Mass and nodules

My first consult today was with a 73 year old previously healthy man. The last time he was sick was 4 years ago when he had stomach pain from an ulcer. It happened on Christmas day. It was so bad he had to go see a doctor. Then for 4 years, nothing. Until this Christmas when after eating a wonderful meal with family and friends, the pain came back. It got so bad that he couldn't sleep and by 4am this morning he decided to come in and see the doctor.

We took some blood and ran some tests. It turns out that he not only has an enlarged thyroid that has moved his wind pipe over to one side of his chest, he also has enlarged lymphs nodes in his chest, and abdomen, almost down to his pelvis. And then his liver is acting up and so his liver enzymes are high. He used to be a heavy drinker over 30 years ago. He also has a mass in his lungs.

What struck me was he was so grateful the pain was gone and he could now sleep. He has no idea that he probably just ate the last meal he will enjoy for a long long time. And he probably just slept the last few hours of worry free sleep.

The next consult I just kind of helped with. The woman is 52 years old. She has had swelling and pain in her right breast for 3 months. She has also had over 20 lb weight loss in that same time and has had chills off and on. The pain got bad enough that she came into the clinic to see the doctor. We saw and examined her and reported back to the senior resident. He looked over all her labs, her history and then her imaging studies.  Then he went into the room to speak with and examine her as well. While he examined her he found big lymph nodes in her right axilla. That was enough to give the most likely diagnosis. He sat down looked her straight in the eye and then said to her "you probably have cancer." Her response? "I know something was wrong but I've been praying for 3 months that Jesus would take it away. What am I supposed to do now?" His voice cracked as he went on to explain what the next steps would be. She was already in another world...

Mass and nodules, two terrible words that can change the course of one's life forever. What are we supposed to do now?