A Ukrainian journalist shared a story about how she was mistakenly diagnosed with cancer several times.
In an article for the Ukrainian Pravda.Life portal, journalist Ekaterina Sergatskova told a personal story about what she had to go through when she was diagnosed with “cancer,” which turned out to be a big medical mistake.
One day I found out that I have cancer
The first thing I felt when I saw the word “sarcoma” in the laboratory report that was checking a recently excised tumor in the uterus was how my legs suddenly became hot. And cheeks. And hands. In an instant it became very hot.
The first thing I did when I left the laboratory was call my friend and retell what was written in the conclusion. Low-grade endometrial stromal sarcoma.
- Well, since the degree is low, it means you can be treated,- she said. - Don't worry.
A few minutes - and my husband’s parents and I are already calling our friends in the pathology laboratory in Kramatorsk. The very next day we pick up the material from the first laboratory and send it there. They say that the diagnosis may not be confirmed.
- It happens often,- the friend assures. I'm calming down.
A week later, the laboratory in Kramatorsk confirms the diagnosis. I don’t feel anything anymore: neither heat nor fear. Just a strange, deaf loneliness.
- The cells are scattered, it's not scary,- They retell to me the words of a friend who watched the material. “The main thing now is to check the body to make sure that these cells have not moved anywhere else.” People live with this for years.
You will have to delete everything
My next step is to go to the clinic at my place of registration. This mandatory procedure which a person diagnosed with cancer must undergo. The local gynecologist is required to write a referral to the oncology clinic.
The gynecological oncologist at the clinic looks at my papers superficially and shakes his head.
- Oh-oh, well, it was clear from your ultrasound that it was oncology,- she says. - Why didn’t you delete everything at once?
- Wait, this is just one of the ultrasounds, the very first one, - I answer. - After him, five more doctors looked at me and most of them assumed that it was benign.
Last December, during a routine examination, I was diagnosed with a neoplasm. I didn’t pay attention to this: there was too much to do, so I postponed the examination for six months. Six months later, the doctor, looking at the tumor on an ultrasound, said something like “something interesting” - and recommended consulting with an oncologist.
The next uzologist called the neoplasm, literally, “incomprehensible garbage.” Another doctor did not call me anything other than “a girl with something unusual.” The fourth doctor said that there was no reason to worry, but the tumor needed to be removed. MRI concluded that there was a massive seroma in the area of the cesarean scar. Each doctor interpreted it differently.
In August the tumor was excised. The first laboratory tests showed that it was a benign leiomyoma.
- In any case, you will have to delete everything,- the gynecologist puts an end to it and sends it to the clinic.
Women who refused later regretted it greatly
The next day I'm at the National Cancer Institute clinic. A place where horror swarms.
Nausea of hopelessness sets in even before entering the hospital. A young girl is sobbing into the phone right on the steps: “ Mom, how did I know it was cancer!“Someone brings out old men with withered faces arm in arm. Someone like me smokes sadly.
There is a queue of a couple of dozen people in the office of gynecologist Victoria Dunaevskaya. Many stand close to its door, so as not to let anyone in front who wants to climb through first. Others sit on chairs in outerwear with their heads down.
Nobody smiles.
Nobody is talking.
Screaming silence. Unhappy, hunted people, gray from permanent horror.
The gynecologist doesn't ask me anything important. Neither about how I felt while I was walking around with the tumor (and I would tell her that I felt absolutely nothing), nor about when the tumor might have appeared. Just reading papers.
He asks if I have children. Later they will explain to me: doctors ask this question because, according to the protocol, a woman who has been diagnosed with cancer reproductive system, this system needs to be cut out in order to save the mother for the child. After the first appointment, I am prescribed an examination of all organs. I go to the Cancer Institute like I go to work. Instead of work. Instead of life.
The queue for each doctor is so huge that when I arrive at the opening of the clinic at 9:00, I leave about an hour before closing, at 14:00. All the nurses who work for doctors are over sixty and do not know how to talk to patients.
One of them shouts at the old man for rummaging through things for a long time before entering the office. Another scolds those who came without a ticket. The third complains that the doctor will not have time to examine everyone.
Examinations show that everything is fine with the body. No metastases, no neoplasms, nothing that could be alarming. Only one test turns out to be bad: the Institute’s laboratory (for the third time) confirms that the excised tumor is malignant.
A repeat appointment with a gynecologist becomes a nightmare that you will dream about more than once at night.
The gynecologist examines the doctors' records out of the corner of his eye and stops at the laboratory report.
- You have to have an operation,- she suddenly says, without even looking me in the eye.
- In what sense?- I say.
- You need to remove the uterus, appendages,- All,- she says. Without looking again.
I sit on a chair, waiting for the doctor to tell me in more detail what’s what. She takes her time to explain. The next patient is already breaking into her office, she switches to him.
- So wait, is this necessary?- I'm trying to get her attention back.
- Young woman,- the gynecologist moves closer to me, knits his eyebrows and says loudly and slowly: - You have uterine cancer. You need to go for surgery. Urgently.
I continue to sit on the chair, trying to squeeze out something like “maybe...”. The doctor doesn't listen. She fills out a referral for removal of the uterus and appendages. Her colleague, the surgeon, stands over her and nods in time with the movements of the ballpoint pen.
