Cervical Cancer Cases

Understanding the Tumor Doubling Defense (continued)

3. Moreover, if adjuvant therapy can destroy 99.9% of residual tumor burden at some point and if chemotherapy is more effective at smaller tumor burdens, one can reasonably conclude that at some point, even after metastasis, 100% of metastatic cells can be eliminated. Consider the patient with recurrent cancer who is administered chemotherapy and enjoys visible shrinkage of tumor mass. Given the limitations of cumulative chemotherapeutic dose (only so much can be given), the only way to eliminate the recurrent cancer is to reduce the tumor burden at the outset. Even if the tumor cannot be eliminated, the benefit of that time required for the tumor to resume its pre-treatment volume cannot be ignored. It is not for the wrongdoer to raise conjecture concerning the magnitude of those chances that he has by his wrongful conduct placed beyond the possibility of realization.

4. The assumption that in all cancers there exists the possibility that metastasis has occurred before diagnosis and removal of the primary tumor is the basis for adjuvant chemotherapy. But even those who believe that metastasis has occurred prior to diagnosis and removal must concede that the size of occult metastases at the time of treatment of the primary tumor and before adjuvant chemotherapy is significant. Adjuvant chemotherapy is known to be less effective when tumor burdens are high.

5. Prior to the development of a surgical treatment for cancer in the 1800's, women died of breast cancer because of hemorrhage within the primary breast tumor and/or infections. Now effective treatment exists for most forms of cancer if treated early. When a medical malpractice defendant attempts to prove otherwise, it is our responsibility to recognize and expose the invalidity of such arguments. By so doing, we free juries to use their collective common sense and intuition and reach the same conclusions that are the basis of 21st century medical practice in the diagnosis and treatment of cancer.

1 Friberg, S., Mattson, S., On the Growth Rates of Human Malignant Tumor, Implications for Medical Decision Making, J. Surg. Oncol. 1997 Aug; 65(4): 284-97.

2 Spratt, J.S., The Relationship Between Rates of Growth of Cancers and The Intervals Between the Screening Exams Necessary for Detection, Cancer Detection Prev., 1981:4(1-4).

3 Friberg, supra.

4 Hamil v. Bashline, 481 Pa 256, 392 A2d 1280 (1978).

5 Steel, G.G., Cell Loss As a Factor in the Growth Rate of Human Tumours, Eur J. Cancer, 1967; 3: 381-7.

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