“We are at rock bottom,” I told her family. “If this tablet works, things can only get better.” She arrived at Jaslok Hospital barely conscious — breathless, drowsy, with oxygen saturation at 80. Minutes later, she suffered a seizure in the emergency room. The 36-year-old mother of two had been misdiagnosed with tuberculosis in her hometown and brought to us in a cardiac ambulance.
A Suspicion Beyond Tuberculosis
One look at her chest X-ray told me this wasn’t just TB. A large, mass-like shadow covered her lungs, but her symptoms — seizure, respiratory failure, and rapid deterioration — didn’t fit the typical TB profile. My instincts pointed to cancer, and we had to act fast.
The Cost of Presumptive TB Diagnoses
In India, lung shadows in younger patients are often presumed to be tuberculosis without proper testing, especially in rural areas, delaying cancer diagnosis and nearly proving fatal in her case.
Racing Against Time for a Diagnosis
We rushed her for urgent scans, which revealed a large lung mass and brain lesions. We drained fluid from her lungs for cancer cell testing and ordered immunohistochemistry to determine the exact type of cancer. Genetic testing soon followed. Within 48 hours, we had the answer: ALK-positive lung cancer.
Understanding ALK-Positive Lung Cancer
ALK mutations occur in about 3–7% of lung adenocarcinomas in India, more often in young, non-smoking patients. However, such an aggressive case with multi-organ involvement in a patient already on life support was rare.
Choosing Targeted Therapy Over Chemotherapy
As reported by TOI, the diagnosis opened a critical treatment option: targeted oral therapy. Instead of chemotherapy, we could use a pill to block the mutated gene pathway driving her cancer. Starting an oral drug on a ventilated patient was unconventional and risky — poor absorption, aspiration danger, and no guarantee of success. But waiting was not an option. Her family understood and placed their trust in us.
Signs of Hope and a Dramatic Turnaround
By day four, her oxygen requirement began to drop, giving us our first glimmer of hope. In the initial 48 hours, survival seemed uncertain — it was a race against time. Within a week, she was off the ventilator. Soon after, she was speaking, eating, and smiling. Such rapid recovery in a critically ill patient was extraordinary.
Complete Response in Three Months
Three months later, her PET scan showed no detectable cancer. Discharging her was a moment to remember — her two children ran into the hospital to embrace her, and her father told me, “You gave us our daughter back.” That memory still gives me goosebumps.
The Promise and Challenge of Precision Oncology
Precision oncology has transformed cancer care. Molecular testing allows us to personalise treatment rather than rely solely on chemotherapy. However, in tier 2 and tier 3 cities, late referrals, financial constraints, and lack of awareness still delay diagnoses.
A Message of Hope
If she hadn’t reached a tertiary centre in time, she might not have survived. Today, she is thriving. This is the message patients and families need to hear: cancer is not always a death sentence. With timely diagnosis and the right treatment, we can change outcomes — and give life back.
By: Dr Jeyhan Dhabar, Consultant, Medical Oncology, Jaslok Hospital and Research Centre, Mumbai