- Here's the surgeon you're going to see, you can talk to her,- says the gynecologist, giving way to his colleague.
I don't miss the chance.
- Is there another option?- I say.
- Which? Do not delete?- she says. Her lips make a movement that looks like a smirk. - You can, of course, watch. But I’ll tell you this: all the women who refused the operation later regretted it very much. Very much.
She emphasizes “very”, and then adds again that absolutely all women regretted it. Everything. And when asked why a sarcoma could form, for some reason he answers that “no one in the world knows why cancer appears.” Nobody in the world. No one at all. For some reason I say “thank you very much” and run out of the office. Another patient with an unhappy face takes my place on the chair.
Uterine cancer is lifelong
The latest visit to the Cancer Institute - for some reason this is the one - makes me think about how serious everything is. Until the end is put in the case, you doubt it. You hope that someone will say that everything is in order and you can move on with your life, think about the birth of a second child, or just about something everyday.
This feeling is probably called despair. Three laboratories - three conclusions about sarcoma. Several doctors agree that the organ needs to be removed, and this does not guarantee that the sarcoma will not “pop up” somewhere else. I feel either hot or cold sweating, and I want to fall asleep and live in a dream in which there is no cancer diagnosis.
One day I dreamed about how a gynecologist from the Cancer Institute locked me in a cold hospital room and said to me, looking into my eyes: “ Rlike the uterus - it's lifelong«.
I don't understand if I can plan my life for next year. I can’t really get down to work. I fall out of conversations with friends, reliving over and over again that conversation with the gynecologist. Her words “girl, you have uterine cancer” and a distant, icy look randomly pop up in my head. Much like on the set of a sitcom, after the next joke, the “Laughter” sign lights up.
Every day I live as if I were on a plane that lost a wheel on takeoff and no one knows if it will be able to land.
Wait, we're not deleting anything yet
After a while, I sign up at Lysod, an Israeli oncology clinic near Kiev, which is called the best in the country. The last step is to make sure you follow the Cancer Institute guidelines.
- Well, tell me- the head physician of the clinic, gynecologist Alla Vinnitskaya calmly says.
I don’t immediately find what to answer. No one had given me a word before. But what should I tell you? How did I go to the Cancer Institute, where every millimeter of air is saturated with the fear of death? How did you look for the causes of the disease in yourself? How did you convince yourself that removal of the uterus was not the worst outcome?
- I was told that I needed to have my uterus removed. And I wanted a second child...- I begin. Alla Borisovna smiles.
- Well, well, wait,- she says cheerfully. - We are not deleting anything yet. And there's no need to talk« wanted« . Say: I want.
She explains that tumors like mine often behave like cancer without being “evil.” An insufficiently professional look at the cells can give a bad result. The material is sent for research to a German laboratory. A week later the result comes. No cancer. No treatment needed. There is no need to remove the uterus. Everything is fine.
I learned a lot in two months of living with cancer.
I learned to boldly read test results and come to terms with the truth, even if it’s lousy. Double-check everything in different laboratories. Don't trust doctors who say there is no problem. Don't trust doctors who say there is only one way out. Don't trust doctors in public hospitals. I learned to endure public hospitals. I realized that an incorrect diagnosis is not the worst thing that happens to a patient.
The worst thing is the attitude of the doctors. The way they talk to the patient. How they are convinced that the patient is doomed to a painful death, instead of exploring his body with him and looking for solutions.
Doctors perceive the patient as a subordinate who has no right to protest their instructions. Post-Soviet hospitals are such a repressive system, in which the patient is put in his place instead of being helped. Another important discovery for me was that it turned out to be incredibly difficult to talk about cancer.
My cancer has become my secret, which is inconvenient, painful, unpleasant to tell others. An inner emptiness without color, in which a growing feeling of shame because you, an active young woman, got sick bad illness and you no longer have the right to be part of society.
It should not be. You can't be silent. Silence makes life unbearable.
I lived for two months flying on a plane that had lost one wheel. And in an instant the plane landed. The passengers applauded, the pilots exhaled. There is no longer any need to be afraid or think about death. You can just keep living as if nothing had happened. And fly on with a tailwind.
Watch the video in which we asked the most exciting questions to an oncologist about cancer:
After decades of misdiagnosed cancer followed by treatments and millions maimed healthy people, the National Cancer Institute and the influential medical scientific journal JAMA (Journal of American Medical Association) finally admitted that they had been wrong all along.
Back in 2012, the National Cancer Institute assembled a group of experts to re-evaluate the classification of some of the most commonly diagnosed cancers and their subsequent “overdiagnosis” and over-aggressive treatment of these conditions. They determined that probably millions of people were misdiagnosed with breast cancer, prostate cancer, thyroid cancer, and lung cancer when in fact their conditions were benign and should have been defined as “benign epithelial lesions.” No apology was made. The media completely ignored this. However, the most important thing was also not done: no radical changes in the traditional practice of diagnosing, preventing and treating cancer occurred.
Thus, millions of people in the United States and around the world who were confident that they fatal disease cancer and who underwent violent and crippling treatment for this reason, as if they heard “Oh... We were wrong. You didn’t actually have cancer.”
