Safety and Health Reporter
Brien Roche Law > Blog > Medical Malpractice > Medical Malpractice and Cancer Treatment

Medical Malpractice and Cancer Treatment

Fairfax Injury Lawyer Brien Roche Addresses Medical Malpractice and Cancer Treatment

Brien Roche

More Is Not Always Better

Most cancer patients opt for any and all available treatment. Even those with remote chance of helping their condition.  Dr. Lowell Schnipper, the chief of hematology-oncology at Beth Israel Deaconess Medical Center in Boston, heads the expert task force on cancer-related treatments.   This group was convened by the American Society of Clinical Oncology. It reports that more is not necessarily better.

Staging

In diagnosing cancer, doctors try to stage the disease. This gauges how aggressive it is.  This involves the use of tissue samples and biochemical analysis. If the cancer has spread, then imaging tests will show where it has spread to.  However if the staging shows a low risk of spreading then radiological studies may not be justified.  These low risk tumors include breast cancer staged at levels 0, I or II.  In prostate cancer Gleason scores of 6 or less or a PSA level of 10 or less are referred to as low risk.  With those types of cancers CT scans, PET scans or bone scans may not be justified. The risk may outweigh the benefit.

In addition, the use of medication to fight infection may not be always justified.  The question to ask is whether the patient is at high risk for low white blood cell count.  If so then it may be necessary to prescribe certain white cell growth medication.  Call, or contact us for a free consult.

If the patient is at the end of life, then the use of more treatment modes may not be justified. In fact they may worsen the condition.  If the cancer has grown or spread after three different treatment regimens, then further therapy is not going to help. Sometimes what is simply needed is palliative care.       

Thyroid Cancer

Thyroid cancer is sometimes referred to as the “good” cancer. It’s thought of as being the good cancer because the survival rate is 97.9% after 5 years.

About 63,000 new cases of thyroid cancer are diagnosed each year in the U.S. Common symptoms associated with this illness are an enlarged thyroid gland or pain in the front of the neck. Others include trouble swallowing, persistent hoarseness, voice changes or constant coughing.

Thyroid Cancer-Treatment

The first line of treatment is removal of the thyroid. This is referred to as a thyroidectomy.

The thyroid is the organ within the body that controls many important functions. They include blood pressure, temperature, heart rate and metabolism.  When the thyroid is removed, patients then must take hormones to regulate these functions.

The problem with the hormone replacements is regulating the right amount.  Too much or too little can produce side effects. They may include significant fatigue or chest pain. In addition there may be increased heart rate, sweating, anxiety, headaches and others.

Radioactive Iodine

After the thyroid has been removed there may still be some tissue left behind that is cancerous.  If so, then the patient needs to undergo radioactive treatment. This with what is called “radioactive iodine”.  This iodine is administered either in liquid or pill form.  After taking it the patient must be isolated for up to a week. The body at that point is letting off low levels of radiation.  As such the patient has to avoid close contact with other people or pets for at least one week.

In addition these radioactive pills or liquids increase the risk of secondary cancer.  That is the kidney, bladder and pelvic organs are now being exposed to radiation. They may become cancerous.

Although thyroid cancer is referred to as the “good” cancer it’s still pretty bad. Call, or contact us for a free consult.

Malignant Bone Tumor Misdiagnosis

Bone tumor misdiagnosis can have fairly immediate consequences.  Malignant bone tumors do not spread through the lymphatic system. Rather they tend to spread through the blood stream.  As a result there is no need to remove the lymphatic system with these types of tumors. 

Most Do Not Start In The Bone

Although some cancers originate  in the bones, most of them originate in other organs. They may then spread to the bones. 

Whether the tumor is malignant or non-malignant it can still be quite destructive.  The non-malignant bone tumors do destroy bone. 

Children sometimes develop bone tumors during growth spurts.  These are difficult to diagnose because they may be associated with some injury.  A history of injury can cloud the diagnosis.

Multiple Tests

In terms of making a proper diagnosis of a bone tumor, biopsy alone is not enough.  You must combine X-ray, MRI and CT scans with pathology reports. This gives the complete picture. 

Many malignant tumors affect the ends of bones. Therefore there may be a need to replace a joint along with the bone. 

A common treatment is CyberKnife radiation. This is an intense form of localized radiation. The intent is to first shrink the tumor before it is surgically removed.

Medical Malpractice and Melanoma

Melanoma is a very common and can be a deadly form of skin cancer.  The melanoma moles come essentially in two forms.  They are either radial or nodular.

