The Art of Medicine
On February 6, 2012, I consulted on a very pleasant 74-year-old artist who regularly displayed her work at the annual Sawdust Festival in Laguna Beach, California. Her findings revealed a biopsy proven breast cancer, a nodule in the lung and a large mass in the right kidney.
Our conversation turned to the likely origins of these findings. After careful review I reasoned that these were actually 3 distinct cancers. The breast cancer appeared early stage, while the kidney mass had features of a clear cell carcinoma and the nodule in the lung appeared isolated and well circumscribed.
We crafted a plan. She would undergo surgery to remove the breast mass, the kidney mass and the lung mass. She sailed through the surgeries and upon review, was found to have an early-stage ER, PR (+) breast cancer, a curatively resected stage II kidney cancer, and a curatively resected carcinoid cancer of the lung; 3 cancers successfully removed. I recommended against postoperative treatment for the kidney and lung and offered postoperative treatment for the breast cancer. I followed the patient for five years and then lost touch.
Eight years to-the-day after my initial consultation, now 82, the patient returned with a mass in the right chest wall that proved to be recurrent breast cancer. We initiated hormonal therapy that worked well for 2 years. Along the way, a cutaneous melanoma was identified and resected for cure.
Despite her now 4 cancers, no germline genomic drivers were ever identified.
After exhausting hormonal treatments, I returned to my original study of this patient's tissue and identified activity for the simple oral drug. In October 2022, we began low dose therapy. Her response was immediate with virtually no side effects.
Despite the gravity of 4 cancers, and her cancer recurrence that has required chemotherapy, today all of her tumor markers remain normal and scans stable.
Now, our every 3-month office visits focus on the Sawdust Festival, art sales and whether her hairstyle with a slightly longer cut, is more becoming (I like the longer look). With one of her Sawdust festival paintings depicting a rustic landscape with an old truck in the foreground, she adapted the motif to do a painting of my 1955 Buick Special, that now hangs in my office
Fully 14 years later, here is an example of the right treatment at the right time for the right patient.
Her vigor, active lifestyle, and indomitable spirit reflect a life well lived despite 4 prior cancers.
The patient has not been cured and may at some point show disease progression. We may yet need to adjust her therapies, but at 89 years of age, continuing her career as an artist and living a full and complete life, I consider her outcome to be an immense victory.
