:  Blood Vessel And Alveoli In Lung Tissue by Science Photo Library Art (use here is a total

copyright infringement but it’s a beautiful image so I don’t care.)
Coloured scanning electron micrograph (SEM) of a section through a lung, showing red blood cells (round, centre) in a tiny blood vessel (centre) surrounded by alveoli (large spaces). Alveoli are the site of gaseous exchange in the lungs, where oxygen is taken up by the red blood cells and carbon dioxide released for exhalation out of the body. The alveolar walls are lined with a one-cell thick layer of epithelium that oxygen must pass through to reach the blood.