Improving medical diagnosis

Diagnostic delay and models of cancer care




There are three basic models of cancer care in the literature, two of them derived from the world of the psychology , the Safer model [23]  and  the Andersen model [24], widely used in publications, and the third one coming from the medical general practice world, the Olesen model [25] developed in Denmark.  Based on her publication we think is also worth to introduce a fourth model, the Walter model [26], a refinement of the Andersen model, that introduces the term “time interval” rather than delay.

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Case Analysis: a problem of perception

Havana,Cuba? No, Málaga, Spain

He was my patient. A serious and educated 55- year-old man with a diagnosis of metastatic colon cancer waiting to start chemotherapy. I started my usual physical examination, normal conjuntival coloration, normal heart sounds, but something keeps my attention: no ventilation in the left basal lung. No signs of pleural effusion or atelectasia. No dyspnea or thoracic pain. I asked for a thoracic X-ray but nothing attracts my attention.

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How can we define delay in cancer?

Clary St., Boston, by Lourdes Alonso

The time between symptom recognition and a definitive diagnosis have been described in many terms including ‘Time-to-Diagnosis’ (TtD), delay to diagnosis, pre-diagnostic interval and duration of symptoms in the literature [6] and we will use TtD across this paper. The concept of the term “delay” assumes that there is an ideal period of time to arrive to a diagnosis in a patient with cancer

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Diagnostic delay in cancer: a complex landscape

People from India

There is a good rational to assume that the smaller a tumor  the better the outcome. However, there are several  variables and prognostic factors involved in the clinical evolution of a patient, not only time. The process of diagnostic in cancer have been artificially divided in different segments related to the patient, the appointment with a doctor and the pattern of referral. In all these models the physician looks like the perfect machine prepared for a perfect diagnosis….

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Hypophysitis: a new member of the family


Hypophysitis was an unusual complication in the late pregnancy and postpartum. Now, other clinicians and mainly oncologist have to think on this important problem because the new immunological treatments are associated with a low percentage (1%)  with this syndrome and the recognition could be difficult, but there is a key symptom…

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A system problem: where was the failure?

Boston, USA

A-72-year-old man with a previous diagnosis of Chronic Obstructive Pulmonary Disease had a diagnosis of pneumonia after three days with high fever, cough and a productive sputum. He stayed at the hospital and  started with antibiotics, enoxaparin, and oxygen, with a favourable clinical evolution. The doctor ordered a new X-ray but the patient started with dyspnea during his journey to the radiology department. Can you suggest a reason for that?

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NUT Midline Carcinoma (NMC): a new disease


Chance or a clever clinical observation is at the origin of the discovery of new clinical entities. A cluster of opportunistic pulmonary infections in young people was associated with HIV infection. Diethylstilbestrol taken by women was related to vaginal cancer in their daughters. NUT Midline carcinoma (the name coming from the rearrangements of the gene NUT) has been defined as a new clinical entity after the observation of several cases with undifferentiated carcinoma located in the midline, from the nasopharyngeal area to the mediastinum…

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Pulmonary embolus and cancer: an image

TEP masivo bilateral
Pulmonary embolism, main branches

Pulmonary embolism and cancer are a very well known association, but only a high index of suspicion will help to reach the diagnosis because very often this entity appears in the context of a progressive disease in a patient with several  symptoms such as dyspnea, fever, fatigue, making the diagnosis of Pulmonary embolus a difficult task.

Molecular Oncology: a step further in diagnosis linked to treatment

Trogir, Croatia

Diagnosis in Medical Oncology is facing a revolution. Morphology and a limited set of cellular markers are the keystone of the diagnosis and at the end, we will classify a lung cancer in two categories, non-small cell lung cancer or small cell cancer, a colorectal cancer in just a category, breast cancer could be divided based on morphology in ductal or lobular and we can continue with the rest of the tumors. But the landscape is evolving…

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