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Tragedy, a term that denotes 'sad outcome' or a 'sad ending' comes true when a Lung Cancer is misdiagnosed for Chest Tuberculosis (Pulmonary Tuberculosis); also, popularly known as 'TB'. Understanding the nuances, misinterpretations, misdiagnosis and its implications on disease outcomes and thereby patients is essential to ensure right diagnosis, right treatment and desired outcomes in patients.

Tragedy of lung cancer misdiagnosis begins with a dilemma, due to the similar manifestations of TB & Lung Cancer. A radiograph of chest that shows 'millet seed'; a nodule of size less than 2 mm, 'a mass or a nodule' in the lung (technically called cavitary lesion) or a 'pleural effusion'; commonly referred to as fluid deposition in the lung walls; are a trap for misdiagnosis of Lung Cancer to Pulmonary Tuberculosis.

While it is essential to rule out one out of two diseases, a 'judgement' is passed to patients for Tuberculosis. India being a high prevalence geography for TB, the said judgement becomes myopic, biased yet justifiable. Sometimes, much before the chest scan is ordered, patients are treated with broad-spectrum antibiotics much like guinea pigs, especially in smaller towns & villages where medical facilities are not evolved.

As an Oncologist, I come across many cases who have been treated for lung TB for no improvement in patient conditions and eventually referred to me for ruling out the chances of Lung Cancer. On the contrary, many such patients on further investigations confirm to have lung cancer. Leaving aside those patients who are referred to oncologists, large chunk of patients is experimented upon further for non-cancerous conditions till the end of their life. This is what I call a 'Crisis of Generalization'.

What is lost in the process is a 'window of opportunity' for treating lung cancer early and aggressively. Lung cancer management has been revolutionized with identification of pathological subtypes and specific treatment targets, inventions of targeted therapies and recently, the immunotherapy. Cancer specialists are well equipped to treat patients for cure and the best quality of life.

What patient also need in the beginning is an inescapable opinion of CANCER SPECIALIST who will identify lung cancer hiding behind TB and other lung diseases.

Dr. Ashish Joshi

MD DM

Sr. Medical Oncologist MOC, Borivali & Vile Parle

ashjoshi44@mocindia.co.in

www.mocindia.co.in