I was a little surprised when I heard the unit clerk call out to me, "Dr S, the radiologist is on line three for you. Says it's about room 8."
Room 8? I mused as I disengaged from the patient I was with and went to answer the phone, That's odd. Why would he be calling me about Room 8?
The man in Room 8 was a guy with a classic kidney stone. Came in with sudden onset right flank pain, writhing and covered in sweat. He had blood in his urine. It was as clear as could be. He felt better after some meds and went off to CT. Now as a rule, the radiologists only call us for Bad Things or Weird Things, and in this case I was not suspecting either. Would the radiologist call me just for a routine stone?
I pulled up the images on the computer as I answered the phone. Sure enough, there was a big ol' stone there in the right mid ureter. I saw it just as the radiologist was telling me about it. 3x7mm -- that's gonna hurt to pass. But what? The kidney? OK, I'll scroll up through that as well.
A largish dense mass on the inferior pole. Almost certainly renal cell carcinoma. That's why he was calling me.
So the patient went back to scan for contrast-enhanced images to verify it, and sure enough, that's what it was.
(image source; my patient's tumor was smaller -- about 5 cm)
The good news for my patient was that the cancer seemed quite localized and without evidence of metastases. This is very important, since Renal Cell Carcinoma is amenable to a surgical cure when caught early, and pretty lethal when it has spread. I reviewed the images with our urologist who thought that he was a great candidate for nephron-preserving surgery, i.e. a partial nephrectomy.
So I had to drop the hammer on him. Worse, it was Christmas Day. Worse (for me), it was my first shift back since my wife's diagnosis. Neither of us were really in a good place to deal with a new cancer diagnosis. But this case had an unusual bright side. Were it not for that kidney stone, I told the patient, you would never have needed that CT scan. Without this early detection, we would never have found this cancer while it was still curable. Kidney stones suck, but this particular kidney stone saved your life!
Sometimes it's all about Luck.