Friday, November 02, 2012

the black cat

many years ago during an inter-school debate, i heard one student taunt his opponent : my esteemed friend over there is confused, like he's in a dark room, looking for a black cat (pause) which isn't there.

looking back, it was a cynical comment & it sounded authoritative yet lacked substance. it's one of those phrases you bandied about just to impress the judges. much like a pick-up line.

a semblance of that statement was taught in med school. searching for a cause of an intra-abdominal infection can be difficult, hence "pus somewhere, pus nowhere, pus under the diaphragm." it just means that if you suspect pus in the abdomen, but you can't seem to find it, try looking under the diaphragm.

and no, i didn't learn any pick-up lines in the lecture halls either, but i digress.

so today, a 30yr-old lady presented with a lump in the groin. a biopsy of the tissue had been done & the lab reported it as metastatic cancer, which means this swelling in the groin (aka secondary tumour) is a result of the spread of a primary tumour.

this lady had been subjected to a battery of investigations to locate the offending growth - tests like gastroscopy, colonoscopy, ultrasound, CT scan, MRI & even a PET scan. but zilch! it's nowhere to be found. i can emphatise with her - it's an unnerving feeling that you know something sinister is growing in you & yet it remained elusive.

like the black cat.

running out of places to scan, & as if to grasp at straws, we did a scraping of the uterus & cervix today. just in case, because already we're at wit's end.

let's hope it's truly darkest before the dawn.


The thumb in every pie said...

This blog post gives me the shudders, Doc. Hard to imagine the frustration, anxiety and fear that she is going through at this moment.

I am just wondering - in situations such as these, what happens if after the latest round of tests, there's still no definitive identification of the problem?

pilocarpine said...

Get back to square one. Get further opinion from the Pathologist with the current progress, or get second opinion from another Pathologist..

pilocarpine said...

Maybe a second review on the histopathological specimen is warranted?

doc said...


sometimes, things like this happen. medicine is not an exact art or science & answers/solutions are often not initially forthcoming. like pilocarpine commented below, it's back to square #1 & we need to review if we've missed out something earlier.

will post on the result when available.

doc said...


that it is metastatic squamous cell Ca is not in dispute. only the primary tumour needs to be sought. stains like TTF1, CK7 & CK20 have also not been useful.

search for the black cat continues...

will post updates when avilable.

Soo said...

Just like my 56y.o aunt! Was told only 2 days ago that the docs in a Penang private hosp couldn't find the origin of her cancerous armpit lump... mammogram and all other scans were clear. It's very worrying indeed :(

Medie007 said...

oh debates... lol.

doc said...


she'll no doubt be subjected to the same battery of tests.