Beti O'Connell

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November 2016:
Beti had initially gone to her Internist, with complaints of congestion, cough, fever, chills, raspy voice and shortness of breath. She was treated with steroids and other medications; she developed edema (swelling in her lower legs). Beti also had chest x-rays and a CT scan (computerized tomography scan combines a series of X-ray images taken from different angles and uses computer processing to create cross-sectional images, or slices, of the bones, blood vessels and soft tissues).

December 2016:
Friday, December 9, 2016
The Nurse Practitioner, called Beti about abnormal CT scan results and a recommendation to see a Pulmonary (lung) doctor.

Tuesday, December 13, 2016
Beti saw both the Pulmonologist and Nurse Practitioner. Beti's health history was obtained and all of the previous records were reviewed along with CT scans from the past. The Pulmonologist explained Beti had areas on her lungs which were abnormal:
    1. Nodules (small masses of tissue in the lung) 
    2. Enlarged lymph nodes in the hilar region (inside the lung) and right neck area (outside the lung)
The Pulmonologist talked about the nodules first; to summarize:
    (4) nodules are present in Beti's right and left lungs
       (3) of the nodules were present on past CT scans 
       (2) of the nodules changed
       (1) nodule in Beti's right lung is new 
       (1) nodule in Beti's left lung is unchanged
The Pulmonologist talked about the lymph nodes next; to summarize, there are three reasons to have enlarged lymph nodes:
    1. Infection
    2. Inflammation
    3. Cancer
The Pulmonologist advised more tests to determine a cause for the abnormalities:
    1. Magnetic resonance imaging (MRI scan) 
    2. Ultrasound (US) of legs 
    3. Positron Emission Tomography (PET scan)
    4. Bronchoscopy (to obtain tissue fluid specimens for biopsy)
In addition, the Pulmonologist would present the information to a panel of experts to determine where best to get biopsy specimens for a diagnosis. 

Wednesday, December 14, 2016
    PET Scan completed

Friday, December 16, 2016
    US completed
      Deep Vein Thrombosis (DVT) detected right leg (clot)
      Beti admitted to hospital for anticoagulant therapy ("blood thinners")
    MRI completed
    Needle Aspirate of enlarged lymph node right neck area (outside the lung) test added/completed
    Bronchoscopy cancelled (due to DVT and Beti needing to be anti-coagulated) 

Sunday, December 18, 2016
    Beti discharged from hospital with the following plan:
      Anticoagulant injections
      Lab (blood) tests scheduled to monitor "blood thinners"
      Initial pathology results given to Beti from the Pulmonologist
      Referral to a medical oncologist  

Thursday, December 22, 2016
     Pathology report indicates Non-small cell lung cancer

Friday, December 23, 2016
    Contacted by Nurse Navigator for Beti
      Confirmed family appointment with Oncologist on Tuesday, January 3, 2017 at noon

Details about some of the testing and results are summarized below:
    PET scan showed abnormalities in the lungs, consistent with the CT scan. No "other" areas were identified for concern
    MRI scan showed abnormalities consistent with old strokes and one area poorly defined
    US scan showed DVT in R leg, 
      Anti-coagulated with injections and pills
      Monitoring of bleeding times done by lab draws
    Biopsy/Needle Aspirate of enlarged lymph node right neck area indicated non-small cell cancer

Other information (paraphrased from American Cancer Society):
There are two major types of lung cancer:
    1. Non-small cell lung cancer 
    2. Small cell lung cancer
    Of note: there is also a Lung Carcinoid Tumor, which occurs in a small percent of lung cancers.
Beti has non-small cell lung cancer, which is the most common type of lung cancer. 

There are sub-types of non-small cell lung cancer:
    Squamous cell carcinoma
    Adenocarcinoma
    Large cell carcinoma
Although the specimen is poorly differentiated, per the biopsy results, Beti does have cancer of the lung, which include production of significant amounts of mucus.

Beti has either Stage IIIB or Stage IV non-small cell lung cancer. We will find out what stage Beti is in from the Oncologist

In summary:
    Beti has been diagnosed with (non-small cell) lung cancer
    Beti (and family wishing to attend) will see the Oncologist (cancer doctor):
        Tuesday, January 3, 2017 
        St. Luke's Medical Center
        Vince Lombardi Cancer Clinic
        2901 W. Oklahoma Avenue
        Milwaukee, Wisconsin 53215
    The appointment will take about 2 hours
    Oncologist will indicate Mom's stage of cancer (IIIB or IV) 
    Oncologist will present treatment options, recommendations and answer questions for Beti /family

This story has a lot of information, even if the content is at a basic level; you can find out more from the American Cancer Society, National Cancer Institute, or American Lung Association.