The Enhanced Doctor-Chapter 572 Contradictory Cases

Chapter 572: 572 Contradictory Cases
"Doctor, how is it?" the patient’s husband asked after wiping away his tears.
It was a very simple question, but at this moment, both Liu Banxia and Wang Huan found themselves speechless, unsure how to respond.
Tumor marker screening is a very important indicator. The patient’s pancreatic head was quite large, and the mass prominent. However, the tumor marker screening had come back negative.
This presented a new problem: the cause of the enlargement might not be a tumor, but inflammation.
Yet, this conclusion led to another issue, one that contradicted common medical knowledge. The symptoms of pancreatitis usually indicated a shrinking organ.
They had treated patients with pancreatitis before; it was typically a self-destructive process within the organ, like a missile exploding in its silo.
If it was pancreatic cancer, why were the tumor markers negative? If it was inflammation, why was the pancreatic head still so enlarged?
How should they explain this to the patient?
"Doctor, does this mean it’s incurable? How am I supposed to live on..." the patient’s husband misunderstood when the two doctors remained silent, and he broke into loud sobs.
"Please don’t get upset yet. Your wife’s condition is a bit complicated. The current test results conflict with a cancer diagnosis, so we need to conduct further tests," Liu Banxia said.
No one would ridicule him; his reaction was born out of deep concern, and besides, the patient’s condition was indeed complicated.
Upon hearing her words, the patient’s husband stopped crying, and the patient’s ashen face showed some improvement.
"From our imaging studies, there’s a prominent enlargement in the head of your pancreas, and the contrast-enhanced CT scan shows significant activity of the contrast agent in this area," Liu Banxia explained, pointing to the CT images.
"However, the blood test results we just received don’t support this finding. The tumor marker tests were negative. You see, right here."
"So, currently, we can’t provide an accurate diagnosis and need to perform further tests. Let me put it this way: this is the first time I’ve encountered such a situation."
"So, does that mean I don’t have pancreatic cancer?" the patient asked nervously.
"Well... although tumor markers are an important indicator, they do have a reference range," Wang Huan said.
"For example, in diagnosing pancreatic cancer, the CA19-9 marker is crucial. While your current test result is somewhat elevated, it doesn’t seem to have reached the threshold for a malignant tumor."
"This is because this marker can also rise with certain digestive tract diseases. For instance, you currently have gallstones and a dilated common bile duct, which affects bile secretion and can also cause this marker to increase."
"Therefore, at this moment, we can neither completely rule it out nor confirm a diagnosis. The standard values are just a range; we still need to make the final diagnosis based on your pancreas itself."
"Doctor, just tell me, is there still a chance to rule out cancer?" the patient asked.
Wang Huan looked at Liu Banxia.
Liu Banxia nodded. "It’s possible. Your pancreas might be exhibiting an unusual form of inflammation, or perhaps a unique type of cyst. Pancreatic cancer would be the next possibility after those."
"Okay, Doctor. What other tests do I need?" the patient asked directly.
She wasn’t considering anything else; at that moment, she felt as if she had narrowly escaped death.
"Right now, the best course of action is a biopsy," Liu Banxia said.
"We can take a sample for pathological examination during your laparoscopic cholecystectomy. This test is the most definitive and accurate."
"Moreover, this approach would be less invasive. After all, your gallstones and common bile duct stones also need treatment. During the removal process, we can simultaneously examine your pancreas and the surrounding tissue."
"However, there’s one thing to consider: we will perform an intraoperative frozen section. If the head of your pancreas is indeed malignant, we might have to convert to open surgery."
"Since we haven’t performed an exploratory laparoscopy yet, we can only use the diagnostic images as a reference. Often, the actual conditions within the abdominal cavity cannot be fully visualized by imaging alone. Do you understand?"
"Doctor, just tell us what to do. We’ll cooperate fully," the patient’s husband said.
"In that case, I suggest proceeding with the laparoscopic cholecystectomy. We’ll then await the pathology results, and I’ll inform you based on the intra-abdominal findings and the pathology . How does that sound?" Liu Banxia asked after some thought.
"Okay, we’ll follow your advice. Can the procedure be done now?" the patient’s husband asked.
"Let’s aim for tomorrow. Preoperative preparations and examinations need to be conducted. Besides, today’s emotional distress isn’t conducive to postoperative recovery," Liu Banxia said.
"Brother Wang, I’ll admit her to the surgical ward first. I’ll check the operating room schedule later, and if possible, I’ll schedule it for the first slot tomorrow morning."
"Alright, let them complete the admission procedures first. We can discuss the specifics of the case later," Wang Huan nodded.
Let alone Liu Banxia, even he had never encountered such a peculiar case.
