No symptoms. Normal hormone levels. And then, one scan changed my life.

 

Dr. Natasha Das,

Consultant, Medical Communications

A papillary thyroid carcinoma patient

On the 16^th of July, I mark one year since a diagnosis that shook my near and dear ones. Until then, I was a doctor and a medical communications professional leading a normal ‘healthy’ life and conducting outreach programs and training people how to do a self-examination of the breast and the oral cavity for early detection of cancer.  

I have always believed in the power of early detection. Now, I have lived it.

The clue I missed – and my friends did not

A year ago, a friend, who is also a doctor, noticed something I hadn’t – a slight swelling on my neck. I had no symptoms. No pain. No voice changes. No trouble swallowing. And like many patients, I could have dismissed the swelling as harmless, especially in the absence of symptoms. But as a doctor, I knew better.

It turned out later, my thyroid hormone levels also were within normal limits. All that I had was just a visible lump that I had not known of till then.  

A few weeks later, another friend nudged me to get a scan to check if it was only a cyst (a fluid filled sac) or a solid tumor. 

The clinical examination

Next, I got myself clinically examined by a physician friend. She examined the swelling and said it felt like a cyst and there may not be much to worry. She insisted that in spite of the normal hormone levels, a swelling is an abnormality. She advised me to get an ultrasound scan followed by a fine-needle aspiration cytology (FNAC) to be sure it was a benign cyst.

The ultrasound that revealed a silent story in the other lobe

I went in expecting the scan to confirm a benign nodule in the area of the swelling. Instead, the ultrasonologist noticed something entirely different.

He didn’t just scan the obvious lump. He thoroughly examined the entire neck. His attention to detail changed the course of my care.

Yes, there was a cyst in the right lobe of the thyroid that did seem to be benign. But the ultrasonologist found foci of microcalcification in the left lobe of the thyroid. Microcalcifications are detected by the ultrasound as small, bright spots – a red flag for thyroid cancer. The ultrasonologist insisted that I get an FNAC from the left side rather than the right.

I cannot emphasize this enough. It was his skill and thorough examination that brought the true picture to light.

A quick and conclusive FNAC report

While the tiny bright spots (less than a mm in diameter) detected by ultrasound were a strong indication of thyroid cancer, they could also have been due to benign conditions such as Hashimoto’s thyroiditis. Because of its association with cancer, since microcalcifications were identified, a thorough evaluation was crucial.

Although I was advised to get an FNAC done with a sample from the left lobe, there was no lump on the left that could be seen or felt. The pathologist therefore, went in for an ultrasound-guided FNAC. The ultrasound was used to locate the position of the microcalcifications. A fine needle was used to withdraw cells from there. These cells were then examined under the microscope to determine if there were any cancerous cells.

It was the FNAC that confirmed the diagnosis of papillary thyroid cancer.

Ultrasound to detect the spread of the cancer

Once the diagnosis was confirmed, a surgery was planned. But before that, the cancer surgeon needed to know about the spread of the cancer.

He advised another ultrasound of the neck. This time, with the cancer already diagnosed, the ultrasound was used to assess the lymph nodes in the neck for any signs of metastasis or spread of cancer.

When the cells in the lymph nodes die, the lymph nodes become what doctors call ‘necrotic’. Necrotic lymph nodes often appear darker on the ultrasound monitor.

This second ultrasound of my neck revealed several necrotic lymph nodes indicating spread of the cancer.

CE CT scan to rule out the rare possibility of abdominal or pelvic mass

In rare cases, follicular or papillary thyroid cancers have presented as pelvic masses or as asymptomatic pelvic bone metastases.

I also underwent a contrast-enhanced computed tomography (CE CT) scan of the abdomen and pelvis to rule out any abnormality in these areas.

Surgery and biopsy that helped determine the staging of the cancer

Since one lobe of my thyroid had a large visible cystic swelling and the other lobe had cancer, the surgeon decided to remove the thyroid gland completely.

As ultrasound had revealed necrotic lymph nodes in the neck, the surgeon decided to clean the neck and remove the nearby lymph nodes.

The surgeon also decided to remove one of the four parathyroid glands as it was too close to the affected area and might harbor cancer cells.

While necrosis of lymph nodes on an ultrasound often points to spread of cancer, it is important to consider other possibilities such as tuberculosis, fungal infections and other chronic inflammatory disease.

