Oncology and Hematology

Physicians writing on KevinMD about cancer: the screening argument that has run since 2009, how a diagnosis is delivered, what treatment costs patients, life after treatment, and what the work does to oncologists. Four maintained records draw on this archive: Cancer: what physicians say, in their own words, End of life: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Opioids: what physicians and pain patients say, in their own words.

Grandma was tired. So she told me goodbye.

James C. Salwitz, MD

Physician

May 8, 2015

At the wake, when the kids kept running around, disturbing the disturbed, their mother, or maybe their aunt, or maybe their neighbor, shooed them to the basement. Adult quiet and proper mourning returned. However, I noticed that Mary, eight years old, or so, stayed upstairs. For a while, I watched her, carrying food, clearing plates, even answering the front door. A petite, hard working, hostess. I wondered why.

“Mary,” I said, …

A surgeon who wasn’t God in the OR after all

Hope Amantine, MD

Physician

May 4, 2015

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Do you know the difference between a surgeon and God? God doesn’t think he’s a surgeon.

Everyone who goes into the study of surgery has ideas about what they’re going to be. I would imagine that each individual has different expectations of what the future holds, though few find their future at all resembles those expectations.

I recall when I started my surgery …

MKSAP: 30-year-old woman is evaluated for a 1-year history of fatigue

mksap

Conditions and Diseases

May 3, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 30-year-old woman is evaluated for a 1-year history of fatigue, headaches, poor sleep, depression, intermittently blurred vision, and weakness when climbing stairs. She takes no medication. Following a physical exam and lab studies, what diagnostic tests should be performed next?

On physical examination, vital signs are normal. Bilateral ptosis and diplopia are …

Dense breast tissue: What is the role for additional screening?

Nicole Saphier, MD

Conditions and Diseases

May 2, 2015

The medical field, more so than many other professional arenas, is continuously struggling to balance the concepts of increasing quality metrics, decreasing overall expenditure, and riding the crest of the current technological and scientific expansion wave. Within the past half century, our profession has borne witness to an explosion of advancement, and with this has come a contemporaneous increase in both the need for sub-specialization and, bluntly, the associated cost of …

A patient this oncologist can’t forget

Don S. Dizon, MD

Physician

May 1, 2015

She was so young — only 32 when diagnosed with ovarian cancer. She had given birth to a son only four months earlier and by all rights should have been celebrating being a new mother. But, instead, she had developed acute pelvic pain, undergone emergent removal of her uterus and ovaries, and was now in my office to discuss …

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A patient this oncologist can’t forget

When a CT scan misses cancer

Michael Kirsch, MD

Conditions and Diseases

April 26, 2015

A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist. I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus.

I expected a benign explanation for her swallowing issue. She was relatively young and not particularly ill. She had seen my partner years in the past for a similar complaint, which he …

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When a CT scan misses cancer

The Elizabeth Sedway case: In defense of Alaska Airlines

Sarah Poggi, MD

Physician

April 24, 2015

Elizabeth Sedway, a 51-year-old undergoing treatment for multiple myeloma, was outraged to be removed from a Hawaii-San Jose flight due to concerns about her health. Wearing a mask to prevent infection as her immune system was compromised from chemotherapy, she requested handicapped seating and told an airline employee she felt “weak.” The employee consulted with an airline doctor who was concerned …

When the back pain red flags aren’t enough

Davis Liu, MD

Conditions and Diseases

April 19, 2015

$28 million was awarded to a patient for a late diagnosis of a pelvic tumor, an osteosarcoma. This rare cancer presented as a case of low back pain and sciatica. The patient claimed that if the osteosarcoma had been caught earlier that the subsequent surgery would have been avoided.

Could doctors have done better in diagnosing more quickly?

These cases strike fear into all primary care doctors. Which patient has a …

We have already changed the way we think about cancer

Leonel Ampie

Conditions and Diseases

April 15, 2015

The tenets engendered by cancer have been slowly elucidated throughout the years. The hallmarks of cancer have been well documented by Douglas Hanahan and Robert Weinberg in Hallmarks of Cancer: The Next Generation. Some of these features are well known and are inclusive of sustained proliferative signaling, evading growth suppressions, and others clearly outlined in their review. These cellular processes have been discovered by basic science researchers and subsequently, modern …

Should we give patients our cell phone numbers?

Anne Katz, RN, PhD

Physician

April 13, 2015

I recently attended the David Stroud Adolescent and Young Adult [AYA] Symposium at Keck Medicine of University of Southern California. It was a very interesting symposium with experts in adolescent and young adult cancer presenting on many different topics important for this population. There was also a panel of young adult …

MKSAP: 54-year-old woman with shortness of breath

mksap

Conditions and Diseases

April 12, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 54-year-old woman is evaluated for shortness of breath of 3 months’ duration and a 4.5-kg (10-lb) weight loss over the preceding 2 months. She has a 35-pack-year smoking history.