Radial

The radial moles are identifiable by the acronym-ABCD:

  • A – asymmetry:  if the mole is asymmetrical from one half to the other half, that is suggestive of it being melanoma. 
  • B – border:  if the borders are irregular as opposed to being smooth, that is suggestive of it being  melanoma.
  • C – color:  if the mole is multi-colored as opposed to simply being one uniform color, then that is suggestive of  melanoma.
  • D – diameter:  if the diameter is more than a quarter of an inch, that is suggestive again of it being melanoma.

The radial moles tend to be fairly flat with the surface of the skin.  The other type of melanoma moles are what are called nodular moles.

Nodular

The nodular moles again are identifiable by an acronym-EFG:

  • E – elevated:  if the mole is elevated as opposed to flat with the surface of the skin, that is suggestive that it is nodular.
  • F – firm:  if the mole is firm as opposed to flabby, that again is suggestive of it being a nodular melanoma.
  • G – growing:  if the mole has been growing for more than two weeks, that is suggestive of it being nodular.

The nodular moles are the ones that tend not to grow that much above the surface. Rather they are boring into the skin causing damage.

From a medical malpractice perspective contour is important. What is most important is early diagnosis. This tends to produce a good result. A delayed diagnosis can well be fatal. Call, or contact us for a free consult.

Interventional Radiology

Interventional radiology has always been part of the cancer treatment regimen.  It is becoming a more important player. This is so with cancers involving the liver, gall bladder and pancreas. In addition it has use with tumors in the lungs, bones and kidneys.  The role of the interventional radiologist is to identify and then treat. This is through catheters that are guided to the tumor site. They either block the blood supply that nourishes the tumor or attempt to kill the tumor. This is through either a heating or cooling process.

Dealing with cancer through surgery, radiation and chemotherapy can now be aided by interventional radiology. They use powerful imaging techniques to first identify the tumor. Then they attempt to isolate. Finally they attempt to destroy it.

Getting To The Tumor

With many of the more traditional treatments it is not possible to even get to the tumor.

Many of these procedures are done percutaneously. There is simply a needle insertion through the skin. This allows catheter penetration.  These catheters apply heat energy to burn and destroy the tumor.  Also they use sub-zero temperatures to freeze and kill the tumor. 

The so-called NanoKnife represents another form of treatment. This targets tumors that are located in difficult area such as arteries or veins.  It allows the doctor through imaging to place small electrodes inside the tumor. They emit pulses that create microscopic holes in the tumor. This causes the cells within the tumor to die. 

Embolization therapy involves cutting off the tumor’s blood supply. The tumor cells are denied oxygen resulting in their death. 

Call, or contact us for a free consult. For more information on medical malpractice issues, see the other pages on this site and on Wikipedia.

The Doubling Growth Defense in Misdiagnosis Cases

The doubling growth defense in cancer misdiagnosis cases is misplaced and flawed.  What this defense consists of is the contention that cancer cells grow exponentially. It contends they grow in a predictable and orderly fashion. That results in the conclusion that cancer is never timely diagnosable. Therefore it is incurable. That is, by the time that the first diagnosis could have been made treatment would make no difference. 

False Premises

Those contentions are false for a number of reasons:

    Growth is Variable

  • The growth rate of cancer cells differ from person to person. The growth rate changes over time. In addition, the growth rate may vary from cell to cell.  The cancer cells may undergo change. This may make them either more resistant or less resistant to therapy.  Cancer cells die over time.  The cells undergo changes in going through different stages in their cycle.  In addition, certain basics such as receiving food, oxygen and space may dictate the rate of growth.  If the cancer has spread to a new organ, the growth rate there may be different than the primary tumor.  Comparing these growth rates is like apples and oranges.
  • Composition is Variable

  • The tumor material can be dramatically different. Tumors are composed of blood and blood vessels.  In addition, there may be infection mingled in. There may be cells from the immune system of the body and normal cells from the body.  All of those change the size and rate of growth of the cancer. In order for the doubling time to apply the proportion of each of these would have to remain constant. That is not the case. 
  • Measurement is Variable

  • The ability to measure the tumor at any time is difficult.  A clinical measurement is, at best, imprecise. The doctor is using imprecise instruments to make the measurement. In addition the measurement may be impossible because the cancer is not a perfect sphere.  The cancer is an octopus with a number of different legs. They are going in different directions each with different composition.  They are measured by direct human contact, radiographically, mammographically, by ultrasound or pathologically.  There is great variability in those modes of measurement. 
  • Nutrient Supply is Variable

    One of the obvious things that effects tumor growth is the ability of the host to provide the nutrients.  Suffice it to say there is a great deal of variability in tumor growth.  

