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Communications to the Editor |

Dr. Kahana’s Lesson : Some More To Learn FREE TO VIEW

Sebastiano Rizzo, MD, FCCP; Policlinico S. Matteo
Author and Funding Information

Pavia, Italy

Correspondence to: Sebastiano Rizzo, MD, FCCP, Div di Pneumologia, IRCCS - Policlinico S. Mattteo, Pavia 27100, Italy; e-mail: rizzos@smatteo.pv.it



Chest. 2001;120(2):687-688. doi:10.1378/chest.120.2.687
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Published online

To the Editor:

In the September 2000 issue, CHEST published the last article1 by Dr. Kahana, a distinguished member of the American College of Chest Physicians, who described the natural history of lung cancer in a patient. The news was that the patient was the author himself. He tried to let us understand what happens on “the other side of the desk,” and I agree with the Editor’s decision to accept and publish the article.

When studying cancer patients, we report cases and numbers, not emotions and feelings. Dr. Kahana reports his double experience as doctor and patient at the same time through the diagnostic approach, the doubt on what was better to do or not to do, the underevaluation of some symptoms and signs, the prognostic expectancy, the therapeutic perspective, the rethinking of a known disease of other patients, and the realistic view of the hardly contrasting new condition. Unfortunately for Dr. Kahana, the diagnosis was late, and we don’t know whether timely investigations (CT scan, fiberoptic bronchoscopy, etc) at the first onset of thoracic symptoms might have changed the course. But, certainly, hemoptysis is not an underevaluable symptom, especially in smokers or former smokers > 40 years of age, even with normal chest radiographic findings, as also shown.24 Reporting his case, Dr. Kahana has given us the opportunity to remember that (1) former smokers are not completely risk free, even though they stopped smoking a long time ago; (2) some tumors grow slowly, may manifest dramatically after several months from the first clinical or radiographic appearance, and they cannot be readily related to lung cancer (which may, perhaps, have happened to Dr. Kahana); (3) when an incidental chest radiograph shows opacities not previously known in asymptomatic patients, especially in smokers or former smokers, lung cancer should be first suspected and further investigations carried out; (4) an apparently complete or good clinical response to antibiotic or steroid therapy should be confirmed by a radiographic follow-up; and (5) diagnostic procedures revealing doubtful results should be repeated within a short time.

Kahana, LM (2000) Living with lung cancer: the other side of the desk.Chest118,840-842. [CrossRef]
 
Colice, GL Detecting lung cancer as a cause of hemoptysis in patients with normal chest radiograph.Chest1997;111,877-884. [CrossRef]
 
Rizzo S. Doubtful cases in the diagnosis of lung cancer: what to do? Presented at: 35th national conference of the Italian Association of Hospital Pneumologists (AIPO); November, 1999; Florence, Italy.
 
Herth, F, Ernst, A, Becker, HD Long-term outcome in patients with hemoptysis of unknown origin. Chest. 2000;;118(Suppl) ,.:229S
 

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References

Kahana, LM (2000) Living with lung cancer: the other side of the desk.Chest118,840-842. [CrossRef]
 
Colice, GL Detecting lung cancer as a cause of hemoptysis in patients with normal chest radiograph.Chest1997;111,877-884. [CrossRef]
 
Rizzo S. Doubtful cases in the diagnosis of lung cancer: what to do? Presented at: 35th national conference of the Italian Association of Hospital Pneumologists (AIPO); November, 1999; Florence, Italy.
 
Herth, F, Ernst, A, Becker, HD Long-term outcome in patients with hemoptysis of unknown origin. Chest. 2000;;118(Suppl) ,.:229S
 
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