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Diagnostic Delay in Musculoskeletal Tumors

A Few Words About Diagnostic Delay in Musculoskeletal Tumors

Delay in diagnosis of tumors remains a major source of concern for patients and physicians alike. Early on, the symptoms of these tumors mimic those of common sprains, strains, bumps and bruises. Tumors can be misdiagnosed, missed, or mistreated for weeks, months, and even years.

The causes of diagnostic delay are many. The early symptoms may be vague and misleading. Initial radiographs may be normal or the findings may be so subtle that they escape detection. Sometimes the caregiver takes a sketchy medical history or performs an incomplete physical examination, and as a result the whole course of treatment is set off in the wrong direction.

Lack of suspicion on the part of the caregiver, inappropriate reassurances that the symptoms are not worthy of real concern, and lack of adequate imaging studies are common reasons for delay. Sometimes there were "red flag" symptoms or findings that should have been heeded. At the core of the problem, many caregivers lack experience and training in these problems and therefore fail to consider a sarcoma in the differential diagnosis.

Delay in diagnosis of musculoskeletal tumors and cancer is not something that necessarily happens to poor physicians performing low-quality care. It also happens to intelligent, well-trained, caring, compassionate physicians who become trapped by the many pitfalls that lie in the path to a correct diagnosis. Patients too can contribute to delay. Some individuals fail to seek out medical care in the face of a problem because of their fear of bad news, or because they may feel that nothing good can come of the treatment process.

Delay in diagnosis of cancer can happen to children as well as senior citizens, to men and to women, to persons with primary bone or soft tissue cancers as well as to persons who have a musculoskeletal manifestation of a cancer that started elsewhere in the body, such as the breast or the lung.

The important thing is to begin the correct treatment immediately once the real diagnosis is discovered. It is important to focus on the good that can be done in the present and in the future rather than the bad that has occurred in the past. A delay in diagnosis does not mean that the tumor cannot be fully treated and cured. Issues related to the delay can be worked out later once the treatment in on track.

Once the treatment is underway, it may be appropriate to go back and examine the course of events. The degree to which the delay may have contributed to the problems of treating the tumor can be assessed and quantified.

The author of this site has a great deal of experience in evaluating and managing diagnostic delay where it relates to tumors of the musculoskeletal system. Please contact the author if you require assistance with these issues.