Doubling Growth Defense Is Not New

The defense would have you believe that the cancer is incurable.  Certainly the doubling growth analysis does not support that theory. 

This defense is somewhat counter-intuitive. The general axiom is that the sooner the treatment is begun then the better the chances of a cure.  The doubling time defense is a counter to that. It asserts that the earlier diagnosis may not have produced any different outcome. 

No Constancy

The doubling time concept means that if the cells are dividing at a constant rate they will double at each such interval.  After 20 doublings you would end up with approximately one million cancer cells.  After an additional 10 doublings there would be over a billion. 

Doctors Do Not Rely On It

The most compelling argument to counter the doubling time defense is that doctors do not rely upon it.  If you review the plaintiff’s medical records, you will probably find that there is no reference whatsoever to any doubling time.  Doubling time is purely a litigation concept.

May Benefit Plaintiff

There are occasions where doubling time can actually work to the benefit of the plaintiff. Given the size of the tumor and the known doubling time, the tumor should have been visible to the doctor.  The argument can likewise apply to bacterial infections.  If in fact doubling time applies then based upon the size at the time of diagnosis, one can extrapolate back. Therefore the growth should have been visible at the time of exam. Call, or contact us for a free consult.

Colonoscopy

Washington Post article of December 24, 2013 addresses the issue of colonoscopy and how effective they are.  They are highly effective in preventing colorectal cancer.  Colorectal cancer is the second deadliest type of cancer.  The colonoscopy allows a doctor to detect precancerous growths in the colon. They are removed on the spot.  The article indicates that 15,000 to 20,000 lives could be saved per year with the increased use of colonoscopy. There are also stool tests that are nearly as reliable.

Colorectal cancer is a slow growing type of cancer and typically takes 10 to 15 years to develop.  As such early screening increases the likelihood of long-term survival. 

Colonoscopy Risks

There is some small risk of bowel perforation. In addition the drugs that are used have a rare but serious risk such as difficulty with breathing.

Medicare and most private insurers are required to cover this type of procedure.

Call, or contact us for a free consult. Also see breast cancer and other related articles on this site and the pages on Wikipedia.  

Comments are closed.

Contact Us For A Free Consultation

Medical Malpractice and Cancer Treatment

Fairfax Injury Lawyer Brien Roche Addresses Medical Malpractice and Cancer Treatment

Brien Roche

More Is Not Always Better

Most cancer patients opt for any and all available treatment. Even those with remote chance of helping their condition.  Dr. Lowell Schnipper, the chief of hematology-oncology at Beth Israel Deaconess Medical Center in Boston, heads the expert task force on cancer-related treatments.   This group was convened by the American Society of Clinical Oncology. It reports that more is not necessarily better.

Staging

In diagnosing cancer, doctors try to stage the disease. This gauges how aggressive it is.  This involves the use of tissue samples and biochemical analysis. If the cancer has spread, then imaging tests will show where it has spread to.  However if the staging shows a low risk of spreading then radiological studies may not be justified.  These low risk tumors include breast cancer staged at levels 0, I or II.  In prostate cancer Gleason scores of 6 or less or a PSA level of 10 or less are referred to as low risk.  With those types of cancers CT scans, PET scans or bone scans may not be justified. The risk may outweigh the benefit.

In addition, the use of medication to fight infection may not be always justified.  The question to ask is whether the patient is at high risk for low white blood cell count.  If so then it may be necessary to prescribe certain white cell growth medication.  Call, or contact us for a free consult.

If the patient is at the end of life, then the use of more treatment modes may not be justified. In fact they may worsen the condition.  If the cancer has grown or spread after three different treatment regimens, then further therapy is not going to help. Sometimes what is simply needed is palliative care.       

Thyroid Cancer

Thyroid cancer is sometimes referred to as the “good” cancer. It’s thought of as being the good cancer because the survival rate is 97.9% after 5 years.

About 63,000 new cases of thyroid cancer are diagnosed each year in the U.S. Common symptoms associated with this illness are an enlarged thyroid gland or pain in the front of the neck. Others include trouble swallowing, persistent hoarseness, voice changes or constant coughing.

Thyroid Cancer-Treatment

The first line of treatment is removal of the thyroid. This is referred to as a thyroidectomy.

The thyroid is the organ within the body that controls many important functions. They include blood pressure, temperature, heart rate and metabolism.  When the thyroid is removed, patients then must take hormones to regulate these functions.

