ACADEMY PUBLIC POLICIES

More often than people realize and contrary to popular belief, a cancer diagnosis is not always a straightforward affair. Cancer may cause symptoms that develop gradually, over months, or suddenly, necessitating urgent medical attention. These symptoms may be caused by the primary tumor or by a cancer’s distant metastases -tumors causing a problem in another organ (this is explained later).

T. came to the emergency room of our hospital because of a sudden onset of headaches, blurred vision, and uncontrolled twitching of one of his arms. A neurologist evaluated him, diagnosed him as having a seizure, and ordered an MRI of his brain. The MRI showed numerous tumors growing in his brain that were characteristic of cancer that had spread from another location in the body.

T. was admitted to the hospital for further evaluation. Because he was a smoker, a CT scan of his chest was performed, which revealed a tumor in one of his lungs. Biopsy of the tumor revealed lung cancer, and he was diagnosed with stage IV lung cancer because of distant metastases to the brain.

T. received antiseizure medicines, steroids (medicines related to cortisone) that reduce brain swelling caused by tumors, and brain radiation. After his condition improved, he was discharged from the hospital with plans to treat the rest of his cancer as an outpatient. T. story illustrates how cancer can sometimes strike suddenly and dramatically, causing a person to seek urgent medical attention.

Like heart attacks and stroke, cancer emergencies require immediate treatment. Because the possibility of cancer is usually not foremost in the mind of a patient who seeks emergency care, a cancer diagnosis under these circumstances often creates tremendous stress.

Being newly diagnosed with cancer in the hospital is one of the most difficult circumstances in which you and your loved ones can find yourselves. In M. and A. case, he was sick and needed treatment before leaving the hospital. The couple wanted to trust their oncologist but weren’t sure if they could or should. Yet whether you are in a hospital or at home, every newly diagnosed cancer patient faces similar immediate issues.

Just as important as making a proper diagnosis of cancer when it exists is not making the diagnosis prematurely without definitive proof. Although this point may seem obvious, the reality is that medicine can be complex. Pathology results are sometimes not definitive, biopsies may need to be repeated, and a sample may need to be evaluated by several expert pathologists before a correct diagnosis is rendered. A guiding principle in the practice of oncology is that, with rare exception, absolute proof of a cancer diagnosis must exist before any treatment is initiated.