UNDIAGNOSED MALIGNANCY

CANCER DIAGNOSED LATE - yes, but can you prove harm? Clinical investigation may have been substandard, but can you show a worsened prognosis?

Most malignancies are well past middle-age before they can be detected. Tumours in internal organs generally must grow to at least a cubic centimetre before detection, and this represents about 30 doublings [1] from a single malignant cell. On average a doubling takes 2 months, varying from 1 month (cancer of the testicle) to 1 year (cancer of the prostate)[1a].

PRACTICE POINT Most cancers are at least 5 years old before they can be diagnosed.

Little wonder that a diagnostic delay of six months - a tiny fraction of the life of many cancers - may not have a demonstrable effect on prognosis.

Solid tumours are generally staged according to the extent of local invasion, the involvement of nearby lymphnodes, and the extent of metastatic spread. Survival rates and life-expectancy tables by stage are available for standard treatments of the common malignancies.

PRACTICE POINT A six month delay in treatment may be insufficient to alter the prognosis.

To prove causation, you must show there was probably a progression to a more advanced stage during the delay in diagnosis.

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