If you look at the problem only from the point of view of “overdiagnosis” and “overtreatment” of breast cancer in the United States over the past 30 years, the approximate number of women affected is 1.3 million. Most of these women do not even know that they have become victims and many of them have a Stockholm Syndrome-like attitude towards their “aggressors” because they think that their lives were “saved” by unnecessary treatment. In fact, side effects, both physical and psychological, almost certainly significantly reduced their quality and life expectancy.
When was the report made? National Institute Cancer, then those who have long defended the position that the often diagnosed “ early cancer breast”, known as encapsulated carcinoma milk duct(DCIS) was never inherently malignant and therefore should not have been treated with lumpectomy, mastectomy, radiation therapy and chemotherapy.
Dr. Sayer Ji, founder of the project-archive of scientific medical works greenmedinfo.com, has been actively engaged in educating people about the problem of “overdiagnosis” and “overtreatment” for several years. Two years ago, he wrote an article “Thyroid cancer epidemic caused by misinformation, not cancer,” which he substantiated by collecting many studies from different countries, which showed that the rapid increase in thyroid cancer diagnoses is due to misclassification and misdiagnosis. Other studies have shown the same pattern for breast and prostate cancer, and even some forms of ovarian cancer. At the same time, it must be remembered that standard treatment Such diagnoses included organ removal, as well as radiation and chemotherapy. The last two are strong carcinogens leading to malignancy of these harmless conditions and secondary cancers.
And, as usually happens with studies that contradict established standards of treatment, these studies also did not make it to the media!
Finally, thanks to the efforts of many honest oncologists, one of the most commonly diagnosed forms of cancer has been reclassified as a benign condition. We are talking about papillary thyroid cancer. Now there will be no justification for those oncologists who offer patients to treat these harmless, inherently compensatory changes with the help of total resection of the thyroid gland, followed by the use of radioactive iodine, placing the patient on synthetic hormones for life and permanent treatment accompanying symptoms. For the millions “treated” for “thyroid cancer” this information came late, but for many it will save unnecessary suffering and deterioration in quality of life due to crippling treatment.
Unfortunately, this event did not become a sensation in the media, which means thousands more people will suffer “by inertia” until official medicine reacts to this.
Film: THE TRUTH ABOUT CANCER Cancer is only a symptom, not the cause of the disease
Oops…! “It turns out it wasn't cancer at all!” admits the National Cancer Institute (NCI) in the Journal of the American Medical Association (JAMA).
On April 14, 2016, in an article entitled “It's Not Cancer: Doctors Reclassify Thyroid Cancer,” The New York Times Magazine pointed to new research published in JAMA Oncology that is poised to forever change how we classify, diagnose and treat the common form thyroid cancer.
“An international group of doctors decided that a type of cancer that had always been classified as cancer was not cancer at all.
This resulted in an official change in the classification of the condition to benign. Thus, thousands of people will be able to avoid removal of the thyroid gland, treatment with radioactive iodine, lifelong use of synthesized hormones and regular examinations. All this was with the goal of “protecting” from a tumor that was never dangerous.
Their findings and the data leading up to them were published April 14 in JAMA Oncology. The changes are expected to affect more than 10,000 diagnosed thyroid cancer patients per year in the United States alone. This event will be appreciated and celebrated by those who have pushed for the reclassification of other forms of cancer, including certain breast, prostate and lung tumors.
The reclassified tumor is a small lump in thyroid gland, which is completely surrounded by a capsule of fibrous tissue. Its core looks like cancer, but the cells of the formation do not extend beyond their capsule and therefore surgery to remove the entire gland and subsequent treatment with radioactive iodine is not necessary and not crippling - this is the conclusion made by oncologists. They have now renamed it from “encapsulated follicular thyroid carcinoma” to “noneinvasive follicular thyroid neopolasm with papillary-like nuclear features, or NIFTP.” The word “carcinoma” no longer appears.
Many oncologists believe that this should have been done a long time ago. For years they fought to reclassify small breast, lung and prostate cancers, as well as some other types of cancer, and remove the name “cancer” from diagnoses. The only previous reclassifications were early stage genitourinary cancer in 1998 and early cervical and ovarian cancer approximately 20 years ago. However, apart from thyroid specialists, no one else has dared to do this since then.
“In fact, the opposite happened,” says Otis Brawley, chief medical officer of the American Cancer Society. “The changes happened in the opposite direction of scientific evidence. This is how small precancerous breast lumps became known as stage zero cancer. Small and early prostate formations turned into cancerous tumors. At the same time, modern examination methods such as ultrasound, CT scan, magnetic resonance imaging is finding more and more of these small “cancerous” lesions, especially small nodules in the thyroid gland.
“If it's not cancer, then let's not call it cancer,” says the president of the American Association of Thyroid gland and professor of medicine at the Mayo Clinic Dr John Si Morris.
Dr Barnet Es Crammer, director of cancer prevention at the National Cancer Institute, said: "We are increasingly concerned that the terms we use do not match our understanding of cancer biology." He goes on to say, “Calling growths cancer when they are not leads to unnecessary and traumatic treatment.”