The removed thyroid gland, parathyroid and neck lymph nodes were sent for biopsy. There were multiple cancerous nodules in the thyroid and the largest one had a diameter of over 2 cm. The cancer was confined to the thyroid. It had spread to four of the neck lymph nodes but there was no distant spread. The cancer was therefore, staged at T2N1M0. Since I was less than 55 y old at diagnosis, this was considered as stage I papillary thyroid cancer.

Adjuvant therapy after the surgery

After the surgery, I underwent adjuvant nuclear therapy in the form of radioactive iodine (RAI) therapy.

The RAI therapy ensured that any remnant thyroid tissue or microscopic disease was treated. It also completed the active phase of my treatment.

A follow-up scan after the RAI therapy ensured that all thyroid cells in my body had been killed.

A pill each morning – that’s all it takes to keep me going

Once the RAI therapy was done, it meant all my thyroid cells were killed – even that microscopic amount that have been left behind after the surgery.

I need thyroid hormones for overall functioning of my body. As my body no longer produces these hormones, I have been put on thyroid hormone replacement therapy.

This means every morning, I get up and take a pill that gives me enough thyroid hormones to allow my body to work to its optimum ability.

A final word – the power of looking closer and paying attention

When I reflect today, 1 year after the diagnosis, on what saved me – I believe it wasn’t just a machine and a test. It was the people behind them who looked closer and paid attention.

A friend who saw what I didn’t.  The ultrasonologist who paid attention to the left side too when the swelling was only on the right side. The pathologist who confirmed the diagnosis. The ultrasonologist who found the necrosed lymph nodes. The surgeon who carefully removed my thyroid gland without any damage to the nerve to my voice box, who removed the neck lymph nodes carefully and sent it for biopsy. The pathologists who did the biopsy and confirmed that the spread was limited only to a few nearby lymph nodes.

My case is a reminder that medicine is as much about vigilance and intuition as it is about technology.

So, if you—or someone you care about—has a neck swelling, don’t ignore it. Even if it is painless. Even if your lab tests are normal. Even if you feel fine. Ask your doctor about an ultrasound. Make sure the scan is detailed and done by someone experienced in thyroid imaging. And follow through if something looks suspicious.

Because early detection doesn’t just improve outcomes. Sometimes, as in my case, it changes everything.

 

P.S.

One year after the diagnosis, I am doing well. 

My last whole-body scan had shown no remnant thyroid cancer cells anywhere in my body.

As a panel moderator at the recently concluded DIA Medical Writing Conference 2025

Grateful to these people in my cancer journey

Dr. Sanjusmita Tripathy, Dr. Preeti Srivastava, Dr. Sharmistha Sarangi, Dr. Biswajit Mishra, Dr. Sandeep Mohanty, Dr. Ranjan Mohanty, Dr. Pradyumna Kumar Sahoo, Dr. Manas Ranjan Baisakh, Dr. Rabi Narayan Mallick, Dr. Manoranjan Mohapatra, Dr. Saroj Kumar Sahu, Dr. Tushar Mohapatra, Dr. Saurendra Das, Ar. Santrupthy Das, Mr. Animesh Das, Dr. Bibhupada Mohanty, Mrs. Yashodhara Das, Mrs. Alaka Das, Mr. Nilolohit Mohanty, Mrs. Mandakini Mohanty, Ms. Swetapadma Acharya, Dr. Purvish Parikh, Dr. Pratap K. Das, Dr. Ghanashyam Biswas, Dr. Soumya Surath Panda, Mr. Ravi Shankar Sharma, Mr. Debakanta Kar and many others.

Also, Zulie bhai (Late Dr. ZH Khan) who always encouraged me to spread awareness for early detection of cancer.

When you have cancer, you do not travel alone. And that’s what makes all the difference. I share my story now so others will listen sooner—to their bodies, to their instincts, and to those who care enough to speak up. Because sometimes, one scan and one set of careful eyes is all it takes to change the ending.

Early Signs of Cancer

Today is the 4th of February. This day is marked as the World Cancer Day ‘to promote ways to ease the global burden of cancer’. The focus for this year’s World Cancer Day is on Target 5 of the World Cancer Declaration – to dispel myths and misconceptions about cancer. You shall, over the next few days, be reading a lot about such myths about cancer. In a previous blog post I talked about 20 myths related to breast cancer.

But today, I am going to share with you a list of possible signs of cancer. These signs are commonly called the C-A-U-T-I-O-N signs…because of the mnemonic they form.