On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 145/82 mm Hg, and pulse rate is 108/min. Oxygen saturation is …

Angelina Jolie’s story is one of true courage and grit

Miranda Fielding, MD

Physician

April 7, 2015

I have always been one of Angelina Jolie’s biggest fans. The Academy of Motion Picture Arts and Sciences saw fit to reward her 1999 performance in Girl Interrupted with an Oscar, but I wasn’t well and truly smitten until the second Lara Croft Tomb Raider movie was released in 2003. In that film, Jolie, who performs her own stunts, is seen …

Projection. From an unlikely source.

Ilana Yurkiewicz

Medical Education

April 7, 2015

The patient was hacking sputum into a tissue when the resident and I entered his room.

“How long have you had that cough?”

“Oh this? As long as I can remember.”

“But it’s been worse lately?”

“Yeah.”

“Worse how?”

“More stuff coming out each time. See?”

He opens the tissue.

“How much sputum is there?”

“Sputum?”

“The stuff you cough up.”

“I don’t look that close.”

“More than two spoonfuls?”

“Oh yes. Definitely.”

“And the color?”

“White-ish.”

“Ever see any streaks of blood?”

“Never.”

“And how long have …

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Projection. From an unlikely source.

Paul Kalanithi: A neurosurgeon leaves his mark on our hearts

Ashley Sumrall, MD

Physician

March 29, 2015

At age 37, after a nearly 2-year battle with stage IV lung cancer, a talented neurosurgeon lost his battle. My oncology-related newsfeed is filled with stories this week about this brave and clever man’s recent passing. In a field where the recent tweets tout results of the latest clinical trials (overall survival prolonged from 2 months to 4 months!), it is sobering to be reminded of what truly matters to …

Changing the way we think about cancer

Jack C. Westman, MD

Conditions and Diseases

March 26, 2015

The sun rises and the sun sets. It seems like the sun rotates around the Earth. Cancer cells rise and are killed by surgery, radiation and chemotherapy. It seems like cancer is a disease. But the sun does not rotate around the Earth, and cancer is not a disease. The many kinds of cancer cells are the products of the disease neoplasia that can emerge in our bodies’ organs and tissues.

Strange …

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Changing the way we think about cancer

Remember the psychological harms of cancer screening

Kenneth Lin, MD

Conditions and Diseases

March 25, 2015

Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force’s recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with prostate cancer screening, other than the overdiagnosis (and resulting unnecessary treatment) of clinically insignificant tumors. Since routine prostate-specific antigen screening had been going on for nearly two decades by then, we expected to …

A thank you to a mother and son in the ER

StorytellERdoc, MD

Physician

March 22, 2015

I walked into room 30 to find two eager sets of eyes awaiting me. One set belonged to a young man, late-twenties, muscular and imposing, sitting in a chair in the corner of the room. His eyes were hazel brown, big and inviting, relieved at seeing my entry into their sheltered world. The other set of eyes, darker brown and magnified by her gold-stemmed glasses, belonged to my patient, a …

Colorectal cancer screening in the elderly: Can we stop the train?

Robert S. Sandler, MD, MPH

Conditions and Diseases

March 20, 2015

The mortality from colorectal cancer has decreased substantially in the U.S. during the past decade. While some of the improvement is due to better cancer treatment and reduced risk factors, the largest proportion is thought due to screening. The concept that early detection saves lives has now become well recognized. The harms of screening — particularly among individuals with limited life expectancy — are less well appreciated.

Royce et al. recently published a …

What would truly personalized oncology look like?

Amy Abernethy, MD, PhD

Conditions and Diseases

March 13, 2015

The concept of “personalized medicine” gets thrown around a lot these days. And as an oncologist and a palliative care doctor, who advocates for using data to get information that can provide more personalized cancer care, I believe strongly in it. But what would truly personalized oncology look like?

More than 14 million people are living with cancer in the United States, according to the National Cancer Institute — and some 1.7 …

I broke my own rule when giving bad news

James C. Salwitz, MD

Physician

March 11, 2015

For 25 years, I have taught medical students how to give bad news. Step one: Be prepared. Step two: Find a safe, personal, quiet environment. Step three, and this is most important: Before you speak, ask. What do the patient and family understand? Fail to follow this vital rule and reap the whirlwind. So, therefore, you might ask, if I have such wisdom and experience in this critical area …

Oncology and Hematology

Oncology and Hematology

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