The article goes on to say that while some specialty medical centers are beginning to treat encapsulated thyroid masses less aggressively, this has not yet become the norm in other medical settings. Unfortunately, there is a pattern that it usually takes about 10 years to scientific evidence reflected in practical medicine. Therefore, medicine is much less “scientifically based” than it claims to be.
It is obvious that the truth about the real causes of cancer, as well as the truth about the myths spread by the oncology industry, is beginning to seep even into such medical institutions like JAMA and even the mainstream media, which usually plays a huge role in spreading misinformation on this topic.
Despite this success, we must continue to work in this direction. Research and educational work must continue. In addition to papillary thyroid cancer, this primarily concerns encapsulated ductal breast cancer, some prostate tumors (intrathelial neoplasia) and lungs. When reclassification of these conditions is achieved, this will entail significant changes in their treatment protocols. Now they will not be treated with organ removal, carcinogenic chemotherapy and radiation therapy, which means that millions of people will not receive crippling treatment that dooms them to constant suffering and dependence on official medicine, and many of them will avoid the appearance of secondary cancers caused by these types of treatments. Many will also not experience malignancy as a result of toxic treatments that destroy the body's defenses and transfer benign process to aggressive malignant.
Just imagine how many people around the world have already suffered and may still suffer, if only in the USA and only in breast cancer there are 1.3 million women? Now it should be obvious to everyone where official oncology gets such optimistic statistics, where it cures cancer in more than 50% of patients. Most of them did not have a correct diagnosis of cancer and if these “patients” survived the treatment, they became officially cured of cancer. Moreover, if many developed secondary cancers after 5-15 years, then of course they were never associated with previous carcinogenic treatment.
Many oncologists, and especially those who use the naturopathic concept of understanding and treating cancer, believe that asymptomatic cancers do not need to be treated at all, but only to make certain changes in their lifestyle, nutrition and thinking. One could, however, go further and cite the words of Dr. Hardin Jones, a professor at the University of California at Bakerly, who stated that according to his statistics of working with cancer patients for 25 years, those who were diagnosed with cancer late stages, and who did not use the official triplet of treatment, lived on average 4 times longer than those who received such treatment.
All this makes us take a fresh look at the situation with the diagnosis and treatment of this disease, and also at the fact that, unfortunately, today we cannot trust official medicine in this regard.
The article was written using material from greenmedinfo.com
Interview with Boris Greenblat in the project 'THE TRUTH ABOUT CANCER'Diagnostic errors oncological diseases, according to independent experts, occur in almost 40% of cases. Official statistics there is no discussion on this issue. The most serious mistakes are those when cancer is “found” where it is not, or, conversely, a malignant tumor is missed. The most common mistakes are made when typing a tumor—the morphological determination of the type of cancer. The result is an incorrectly chosen treatment tactic and a sad outcome.
The price of a mistake
The patient forum on the “Movement Against Cancer” website is very indicative in this regard. Here are some messages from there. “I had a mistake in the type of cancer, and a friend’s repeat IHC (immunohistochemistry) did not confirm the diagnosis. I retook it in Israel.” “In one place - one IHC result, in another - it turned out to be different. How to understand where the correct analysis is? Where is the guarantee that no mistake was made in the second place?” Patients and their relatives from all over the country tell the coordinators of the Movement about how things are going with the diagnosis: “The diagnosis was made without identifying the focus, now the symptoms have worsened, in another city they paid for the diagnosis and found the focus. I returned home and the treatment was changed,” “IHC was not done and a biopsy was not taken, the treatment was selected at random.”
Moreover, the further the patient is from central clinics, the less chance he has of an adequate diagnosis. And this situation has not changed for decades. As a healthcare veteran from a remote region told MedNews, when her colleagues diagnosed her with breast cancer back in the mid-70s, she took the glass to Moscow on the first plane. As a result, the diagnosis was not confirmed.
According to Unim, a medical technology company that verifies (rechecks histological diagnoses), about 40% of diagnoses contain errors, both in determining nosology and in determining malignancy in general. In some types of nosologies this percentage is higher. For example, about 50% of lymphomas are incorrectly diagnosed, and in the case of central nervous system tumors this figure reaches approximately 80%. The most problematic regions in Russia are the south of the country and the Far East.
“We also conducted a small study on the diagnosis of breast cancer,” said UNIM founder Alexey Remez. – On average, the regional cancer clinic performs five breast removal operations per day. Moreover, according to some estimates, one operation per week is statistically performed on the basis of an incorrect diagnosis. That is, about 4% of women have their breasts removed by mistake.”
Diagnostic "conveyor"
What leads to erroneous diagnoses and why it is so important to get a “second opinion” was told to MedNews by the head. pathomorphological department of the Federal State Budgetary Infectious Diseases Clinical Hospital, candidate of medical sciences Dmitry Rogozhin.
The histological diagnostic process should work like a well-oiled conveyor belt. Each stage must be very well thought out and performed according to certain standards in order to ultimately obtain a high-quality drug that can be used to make a diagnosis. If at least one of these stages is violated, then there will be no high-quality result. When material is sent to our or another central clinic for analysis, we often have questions about the adequacy of this material itself.