The problem with the hormone replacements is regulating the right amount.  Too much or too little can produce side effects. They may include significant fatigue or chest pain. In addition there may be increased heart rate, sweating, anxiety, headaches and others.

Radioactive Iodine

After the thyroid has been removed there may still be some tissue left behind that is cancerous.  If so, then the patient needs to undergo radioactive treatment. This with what is called “radioactive iodine”.  This iodine is administered either in liquid or pill form.  After taking it the patient must be isolated for up to a week. The body at that point is letting off low levels of radiation.  As such the patient has to avoid close contact with other people or pets for at least one week.

In addition these radioactive pills or liquids increase the risk of secondary cancer.  That is the kidney, bladder and pelvic organs are now being exposed to radiation. They may become cancerous.

Although thyroid cancer is referred to as the “good” cancer it’s still pretty bad. Call, or contact us for a free consult.

Malignant Bone Tumor Misdiagnosis

Bone tumor misdiagnosis can have fairly immediate consequences.  Malignant bone tumors do not spread through the lymphatic system. Rather they tend to spread through the blood stream.  As a result there is no need to remove the lymphatic system with these types of tumors. 

Most Do Not Start In The Bone

Although some cancers originate  in the bones, most of them originate in other organs. They may then spread to the bones. 

Whether the tumor is malignant or non-malignant it can still be quite destructive.  The non-malignant bone tumors do destroy bone. 

Children sometimes develop bone tumors during growth spurts.  These are difficult to diagnose because they may be associated with some injury.  A history of injury can cloud the diagnosis.

Multiple Tests

In terms of making a proper diagnosis of a bone tumor, biopsy alone is not enough.  You must combine X-ray, MRI and CT scans with pathology reports. This gives the complete picture. 

Many malignant tumors affect the ends of bones. Therefore there may be a need to replace a joint along with the bone. 

A common treatment is CyberKnife radiation. This is an intense form of localized radiation. The intent is to first shrink the tumor before it is surgically removed.

Medical Malpractice and Melanoma

Melanoma is a very common and can be a deadly form of skin cancer.  The melanoma moles come essentially in two forms.  They are either radial or nodular.

Radial

The radial moles are identifiable by the acronym-ABCD:

  • A – asymmetry:  if the mole is asymmetrical from one half to the other half, that is suggestive of it being melanoma. 
  • B – border:  if the borders are irregular as opposed to being smooth, that is suggestive of it being  melanoma.
  • C – color:  if the mole is multi-colored as opposed to simply being one uniform color, then that is suggestive of  melanoma.
  • D – diameter:  if the diameter is more than a quarter of an inch, that is suggestive again of it being melanoma.

The radial moles tend to be fairly flat with the surface of the skin.  The other type of melanoma moles are what are called nodular moles.

Nodular

The nodular moles again are identifiable by an acronym-EFG:

  • E – elevated:  if the mole is elevated as opposed to flat with the surface of the skin, that is suggestive that it is nodular.
  • F – firm:  if the mole is firm as opposed to flabby, that again is suggestive of it being a nodular melanoma.
  • G – growing:  if the mole has been growing for more than two weeks, that is suggestive of it being nodular.

The nodular moles are the ones that tend not to grow that much above the surface. Rather they are boring into the skin causing damage.

From a medical malpractice perspective contour is important. What is most important is early diagnosis. This tends to produce a good result. A delayed diagnosis can well be fatal. Call, or contact us for a free consult.

Interventional Radiology

Interventional radiology has always been part of the cancer treatment regimen.  It is becoming a more important player. This is so with cancers involving the liver, gall bladder and pancreas. In addition it has use with tumors in the lungs, bones and kidneys.  The role of the interventional radiologist is to identify and then treat. This is through catheters that are guided to the tumor site. They either block the blood supply that nourishes the tumor or attempt to kill the tumor. This is through either a heating or cooling process.

Dealing with cancer through surgery, radiation and chemotherapy can now be aided by interventional radiology. They use powerful imaging techniques to first identify the tumor. Then they attempt to isolate. Finally they attempt to destroy it.

Getting To The Tumor

With many of the more traditional treatments it is not possible to even get to the tumor.

Many of these procedures are done percutaneously. There is simply a needle insertion through the skin. This allows catheter penetration.  These catheters apply heat energy to burn and destroy the tumor.  Also they use sub-zero temperatures to freeze and kill the tumor. 