But, as Liu Banxia had said, the pathology results would be decisive, and many conditions could only be truly understood through surgical exploration.
Diagnostic equipment, after all, was just equipment; it couldn’t provide a complete picture of the detailed conditions within the abdominal cavity.
For the patient and her husband, it seemed like things had taken a turn for the better. However, Liu Banxia and Wang Huan weren’t as relieved; they still considered pancreatic cancer a strong possibility.
"Brother Wang, have you figured out what might be going on?" Liu Banxia asked after returning from making arrangements.
Wang Huan shook his head. "Let’s not guess blindly. You must be thinking, like me, that it’s still likely pancreatic cancer, just that certain factors might be obscuring the carbohydrate antigen 19-9 levels."
"Otherwise, what kind of inflammation could cause the pancreatic head to enlarge like that? I didn’t dare say it directly earlier, only hinted at it."
Liu Banxia nodded. "That’s more or less what I was thinking too. Let’s wait for tomorrow’s exploratory surgery to see. I’m just not sure how we’ll break the news to the couple."
"Especially since the patient wants to have a child. If it really is pancreatic cancer, how could she? The recovery period after surgery, the recovery from chemotherapy... a body that weak is a serious concern."
"Exactly," Wang Huan said. "You go ahead and get busy. I still have patients to see."
Wang Huan also couldn’t take up too much of Liu Banxia’s time, so their consultation about this patient had to end there for now. The rest would depend on tomorrow’s surgical findings and the intraoperative pathology .
Leaving the room, Liu Banxia was still puzzled. This patient’s condition was exceedingly complex, with too many conflicting indicators.
She decided to stop thinking about it for now.
It was too much to dwell on, and all the answers would be revealed during tomorrow’s operation anyway. We’ll deal with it then.
If it really was pancreatic cancer, it would be a major operation. She would have to wait until Zhou Shuwen was out of his current surgery to discuss with him about potentially adding another procedure for tomorrow.
Although she could perform the surgery herself, she still lacked Zhou Shuwen’s extensive experience.
"Teacher Liu, what’s wrong?" Liu Yiqing approached her.
"I was just stumped by a patient’s case. Enlarged pancreatic head, slightly elevated CA19-9 levels. Any thoughts?" Liu Banxia asked with a smile.
Liu Yiqing blinked. "Teacher Liu, are you teasing me again? I’m about to start my rotation; couldn’t you offer a little encouragement?"
"No, I’m serious. It’s true. So, inform the rest of the team: tomorrow morning we’re adding a laparoscopic cholecystectomy to explore this patient’s condition," Liu Banxia said.
"Teacher Liu, is there really such a patient?" Liu Yiqing still found it hard to believe.
"Indeed. But Doctor Wang and I are leaning towards it still being pancreatic cancer. So, tomorrow morning, we might end up performing a pancreatoduodenectomy. Be prepared," Liu Banxia added.
Liu Yiqing nodded and went to inform the other team members, pondering the situation herself.
Liu Banxia shook her head, deciding to definitively put the matter out of her mind. Dwelling on something she couldn’t figure out might affect her upcoming work.
"President Liu, when should we start contacting potential donors from outside?" Wang Chao came over.
"Have you thoroughly mastered the techniques yet?" Liu Banxia asked.
Wang Chao shook his head decisively. "It’s mainly that the patient’s parents are getting anxious."
"Let’s try to persuade them to be patient. Otherwise, how are we supposed to store so many samples if we collect them prematurely?" Liu Banxia replied helplessly.
"You need to study it thoroughly again. Understand every process, every step, and all the key points before we take action. The patient’s current condition allows for a few more days’ wait. Rushing into a transplant wouldn’t be good."
Wang Chao nodded. "Actually, I was thinking the same. Could you give me an approximate timeline? That way, I can reassure the old couple."
"For you to get a thorough grasp of the general procedures, it will likely take another three or four days, right? At that point, I’ll start contacting external sources. Hopefully, we can screen for healthy donors then," Liu Banxia said.
"But I must also remind you: you’re becoming a bit too emotionally invested in this patient. You need to maintain a proper distance. After all, fecal microbiota transplantation is only a possibility, and one with a very low success rate at that."
Wang Chao nodded again. "I understand. But since I took on this task, I have to do it diligently. Don’t worry, I know what I’m doing."
Liu Banxia patted his shoulder and said no more.
A gentle reminder was sufficient; Wang Chao had understood her words, and that was enough.
They were all adults, not children. If he still became too deeply entangled despite her reminders, there was nothing more she could do.
It was fine to care for patients, but it was best to limit that concern to the medical aspects. When personal emotions became involved, it often led to counterproductive results.