Stages of Breast Cancer

One of the first things to understand about a breast cancer case is staging.  Breast cancer stages range from 0 to IV, with many subcategories. Lower numbers indicate earlier stages of cancer, while higher numbers reflect late-stage cancers.  If a doctor waits too long to order the appropriate tests, the disease can progress without treatment.  This delay in diagnosis is a common form of medical malpractice.


Stage 0
This stage describes noninvasive (in situ) breast cancer. Ductal carcinoma in situ (DCIS) is an example of stage 0 cancer.

Stage I
This stage is an early stage of invasive breast cancer in which:

• The tumor measures no more than 2 centimeters (cm), or about 3/4 inch, in diameter
• No lymph nodes are involved — the cancer has not spread outside the breast

Stage II
This stage describes invasive breast cancers in which one of the following is true:

• The tumor measures less than 2 cm (about 3/4 inch) in diameter but has spread to lymph nodes under the arm.
• No tumor is found in the breast, but breast cancer cells are found in lymph nodes under the arm.
• The tumor is between 2 and 5 cm (about 3/4 to 2 inches) in diameter and may or may not have spread to lymph nodes under the arm.
• The tumor is larger than 5 cm (2 inches) in diameter but hasn't spread to any lymph nodes.

Stage III
Stage III breast cancers are subdivided into three categories — IIIA, IIIB and IIIC — based on a number of criteria. By definition, stage III cancers haven't spread to distant sites.
For example, a stage IIIA tumor is larger than 5 cm (2 inches) and has spread to one to three lymph nodes under the arm. Other stage IIIA tumors may be any size and have spread into multiple lymph nodes. The lymph nodes clump and attach to one another or to the surrounding tissue.

In stage IIIB breast cancer, a tumor of any size has spread to tissues near the breast — the skin and chest muscles — and may have spread to lymph nodes within the breast or under the arm. Stage IIIB also includes inflammatory breast cancer, an uncommon but aggressive type of breast cancer.
Stage IIIC cancer is a tumor of any size that has spread:

• To 10 or more lymph nodes under the arm
• To lymph nodes above or beneath the collarbone and near the neck
• To lymph nodes within the breast itself and to lymph nodes under the arm

Stage IV
Stage IV breast cancer has spread to distant parts of the body, such as the lungs, liver, bones or brain.

• The size of your tumor
• Whether cancer cells have spread to lymph nodes under your arm (axillary lymph nodes)
• Whether cancer cells have spread to other parts of your body

In its earliest stages, breast cancer may not cause any symptoms. A lump may be too small to feel or cause unusual changes. Often, an abnormal area turns up on a screening mammogram (x-ray of the breast), which leads to further testing.
In some cases, however, the first sign of breast cancer is a new lump or mass in the breast that you or your doctor can feel. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But sometimes cancers can be tender, soft, and rounded. So it's important to have anything unusual checked by your doctor.
According to the American Cancer Society, any of the following unusual changes in the breast can be a symptom of breast cancer:

• swelling of all or part of the breast
• skin irritation or dimpling
• breast pain
• nipple pain or the nipple turning inward
• redness, scaliness, or thickening of the nipple or breast skin
• a nipple discharge other than breast milk
• a lump in the underarm area

These changes also can be signs of less serious conditions that are not cancerous, such as an infection or a cyst. It’s important to get any breast changes checked out promptly by a doctor.
If you reported symptoms like this to your doctor, but did not run necessary tests to rule out breast cancer, the cancer can spread.  If you or one of your loved ones presented with early symptoms of breast cancer, including palpable lumps, nipple retraction, or other early signs of cancer, but the physician overlooked them, please contact Utah attorney Ryan Springer for a free legal consultation about your legal rights and a confidential case evaluation.

Medical Malpractice: Colorectal Cancer Misdiagnosis

In the United States, only lung cancer claims more lives than colorectal cancer, which encompasses cancers of the colon, rectum, anus and appendix. Out of the more than 130,000 people in the United States who receive a colon and rectal cancer diagnosis each year, more than 50,000 people die.

Although colon and rectal cancers develop slowly, they are often not detected until they are life-threatening. Symptoms include changes in bowel habits, ranging from diarrhea, constipation, narrowing of the stool and rectal bleeding to cramping, steady stomach pain, and weakness and/or tiredness. Such symptoms can be evident even if the growth is in an early pre-tumor state, known as a "polyp."

Screening for Colorectal Cancer: Patients presenting to a doctor or medical professional should be given a cancer screening. Early screening can greatly increase the chance of survival. The two most typical types of screening for colorectal cancer are a flexible sigmoidoscopy, in which a doctor inserts a sigmoidoscope in the rectum and searches for growths, and a colonoscopy, in which a doctor uses a larger tube, a colonoscope, in the rectum and is able to examine the entire colon.

Early sigmoidoscopy or colonoscopy can allow a doctor to find a polyp and remove it before it becomes malignant. The American Cancer Society Colorectal Cancer Screening Guidelines state that beginning at age 50, both men and women should have a flexible sigmoidoscopy every 5 years, along with a yearly blood stool test. The guidelines also recommend a full colonoscopy every 10 years.

