General Medicine

» tinuviel - 10 cm margin

In response to 10 cm margin posted by redback:

What do you mean by "Stay around"? Do you mean "don't die"? If that's the case, I'll try, but I can't promise anything. There's a guy that chops grass (lawns) and takes care of some animals in a common around here. He's been doing it since I was little. I just found out he died a couple days ago. He slipped on a slope, hit his head on a rock, and fell into a corner on the side of the path. No one found him for two days.

Death comes looking for you sometimes, when you've done nothing to deserve it.

They just announced free health care for all children in my country. This began last Monday. My cousin's surgery doesn't qualify though, since it will be done at the University Hospital. This, I take it, is a private institution. But in all this time I've been wondering about spinal surgery. Last I heard, people didn't want to be doing things to the spine with knives or scalpels, etc. Can a tumour really be removed from the spine?

-- posted by tinuviel

» P_Al - 10 cm margin

In response to 10 cm margin posted by tinuviel:

Are you sure the tumour is in the spine itself, or is it within the spinal canal? It could be in the vertebral column (back bones) and impinging on the spine.

I'm no surgeon, but my understanding is that some tumours are well circumscribed and may be dissected free from normal tissue and removed whole. Just as with a brain tumour. I believe that much of the problems arise when the tumour is not so well defined and therefore the surgeon cannot remove all of it without risking damage to normal tissue. And when this involves vital structures like the brain and spinal cord the stakes become very high.

This is one reason why the prognosis is often so different for a stage 1 cancer versus and stage 3 or 4. The former is often well localized and amenable to complete removal. Not so for a locally advanced tumour that has started to spread irregularly throughout the normal surrounding tissues.

-- posted by P_Al

» P_Al - 10 cm margin

In response to 10 cm margin posted by tinuviel:

This is one of the limitations of sugery - it is not a microscopic tool. Surgery therefore does not erradicate every last cancer cell. However, molecular approaches are being developed that may change this.

-- posted by P_Al

» tinuviel - 10 cm margin

In response to 10 cm margin posted by P_Al:

No, I'm not sure precisely where the tumour is. All I know is it's somewhere in the vicinity of the spine. Whether it's the cord itself or just in the bone--I don't know.

So, from what you said just now, do you think maybe they'll be trying to remove the bulk of it and then get the un-removable parts through some form of chemotherapy? Is chemotherapy one of the molecular solutions you mentioned, or are there newer things? (I don't know if chemotherapy really is molecular, or what it even does in fact.)

-- posted by tinuviel

» P_Al - 10 cm margin

In response to 10 cm margin posted by tinuviel:

I can't say as I don't know what the particular circumstances are. Only a doctor familiar with the case can answer that.

In terms of molecular solutions, these are largely in the experimental stage. Chemotherapy does help to attack cancer cells left behind by surgery. However, molecular approaches would include identifying a target on or within cancer cells that can be attacked precisely, thus leaving non-cancerous cells unaffected.

A good example is the relatively new drug 'Gleevec', used to treat chronic myeloid leukemia. It specifically attacks a genetic abnormality within the cells.

-- posted by P_Al

» redback - 10 cm margin

In response to 10 cm margin posted by tinuviel:

OOPS! I meant "stay around" in the sense of hanging around suite101. Coz other people may pop in who have direct experience. We're fiddling with generic theory here ie we don't even know what specific tumour is involved nor precisely where. Spinal cord, spinal column etc etc. And that's a very sound reason not to try to be too specific here.

Paul's referred to how advanced a tumour may be and the prospects for success. The tumour I had on my nose was ill-defined so I had to "donate" a larger sample of my nose to ensure all was removed. And that's all that may be needed. But sometimes "ill-defined" may mean they can't tell how far it's spread or whether it's in fact the primary site.

There's a large bank of information "out there" on how relatively common or rare specific tumours are. And the relative recovery rates, remission rates and whether surgery, radiotherapy alone or in conjunction with chemotherapy, steroids etc works best. This data is not always helpful to morale unless they indicate overwhelming success rates.

I don't know what country you're in. UK? But maybe, a university-based hospital is public?? Or your cousin can be a public patient in a private hospital? I found out some time ago, the international language of 'private' and 'public' is confusing.

Hope all is still going OK with your cousin. My cyber best wishes to you and your cousin.

-- posted by redback

» P_Al - 10 cm margin

In response to 10 cm margin posted by redback:
There really is a vast body of information out there. That's one reason why it is important to have an accurate diagnosis so as to properly apply the data to an individual case.

-- posted by P_Al

» redback - informed support

In response to 10 cm margin posted by P_Al:

I was thinking the other day about 'informed consent'. And the family that sit on the sidelines like here...hoping for the best without knowing all the details. I have to bite my tongue when it happens within my family UNLESS they come to me.

There is value to increasing awareness. In mental health, it's called increasing mental health literacy. The more we know of the issues and needs, the more we can give support so I'm thinking 'informed support'. That's where those support groups come in.

The exact diagnosis is one issue but it probably makes no differeence to the pain, distress, fear of the unknown, disruption to family and work life, costs etc going on.

In amongst all this is the importance of gaining trust in those charged with treating the child. Any concerns here need to be nipped in the bud as efficiently as possible.

-- posted by redback

» P_Al - informed support

In response to informed support posted by redback:

I recently reviewed the book "What you don't know can kill you". It points to the importance of being your own advocate when it comes to health care.

The medical system does alot of good. However, it is composed of human beings who are not infallable. Parents, patients and friends therefore need to be vigilant so as to catch problems early and rectify them.

In terms of informed consent - this carries an assumption that the patient/guardian fully understands the relevant issues with respect to their condition. A proper diagnosis is often required for this.

-- posted by P_Al

» redback - informed support

In response to informed support posted by P_Al:

A part of the package of 'informed consent' is that the problems, procedures required, risks etc have all been properly explained maybe using checklists and simple fact sheets to check the patient really has the claimed understanding.

I think they are serious about it here. The concept of 'informed financial consent' has also been identified. This is where all costs are known upfront...there will be NO surprises. Sometimes there are extra costs even if the public hospital treatment itself is free. I'm in a private fund where "participating" hospitals were up to now, fully covered. But the government has now decided the costs of certain procedures need to be reined in so limits are being set. These are things like hip replacements etc...but not cancer treatments.

-- posted by redback