- Please tell us more about the stages?
First of all, you need a normal amount of material. Before performing a biopsy (obtaining histological material in the operating room), the surgeon must clearly understand how he will do it. If it does not get into the tumor itself, but into the zone of reactive changes, then, naturally, there will be no result, and the operation will have to be repeated. The surgeon should discuss and plan this work together with the morphologist and radiologist (if we are talking about a bone tumor). Sometimes the biopsy itself is performed under the supervision of a radiologist and in the presence of a pathologist.
The resulting histological material must be fixed in a certain way in formalin and in as soon as possible delivered to the pathology department or histology laboratory, where it is described by a pathologist. The next stage is histological examination (special chemical treatment fabrics). Then the material is poured into a special medium, which is simply called paraffin, after which the laboratory assistant makes thin sections and places them on a special glass. The sections are properly stained and submitted to specialists (pathologists) for evaluation.
And here there are two options. Or we have enough data to make a final diagnosis, which is the basis for prescribing appropriate treatment. Or, we cannot formulate a diagnosis and must make a differential diagnosis between other tumors with a similar structure. In such cases, an additional study is used - immunohistochemistry (IHC). Depending on the specific set of antigens on the cells of the tumor itself, which this study shows, we again evaluate everything and formulate a final conclusion, which is also a guide to action. This is a fairly routine method. But, unfortunately, it is not used everywhere in the regions.
- And this is the main reason for incorrect diagnosis? Or are there other problems?
There are others too. Each region, of course, has its own characteristics, but there are several common basic problems. Firstly, there is insufficient funding. And, as a consequence, the lack of normal equipment - certain equipment and consumables.
The second reason is the lack of experience among specialists and the problem with their coordination. I have already talked about the interaction between the surgeon, pathologist and radiologist, which, already at the stage of planning a biopsy, can narrow the range of diagnoses and preliminarily decide what pathology we are dealing with. In regions there is often no such interdisciplinary interaction.
Other serious problem, which both large central institutions and regional clinics encounter - these are rare diagnoses. You can work your whole life and not encounter any type of tumor. And here it’s not a matter of low qualifications of the doctor, but of specialization. Every pathologist has a certificate. And he must look at all the material, any biopsy. And this is not entirely correct. It is not for nothing that there are various specialties within medicine and divisions within the specialties themselves, when a person deals with a narrow range of problems.
Also, a pathologist must specialize in something specific. If he encounters a tumor that he has never dealt with, he may come to the wrong conclusion. A correctly diagnosed tumor means a specific treatment program for this particular tumor, and therefore a prognosis. If, due to a pathologist's error, the wrong treatment protocol was applied, the cost of such an error can be very high.
- So what should we do?
It is very important to get a second opinion, which is why there are reference centers in large clinics, depending on their specialization. If a pathologist in the region sees a tumor for the first time, then he should act as a switchman: if, for example, it is a bone tumor, he suggests sending it to the Russian Children's Clinical Hospital, if it is a tumor of the lymph nodes, to the DGOI named after. Rogachev, where there are specialists who deal only with lymphomas and leukemia. They see dozens of such tumors a day, they have enormous experience.
The system of requiring an independent second opinion exists throughout the civilized world. And if the diagnoses coincide, the likelihood of error is minimized, and there is more confidence that the treatment will be prescribed correctly. Central Russian clinics also have this practice. At the Russian Children's Clinical Hospital we have an oncology department where children with rare diseases, bone and soft tissue tumors are admitted. We make our diagnosis and, as a rule, the material is sent to another central medical institution to obtain a second opinion. This could be the Blokhin Russian Scientific Research Center, or the DGOI named after. Rogachev, or some other medical institution. It happens that the diagnoses do not coincide, and then it is advisable to obtain a third opinion, say from foreign colleagues.
Now it is possible to consult with foreign experts without sending them the material itself - Russian company UNIM has developed a Digital Pathology program for remote diagnosis. We load histological preparations digitized using a special scanning microscope into this system, and a foreign expert can view them on a computer screen in the same way as he would look under a microscope. He can enlarge them, reduce them, examine any field of view, put marks, measure something.
In addition, properly sorted drugs form an electronic archive, which can be returned to at any time if necessary. This need arises, for example, when several years after treatment the patient experiences a relapse of the disease. We must go back to the old material, compare and establish a cause-and-effect relationship. Theoretically, paraffin blocks, from which histological preparations can be re-made, can be stored almost forever (subject to certain conditions). But their quality still decreases over the years, and if clarification of the diagnosis requires additional research– immunochemical or cytogenetic – it is much more difficult to work with this material. There are no such problems with an electronic archive.
- Are such technologies used within the country?
Yes, such a system works well within the country. Contracts are concluded with medical institutions in the regions. And where quality and equipment allow, histological preparations are scanned and sent to us for reference. This is an absolutely logical and progressive solution to the problem.
Our clinic treats children from all regions of Russia. We have a telemedicine center that allows for remote consultations. Our and regional specialists can get together and together determine some points in the child’s treatment. And now we can also consult on histological preparations. It's great!