Changes in stool or urine

 Long term constipation or diarrhea

More often or infrequent stool or urine
Pain while passing urine

A sore or a white patch that does not heal

A sore that takes >3 weeks to heal
A white patch in the mouth or private parts
White spots on the tongue 

Unusual discharge and bleeding

Blood in the stool, urine or sputum

Unusual bleeding from the vagina

Bloody discharge from nipple

Thickness or lump

Lump in breasts or almost anywhere in the body

Thickening of testicles or lymph nodes

     Indigestion & difficulty in swallowing

Though mostly caused by other reasons, persistent indigestion or swallowing problems may be related to cancer of the food pipe.

          Obvious changes in moles & warts

Change in color, size, or shape

Loss of definite border

        Nagging cough or hoarseness

Cough that does not go away

Persistent hoarseness of voice

Please remember: 

• Less common signs & symptoms are not listed here.
• If you notice ANY change in your body or the way it functions, especially if it lasts a long time, see a doctor.
• If it is not cancer, the doctor will find out more about the condition and treat it, if needed.
• If it is cancer, there will be a good chance of early treatment.  

A Doctor's Encounter with Breast Cancer

A physician friend of mine was detected with Breast Cancer a few years back when she was merely in her 30s. But the active person that she is, many of our friends still do not believe she has cancer.

I had always been pestering her to write her side of the story...to tell the world about how it feels like to be doctor who has been detected with cancer.

It's a combination of conflicting feelings one has.

At one end, you feel you are a doctor and you are very careful about your health. So cancer cannot happen to you! At the other end, as a doctor, you know cancer can happen to anybody...just about anybody. It is only another chronic disease needing lifelong treatment and care...like diabetes or high blood pressure or heart disease. And yet as a patient you know life is not the same anymore once you are detected with cancer.
You know you will lose hair with chemotherapy, you will feel nauseated, you may even throw up often...And you also know of all the other complications that chemotherapy brings along. At the same time, you also know chemotherapy will make you feel better as it will help destroy the cancer cells.

You are trying to show the world you are a brave person with a very positive frame of mind. Nothing, not even cancer, can pull you down! And then one subtle comment on your wig or your breast implant lets you down...makes you feel defeated and bereft.

Through these ups and downs of life after detection, my friend came out as a triumphant young lady. She went on to win a yoga championship and publish volumes of medical articles in journals. She continues to live  a wonderful life of a busy doctor, a caring mother and a loving wife. And she joins hands in spreading awareness about cancer.

Read my interview with her where she talks about her cancer and the changes it brought about in her life. What is it about cancer that makes people realize their own inner strength...an inner strength and beauty that they never knew existed?

To the strongest cancer patient I have encountered...love being your friend!

"Cancer is not a killer." What kills is ignorance, carelessness, delayed diagnosis, and late, improper or no treatment.


If you have encountered cancer at close quarters, do share your story with others. Your story may inspire others.

How to do a Breast Self Exam

So, you have decided to do a regular self examination of the breast but are not sure how to get started? Here's a simple way to do it. Don't be overwhelmed by the pictures. Read through. It's really simple to do.

Like I mentioned in a previous post, there is no fixed or best method of doing a breast self exam. The only thing you must remember is to examine all areas of your body that are likely to contain breast tissue. And examine this area very carefully and thoroughly. Remember missing out a small change for a long time can be really bad.

Area to examine when doing a breast examination

So which area should you examine? I repeat - examine the whole of your chest (the front and the sides as well) and the armpit. I just love this picture. It shows the entire area you must examine.

From the collar bone to the bra line and from the middle of the chest to the sides, including the armpit...that's the area you need to examine.

Examining the breast is not rocket science. It is as simple as examining a pimple on your face. What do you do? You look at it in the mirror and then feel it with your hand. That's exactly what you do with your breasts.

Looking for changes:

In a well-lit room, stand in front of the mirror with your hands by your side. Look at the front of your chest. Compare what you see on either side. Then turn to the left and then to the right. Examine the sides.

Once you are convinced there is no new change, try out these positions. In each position, remember to check not just the front but also the sides. 

This is all you need to know about looking for changes. Simple, isn't it? The next is feeling for changes in your breasts.

Feeling for changes:

There are several different methods to feel for changes in your breasts and you may try out all or any of them. Here's one method that I believe covers the entire area and thickness of the breast. If you follow this single method, you should be able to detect changes in any area of your breast.

Lie down on a bed with a pillow/folded towel under the left shoulder if you wish to examine the left breast first. Keep your left hand folded at a right angle as in the picture here.

