Sunday, May 25, 2008


Late presentation of cases occurs in all types of cancer. I believe the common cause for this is absence of pain. Unfortunately for many cancers, pain is not an important feature; unlike inflammatory disease such as infection. Look at these pictures; the elderly lady had a fungating cancer in the groin. An infective ulcer would usually be very painful, but this is a lymphoma; a potentially curable cancer of the lymphatic system. The lymphoma is usually treated with chemotherapy. Surgery is usually limited to biopsy in order to get to the diagnosis. The lady had to be operated, leaving a huge defect that required a vascularised myocutaneous flap from her thigh to cover the defect. She was then referred to the oncologist for chemotherapy, ...... and she defaulted !

The fungating tumour

Covering the defect with a flap

End of surgery

There are cases of neglected inflammatory or infective ulcers. As the general rule, this is usually painful, but some patients do come with advanced lesion; more appropriately neglected lesions. These are usually elderly peoples, diabetics or in the next pictures a schizophrenic.

You can see maggots squirming in it

During surgery; the infection was noted extending into the pelvis, perineum and even the bones. And at the end of the operation I did not charge for the procedure I did, but for the smell that I had to bear !
After all these, I am still wondering why patients need to wait till it is very late !

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