But here, too, the main problem is the lack of funding in the regions. And often, there is also a lack of understanding of this problem - this immediately excludes the possibility of using new technologies. Of course, not all regions are in an equal position. For example, in Rostov and the Rostov region, which attract the entire southern territory of the country, the work is done very well. They understand and follow all stages of obtaining histological preparations and provide us with quality materials. But there are regions that do not contact us at all. And patients who want to get a second opinion have to solve this problem privately and the old fashioned way - take their material to Moscow themselves or send it by courier.
Publishing house "Medicine", Moscow, 1980
Presented with some abbreviations
From the standpoint of medical deontology, every doctor conducting examinations of the population and dispensary observation must be aware of modern methods detection of tumors, since there are still many cases where delayed diagnosis is associated with underexamination of patients who have recently undergone a medical examination: either in a woman with initial form of cervical cancer, a cytological examination was not carried out, which would have made it possible to identify the tumor in the very early period, or was not produced in a timely manner X-ray examination lungs, and then diagnosed with advanced lung cancer, etc. There are also mistakes made by radiologists and other specialists who do not notice early symptoms diseases.
Oncological negligence should force a doctor of any specialty, when examining a patient for any reason, to use this examination in order to determine whether the patient has signs of a tumor.
A presumptive diagnosis of cancer in the absence of a tumor, i.e. overdiagnosis, causes anxiety and distress, but this is better than underestimating existing symptoms, leading to late diagnosis.
A common mistake made by surgeons in non-oncology institutions is that during operations to identify an inoperable tumor, they do not perform a biopsy, which makes it difficult to decide on possible chemotherapy when the patient is admitted to an oncology institution. Having decided that the patient cannot be helped by surgery, the surgeon often advises him to go to an oncological institution and talks about the need for treatment with special non-surgical methods, but at the same time has no information about the nature of the tumor, since he did not do a biopsy.
From the standpoint of deontology, no mistake should pass without discussion. Errors made in other institutions that referred the patient to the cancer hospital must be reported to these institutions.
In the oncological institution itself, each diagnostic error, every error or complication during the treatment process. It is very important that the team knows that criticism and self-criticism do not only concern young people, but apply to all employees, including managers.
The tradition of self-criticism in Russian medicine was promoted by N. I. Pirogov, who saw the harm that concealing medical errors in scientific medical institutions. “I am sufficiently convinced that measures were often taken in famous clinical institutions not to discover, but to obscure scientific truth. I made it a rule when I first entered the department not to hide anything from my students... and to reveal to them the mistake I made, whether it was in the diagnosis or in the treatment of the disease.” Such tactics are necessary from the standpoint of deontology, as well as for the purpose of educating young people.
Late detection of tumors often depends on the fact that the patient himself consults a doctor too late, which is associated with few symptoms, in particular the absence of pain in the early stages of the disease, as well as insufficient awareness of the population due to poorly delivered popular science anti-cancer propaganda.
Providing correct information to the public is the duty of specialists, but it is not an easy job. How should the promotion of knowledge about cancer be carried out from the standpoint of medical deontology? In any presentation to the population, be it a popular science lecture, brochure or television appearance, as well as in a popular science film about cancer, it is necessary, first of all, to truthfully present information about the disease, its dangers, high mortality, and emphasize that the etiology and pathogenesis of tumors have not been fully studied, etc. The importance of the problem should not be underestimated or successes in solving it should not be exaggerated. This will only cause mistrust.
On the other hand, it is necessary to provide information about the curability of tumors, especially in the early stages, and to promote the need to consult a doctor with minimal symptoms, which may be a manifestation tumor process. We need to popularize periodic preventive examinations, focus on early signs diseases, as well as fight against factors that contribute to the occurrence of certain tumors (smoking, abortion, etc.).
There is no need to scare listeners, given that even without this, the fear of malignant tumors among the population is very high. Among patients who turned to an oncologist too late, there are people who say that they have known about their illness for a long time, but have never consulted a doctor, afraid to hear that they have cancer. This demonstrates the widespread fear of cancer and the lack of knowledge about the possibility of a cure.
A speech for the general public is a meeting with a large number of people, many of whom have a special interest in the issue under discussion, perhaps suspecting themselves or their loved ones serious disease. Such speeches require the doctor to strictly adhere to the principles of medical deontology.
Case #28:
Materials from a 14-year-old patient with a suspected malignant testicular tumor were received by the UNIM laboratory in the Skolkovo Technopark. All necessary histological and immunohistochemical studies were carried out, the materials were consulted using the Digital Pathology© system with five Russian and foreign pathologists. Based on the results of the consultation, the experts came to the conclusion that the patient has mesothelial proliferation without signs of malignancy (adenomatoid tumor or reactive mesothelial proliferation) - treatment and prognosis will be radically changed.
Case #27:
Materials from a 32-year-old patient with suspected malignancy the lower lobe of the left lung were taken to the new UNIM laboratory in the Skolkovo Technopark. Within 3 days, all the necessary histological and immunohistochemical studies were carried out, the materials were consulted by three pathologists, who collectively determined that the patient had sclerosing pneumocytoma, a rare benign tumor.