In this position, the entire breast spreads out flat and is of almost the same thickness throughout making it easier to examine.

Feel your left breast using the flat or pulp of the three middle fingers of your right hand. At each place where you put your fingers, make three coin-sized circles with your fingers.

Why three circles? Well, in order to apply three different pressures while feeling for lumps.

One pressure should be light enough to move the skin without moving the tissue underneath. Then apply a medium pressure so you can reach midway into the tissue. And then apply a deep pressure so that you can reach your ribs. These three different pressures allow you to reach different thicknesses of your breast tissue. See the adjoining pressure to know what I mean.

At each place, use these three different pressures in circles to check for changes. Without lifting your fingers, slide them and check another area of the breast. If you lift your fingers, you are likely to miss out some areas of the breast.

How do you slide the fingers? In which pattern? I follow a simple stripe pattern that covers the entire area of the breast.

Start from the armpit. Keep sliding down till your bra line. Then move a little medially (towards the middle of the chest). Keep sliding up till you reach the collar bone. Move medially again and come down to the bra line...Keep repeating till you reach the middle of the chest.

After you have done this, don't forget to let your arm loose and check in the armpit for lumps.

Then check your nipple for changes or any abnormal discharge. And before you know it, you have thoroughly checked for changes in one breast. Repeat all the steps in the other breast.

With some practice, you should be able to check your breasts in less than 5 minutes. And you need to check for changes only once in a month. So that's not much, is it?

Know your breasts well so that you can detect any change at the earliest. If you detect any abnormality, do not panic. Most lumps or changes in the breasts are not cancer. But they do need attention and treatment. So see a doctor in time.

Early Detection of Breast Cancer

Breast cancer - it certainly is not a death sentence! Cancer is a group of over 200 different diseases that result due to uncontrolled divisions of cells in the body. But luckily enough, breast cancer is a condition that can be easily detected at an early stage and treated adequately.

The survival rates of breast cancer are some of the best. The most commonly used term to describe survival rates is the 5-year survival rates. The 5-year survival rate refers to the percentage of patients who live for at least 5 years after their cancer is detected. Many live much beyond that. In fact, my grandmother lived for over 18 years after her breast cancer was detected and when she finally died, her death was not related to her cancer.

The 5-year survival rate for breast cancer that is detected early can be higher than 90%. Check the American Cancer Society's data on breast cancer survival.

Now, how do you detect breast cancer at the earliest? It's an easy 3-step method.

• Breast Self Exam

This is a simple technique which you can do at home. Just pay attention to any changes in your breasts. Look and feel for changes in your breasts. There are several different methods to do this. You really do not need to bother much about all the different methods. Just remember you need to look and feel for changes on the entire area of your body that contains breast tissue.

This includes an area that starts from your collar bone on top to your bra line at the bottom, from the middle of the chest to the side of your chest (including your armpit). Here's a picture that should tell you where to examine for changes.

Remember that breast tissue spreads much beyond just the protruding bulge.

When you examine just the bulging part you tend to miss out on many other areas where breast tissue is found. In fact, breast cancer is commonest in the outer upper quadrant of the breast which does not have much of a bulge.

How often should you do a self exam? Once a month should be sufficient. Start once you are 20 years of age and continue doing a self exam throughout your life. Make it a part of your regular life.

• Clinical Breast Exam

This is about getting your breasts examined by a clinician. 

Get a clinical exam done once in three years if you are less than 40 years old. Once you are above 40 years, go for an annual checkup with a clinician. 

Who should you go to? Ideally, it should be a surgeon who has been examining a lot of breasts and can detect changes early. But you can get yourself examined even by your gynecologist or your family physician. Just get yourself examined regularly. 

• Screening Mammography

This is a special x-ray of the breast. It helps detect minor changes in the architecture of the breasts. An annual screening mammography is recommended for women above 50 years of age. If your mammograms are normal, you may go for a screening mammography every two years. 

Mammography does not seem to help younger women much. However, if your clinician suspects a change in your breast, he/she may advise you to get a mammography done at a younger age. Do not defer from getting a mammography done in that case. 

Please remember to do a regular self-exam, in addition to, not in place of clinical breast exam and a mammography. When you combine all the three different methods for screening, you are more likely to detect cancer at its earliest. 

If you have never gone for a breast cancer screening. This is an excellent time to start. Get started!

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P.S. The pictures used here are from various sites derived after a Google search. I used them because I felt they gave an apt description of what I wanted to convey. If you have any issues about my use of these pictures, please write to me.