The so-called NanoKnife represents another form of treatment. This targets tumors that are located in difficult area such as arteries or veins.  It allows the doctor through imaging to place small electrodes inside the tumor. They emit pulses that create microscopic holes in the tumor. This causes the cells within the tumor to die. 

Embolization therapy involves cutting off the tumor’s blood supply. The tumor cells are denied oxygen resulting in their death. 

Call, or contact us for a free consult. For more information on medical malpractice issues, see the other pages on this site and on Wikipedia.

The Doubling Growth Defense in Misdiagnosis Cases

The doubling growth defense in cancer misdiagnosis cases is misplaced and flawed.  What this defense consists of is the contention that cancer cells grow exponentially. It contends they grow in a predictable and orderly fashion. That results in the conclusion that cancer is never timely diagnosable. Therefore it is incurable. That is, by the time that the first diagnosis could have been made treatment would make no difference. 

False Premises

Those contentions are false for a number of reasons:

    Growth is Variable

  • The growth rate of cancer cells differ from person to person. The growth rate changes over time. In addition, the growth rate may vary from cell to cell.  The cancer cells may undergo change. This may make them either more resistant or less resistant to therapy.  Cancer cells die over time.  The cells undergo changes in going through different stages in their cycle.  In addition, certain basics such as receiving food, oxygen and space may dictate the rate of growth.  If the cancer has spread to a new organ, the growth rate there may be different than the primary tumor.  Comparing these growth rates is like apples and oranges.
  • Composition is Variable

  • The tumor material can be dramatically different. Tumors are composed of blood and blood vessels.  In addition, there may be infection mingled in. There may be cells from the immune system of the body and normal cells from the body.  All of those change the size and rate of growth of the cancer. In order for the doubling time to apply the proportion of each of these would have to remain constant. That is not the case. 
  • Measurement is Variable

  • The ability to measure the tumor at any time is difficult.  A clinical measurement is, at best, imprecise. The doctor is using imprecise instruments to make the measurement. In addition the measurement may be impossible because the cancer is not a perfect sphere.  The cancer is an octopus with a number of different legs. They are going in different directions each with different composition.  They are measured by direct human contact, radiographically, mammographically, by ultrasound or pathologically.  There is great variability in those modes of measurement. 
  • Nutrient Supply is Variable

    One of the obvious things that effects tumor growth is the ability of the host to provide the nutrients.  Suffice it to say there is a great deal of variability in tumor growth.  

Doubling Growth Defense Is Not New

The defense would have you believe that the cancer is incurable.  Certainly the doubling growth analysis does not support that theory. 

This defense is somewhat counter-intuitive. The general axiom is that the sooner the treatment is begun then the better the chances of a cure.  The doubling time defense is a counter to that. It asserts that the earlier diagnosis may not have produced any different outcome. 

No Constancy

The doubling time concept means that if the cells are dividing at a constant rate they will double at each such interval.  After 20 doublings you would end up with approximately one million cancer cells.  After an additional 10 doublings there would be over a billion. 

Doctors Do Not Rely On It

The most compelling argument to counter the doubling time defense is that doctors do not rely upon it.  If you review the plaintiff’s medical records, you will probably find that there is no reference whatsoever to any doubling time.  Doubling time is purely a litigation concept.

May Benefit Plaintiff

There are occasions where doubling time can actually work to the benefit of the plaintiff. Given the size of the tumor and the known doubling time, the tumor should have been visible to the doctor.  The argument can likewise apply to bacterial infections.  If in fact doubling time applies then based upon the size at the time of diagnosis, one can extrapolate back. Therefore the growth should have been visible at the time of exam. Call, or contact us for a free consult.

Colonoscopy

Washington Post article of December 24, 2013 addresses the issue of colonoscopy and how effective they are.  They are highly effective in preventing colorectal cancer.  Colorectal cancer is the second deadliest type of cancer.  The colonoscopy allows a doctor to detect precancerous growths in the colon. They are removed on the spot.  The article indicates that 15,000 to 20,000 lives could be saved per year with the increased use of colonoscopy. There are also stool tests that are nearly as reliable.

Colorectal cancer is a slow growing type of cancer and typically takes 10 to 15 years to develop.  As such early screening increases the likelihood of long-term survival. 

Colonoscopy Risks

There is some small risk of bowel perforation. In addition the drugs that are used have a rare but serious risk such as difficulty with breathing.

Medicare and most private insurers are required to cover this type of procedure.

Call, or contact us for a free consult. Also see breast cancer and other related articles on this site and the pages on Wikipedia.  

Contact Us For A Free Consultation

Contact Us For A Free Consultation