Case #26:
An important argument for conducting immunohistochemical studies is the possibility of suggesting a primary tumor site in the case of metastases from an unknown site. In this case, patient material was received with the description of “poorly differentiated adenocarcinoma without convincing organ-specific signs.” Immunohistochemical studies suggested the most likely primary site - the mammary gland.
Case #25:
IN difficult cases diagnostics even experienced doctor may have difficulty setting up accurate diagnosis. Pathologists then turn to colleagues who specialize in certain types of tumors, such as dermatopathologists, as in the case of this patient. Previously, the material had to be physically transported to another doctor's desk. Now this problem can be solved quickly and simply - consultations with other pathologists can be carried out through the Digital Pathology system. The patient was suspected of having a malignant skin process. Based on the results of the consultation, the assumption of a malignant process was not confirmed.
Case #24:
With the help of immunohistochemistry, it becomes possible to distinguish conditions that are very similar in appearance, malignant and benign. The quality of the research in such cases plays an important role. A doctor contacted us to clarify the results of an immunohistochemical study. Based on the results of immunohistochemistry, the doctor suspected 2 diagnoses: follicular lymphoma (malignant process) or chronic lymphadenitis with follicular hyperplasia (benign process). Our specialists carried out additional staining, which allowed us to make an accurate diagnosis. The patient was diagnosed with reactive follicular hyperplasia lymph node, this is a benign process.
Case #23:
If a lymphoproliferative disease is suspected, histological examination should be supplemented by immunohistochemical examination. Quite often, the diagnosis suggested by the results of histological examination is corrected by the results of immunohistochemistry! This case was no exception. We received material with an incoming diagnosis of angioimmunoblastic lymphoma. Immunohistochemical studies led to the diagnosis being corrected to benign - the patient was diagnosed with Castleman's disease.
Case #22:
The next patient’s material came to us for study from Kazakhstan. The included diagnosis is non-Hodgkin lymphoma (nodal B-cell marginal zone lymphoma). For a high-quality diagnosis of suspected lymphoproliferative disease, an immunohistochemical study is required! This case is indicative, since the results of immunohistochemistry did not confirm the oncological diagnosis. The patient was diagnosed with reactive follicular hyperplasia of lymphoid tissue.
Case #21: 
The incoming histological diagnosis was epithelioid cell low-pigment melanoma without ulceration. After a histology review, the diagnosis was changed to epithelioid cell nevus of Spitz. This type of benign formation often causes difficulty in differentiating it from melanoma early stage, therefore it is very important in this case to carry out a review histological slides from a pathologist specializing in this field. Since this benign education, removed radically, the patient will not require additional treatment.
Case #20: 
This case illustrates the need for review of histological slides when a malignant diagnosis is initially made. We received materials from a girl born in 1987 for research. diagnosed with ovarian cancer. Based on the results of reviewing the materials, our specialists made a different conclusion - a serous borderline tumor. The patient will require different treatment than in the case of a malignant tumor.
Case #19: 
Another case from practice clearly shows the need for immunohistochemical studies to make an accurate diagnosis. The material came to us with an incoming diagnosis - fibromyxoid sarcoma (malignant neoplasm). To make a diagnosis, immunohistochemical studies were performed. Based on the results of these studies, another diagnosis was made - pleomorphic fibroma (this is a benign formation).
Case #18:
This case illustrates the importance of obtaining a timely second opinion from highly qualified specialists. 
The patient underwent histological and immunohistochemical studies on site and was diagnosed with breast cancer. With this diagnosis, the materials came to us. The slides were reviewed and repeated immunohistochemical studies were performed. Based on the research results, no evidence was obtained for a neoplastic (malignant) process. The patient fibrocystic mastopathy proliferative form with foci of sclerosing adenosis - this is not cancer.
Case #17:
This case is another confirmation of the need for immunohistochemical 
research. We received histological material with suspected lymphoproliferative disease. Histochemical and immunohistochemical studies were carried out, but no evidence of neoplasia was obtained. The patient was diagnosed with hypoplasia of hematopoietic tissue; this is a benign process.
Case #16:
Tumors of the central nervous system often present diagnostic difficulties. 
This case was no exception. The incoming diagnosis is anaplastic astrocystoma. As a result of revision of histological slides, the diagnosis was corrected to pilocytic astrocystoma. This diagnosis is also malignant, however the patient's treatment strategy will be significantly changed.
Case #15:
Another case confirming the fundamental need for immunohistochemical studies when making oncological diagnoses. Incoming histological diagnosis - malignant fibrous histiocystoma tibia. To clarify the diagnosis, immunohistochemical stains were performed. As a result, the diagnosis was changed to diffuse large B-cell lymphoma. As in the cases given above, histological examination was not enough for an accurate diagnosis.
Case #14:
The clinical diagnosis of the 52-year-old woman was B-cell lymphosarcoma. 
with damage to the lymph node of the right axillary region. This is an oncological diagnosis, it requires appropriate severe treatment. Immunohistochemical studies were carried out, which showed that there was no oncology - the patient had nonspecific paracortical hyperplasia of the lymph node tissue. This case once again demonstrates the critical need for immunohistochemical studies, especially for lymphoproliferative diseases.
