The first line of treatment for many forms of cancer is surgical resection. This involves a surgeon physically removing the visible tumor plus sufficient margins of healthy-appearing tissue around the tumor to remove cancer cells that aren’t visible to the naked eye.
This requires a careful balance. Surgeons and their patients don’t want to remove too much tissue—sometimes causing unsightly scars—but want to remove enough tissue to get all the cancer. You might think of it as the Goldilocks principle, getting it “just right,” like in the children’s story.
After the surgeon cuts out or resect the cancerous tumor, it’s sent to a pathologist for analysis. Pathologists are physicians trained in the microscopic examination of tissue. For surgeries of this nature, the pathologist examines the tumor to confirm the type of cancer and staging.
Oncologists use staging to describe how far the cancer spreads. Lower numbers are better. Higher staging numbers, such as Stage IV, indicate that the cancer has spread beyond the primary tumor site.
When examining resected tumors microscopically, pathologists also look carefully at the margins of healthy tissue from around the tumor that were removed by the surgeon. It’s good news when the pathologist confirms that there are negative or clean margins, which means that the pathologist found no cancer cells in the tissue surrounding the tumor. This is felt to be a good sign that the surgeon removed all of the cancer. On the other hand, positive margins mean that cancer cells are still in place, posing a potential risk to patients.
In some situations, it may be medical malpractice if the surgeon does not resect a sufficient amount of tissue. Surgical experts carefully review the medical records, radiology scans, and operative reports to make this determination on a case-by-case basis.
Here at Painter Law Firm, we recently handled a tragic case where a young mother lost her life because a colon-rectal surgeon didn’t perform an adequate resection. The surgeon was successful in surgically removing the tumor itself, but the pathology report showed that the margins weren’t clear. As we investigated the lawsuit, the surgeon’s deposition testimony revealed that he had an adequate opportunity to get it right but missed the mark.
The consequences of an insufficient tumor margin resection can be profound for patients. For many types of aggressive cancer, it may mean the difference between likely survival with chemotherapy or radiation therapy after surgery, or essentially a death sentence without another surgery to remove the residual cancer cells.
Another form of medical malpractice following cancer resection surgery is when the post-operative pathology report comes back showing positive margins (all the cancer wasn’t removed), but this information isn’t communicated to the patient. Typically, the pathologist, as a consultant, prepares a report that’s sent to the surgeon. It’s up to the surgeon to share this important information with the patient.
This is a good place to point out that this is one of the myriad reasons why you should always request a complete set of your medical records from the hospital or surgery center after any operation, surgery, or procedure. The pathology report will be part of those records and you can read the results for yourself and then ask your surgeon about them.
In another case, a patient had a lump identified on one of her breasts during her annual well-woman exam. A biopsy revealed that the lump was cancerous and a surgical oncologist performed a lumpectomy, a procedure to remove the breast lump. The patient received care from a medical oncologist and radiation oncologist that were part of the same practice group as the surgical oncologist. This is significant because it means that all three of the physicians from different specialties had instant access to the patient’s medical records and all of the information related to her condition and care.
The surgical oncologist sent the lumpectomy and margins to a pathologist for review. Separately, the pathologist returned a report that the margins were positive for cancer cells. Under this situation, the standard of care requires the surgeon to inform the patient and perform an additional surgery to resect the remaining cells.
As you might’ve guessed by now, the surgeon, as well as the surgeon’s colleagues in the same practice group, never mentioned this information to the patient, even though she continued to receive regular treatment within their practice group. As a result, the patient’s breast cancer continued to grow and develop into Stage IV cancer, metastasizing (spreading) to her lungs, liver, ribs, leg bones, and spine. This left her with no chance of survival.
Finally, a third type of cancer-related malpractice occurs when a pathologist misses cancer cells on microscopic examination. In this situation, the pathologist would return a faulty report that would misguide the clinical physicians involved in the ongoing care of the cancer patient.
If you’ve been seriously injured because of poor cancer or pathology care in Texas, then contact a top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.