Case #13:
Material was received with an incoming clinical diagnosis - neuroblastoma. Conducted 
immunohistochemical staining of the material. Based on the results of these studies, the diagnosis was changed to B-lymphoblastic lymphoma, and, according to this, the patient will require radically different treatment. Lymphoproliferative diseases often become a source of incorrect diagnoses, since they are very difficult to diagnose and cause great difficulty in differentiating them from other pathological processes.
Case #12:
The entering histological diagnosis is anaplastic ganglioglioma (GIII). According to the results 
After additional immunohistochemical studies, the diagnosis was corrected to anaplastic astrocystoma. Tumors of the central nervous system often present particular challenges for accurate diagnosis. And despite the fact that both diagnoses, incoming and delivered, mean malignant processes, the revision procedure is very important - the patient’s treatment strategy will be adjusted to a more suitable and effective one.
Case #11:
Materials were received from a 9-year-old patient from Novokuznetsk with suspected myxoid 
liposarcoma (malignant neoplasm). Immunohistochemical studies were carried out, which allowed us to reject the oncological diagnosis. The patient has a benign formation - neurofibroma. The case is notable because myxoid liposarcoma usually develops from a neurofibroma, and this makes it difficult to differential diagnosis between these two neoplasms.
Case #10:
The incoming clinical diagnosis is prostate cancer. The patient asked for 
carrying out an immunohistochemical study, which was carried out by our specialists within two days. According to the results of the study, the oncological diagnosis was canceled, the patient had a benign tumor - glandular hyperplasia prostate gland. Errors in histology for this nosology are not uncommon.
Case #9:
A 65-year-old man, Ulan Ude, was initially diagnosed with prostate cancer; after a simple examination of the glasses, our specialists diagnosed hyperplasia (not cancer). What's interesting about this case is that it is the most common type of cancer in men over 50.
Case #8:
The initial diagnosis of a 25-year-old patient from Irkutsk is liver cancer. Immunohistochemical studies were carried out, the material turned out to be very difficult to diagnose and was consulted through the Digital Pathology system with professor from Germany Dieter Harms, and the consultation took less than 24 hours. The oncological diagnosis was changed to benign - the patient had liver adenoma.
Case #7:
Material was received with suspicion of peripheral cancer of the lower lobe right lung. The examined tissue of the intrapulmonary lymph node contained signs of follicular hyperplasia and anthracosis. Based on the results of the consultation, no tumor lesion was identified.
Case #6:
Materials were received with suspicion of small cell lymphoma. Based on the results of histological and immunohistochemical studies, the absence of tumor material was established. The oncological diagnosis was changed to benign lymph node hyperplasia, probably of viral origin. Benign lymph node hyperplasia often requires the opinion of a pathologist specializing in this type of cancer for differentiation from lymphomas.
Case #5:
The incoming clinical diagnosis is a systemic disease of the lymph nodes of the neck, 
suspected Hodgkin's paragranuloma. After histological and immunohistochemical studies, reactive follicular hyperplasia of the lymph node tissue was determined. Lymphoproliferative diseases often cause difficulties in diagnosis; counseling in such cases is not uncommon.
Case #4:
The material was received with a clinical diagnosis of grade 4 glioblastoma. The diagnosis was not confirmed and, after consultation with colleagues, was adjusted to anaplastic oligoastrocytoma. Accurate diagnosis of the type of tumor is the key to successful treatment. Unfortunately, in the field of tumors of the central nervous system, up to 80% of diagnoses received for consultation in the laboratory of the Federal Scientific Center for Children's Orthopedics of Goi named after. D. Rogachev are being adjusted.
Case #3:
Material came from Far East, with the need to establish the primary tumor site based on a metastasis biopsy. The task was successfully completed. In 90% of cases, the doctors of the laboratory of the Federal Scientific and Clinical Center for Children's State Orthopedics named after. D. Rogachev can determine the primary tumor site by metastasis, this is one of the best such indicators. Establishing the primary lesion is necessary for effective and successful treatment.
Case #2:
The diagnosis is quite difficult to differentiate. The material was received for IHC research on the initiative of the head of the regional laboratory. To make an accurate diagnosis, the glasses were consulted by leading specialists from the USA and Italy. This is one of the principles of the laboratory - in the event of lack of 100% confidence in the diagnosis, the laboratory doctors of the Federal Scientific Center for Children's and Pediatric Orthopedics named after. D. Rogachev will never sign the conclusion. In such situations, the material is consulted with leading specialists in Europe and the USA, and this does not in any way affect the cost of the study for the patient. This is one of the professional principles of doctors of the Federal Scientific Center for Children's and Orthopedics named after. D. Rogacheva.
Case #1:
Patient: boy, 21 months. The clinical diagnosis is embryonal liposarcoma (this is a malignant neoplasm). An operation was performed to remove the tumor, and part of the intestine was removed as a preventive measure. A histological report from a local laboratory confirmed the diagnosis. The attending physician decided to send the material to the laboratory of the Federal Scientific Center for Children's and Pediatric Orthopedics named after. D. Rogacheva. A repeated immunohistochemical study did not confirm the diagnosis; the clinical diagnosis was changed to lipoblastoma, which is benign neoplasm. Removing part of the intestine was not practical, and chemotherapy was stopped.