If you or a loved one is suffering from painful treatments for colon or rectal cancer, or if you have a loved one who has passed away because of the condition, it is possible that your doctor misdiagnosed the condition or made some other crucial error. Medical negligence attorney Ryan Springer works closely with medical experts to examine medical records and discover whether negligence or misdiagnosis led to otherwise avoidable surgery, pain, suffering, or wrongful death.

To determine whether you, or a loved one, suffered from an incorrect diagnosis or other medical error, please contact malpractice lawyer Ryan Springer at (801) 424-9088 for a free, no-obligation initial consultation.  Ryan helps malpractice victims throughout the State of Utah, including Salt Lake City, Provo, Ogden, Logan, St. George, Moab and Price.

Gentamicin Questions and Answers

Q. What is Gentamicin?

A. Gentamicin is a potent, yet highly toxic antibiotic belonging to a class of drugs called aminoglycosides.  It is used in the treatment of bacterial infections affecting the skin, bone, lungs, joints, stomach, urinary tract, or blood. It is administered either intravenously or by injection into your muscle.

Q. What is Gentamicin poisoning?

A. Gentamicin toxicity is a harmful side effect caused by negligent administration of the antibiotic. When it is prescribed for a long period of time or in high dosages, it can accumulate and cause serious damage to the hair cells of the inner ear.  Usually, doctors who negligently prescribe Gentamicin fail to order appropriate monitoring.  Patients receiving Gentamicin should be under close clinical supervision, and should have regular monitoring of Gentamicin levels as well as kidney function.
Q. What are the symptoms of Gentamicin poisoning?
A. Because Gentamicin damages the inner ear, it can impair the patient's entire vestibular system.  Common symptoms include:

• Blurred vision
• Balance issues
• Feelings of vertigo
• Dizziness
• Nausea
• Ringing in the ears (tinnitus)
• Difficulty in crowds or in dark places

Q. What treatment options are available if I have suffered inner ear damage from Gentamicin?

A. Currently, there is no cure for inner ear damage caused by Gentamicin poisoning. It is possible to experience a partial recovery from injuries; however, the process is very slow. Your brain may be able to partially compensate for your inner ear damage by relying on other senses to provide important information. Vestibular rehabilitation, which stimulates your damaged ear region, may also provide some relief.

Q. Who can be held accountable for my Gentamicin poisoning injuries?

A. Medical malpractice lawsuits can be brought against negligent doctors, hospitals, or home health agencies responsible for prescribing, administering, and monitoring your use of Gentamicin.  Attorney Ryan Springer is an experienced Salt Lake City medical malpractice lawyer who has successfully litigated many Gentamicin poisoning cases on behalf of injured patients.  He can provide you with a free case evaluation to help you determine who can be held accountable for your damages.

Q. Are there time limits affecting my Gentamicin case?

A. Yes. There are statutes of limitations governing Gentamicin cases. It is crucial that you file your claim within these time limits in order to be able to receive the compensation you deserve. Since the statute of limitations may begin to run from the time the drug is negligently administered, it is important to talk with an experienced Utah malpractice lawyer immediately to ensure you do not miss important filing deadlines.
If you have suffered an injury caused by Gentamicin poisoning, contact Salt Lake City personal injury lawyer Ryan Springer at (801) 424-9088 today to schedule a free initial consultation.

Understanding Life Care Plans

One of the primary reasons people bring a personal injury suit is to ensure that the negligent party is held accountable for future medical and other needs that were caused by the injury.  In some cases–especially those involving spinal cord injuries, brain injuries, or other permanent damage– this requires a detailed, specific plan of what those needs will be.  In those cases, one of the tools that I use in preparing cases for trial is a “Life Care Plan.”
According to the International Academy of Life Care Planners, a Life Care Plan is a “dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research, which provides an organized, concise plan for current and future needs with associated costs, for individuals who have experienced catastrophic injury or have chronic health care needs.”
By using qualified life care planners as part of the trial team, we do not leave future medical needs to chance or guesswork.  We provide the jury with a detailed and specific plan and the costs for future needs.  An economist assists by predicting the future costs of those needs after adjusted for inflation.

Some attorneys will be eager to sign up a client who has suffered catastrophic injuries and hope that a jury can correctly guess how much the victim will need for future medical needs.  But if they don’t prepare for trial by using specific life care plans, they put their clients’ future care in jeopardy by leaving it to chance–if they’re able to make the claim at all.

If you have a medical malpractice or personal injury claim resulting in future medical needs that will last a lifetime, you need an attorney that understands the role of life care plans and includes them as part of the trial team.

Adding Insult to Injury: When Doctors Lie to Patients

Last Summer, I wrote about the increasing number of doctors that withhold critical information from their patients, especially when that information involved medical mistakes.

According to a survey published by Health Affairs, things are getting worse, not better.  The study shows that although two-thirds of doctors agree they should share serious medical errors with their patients, at least one-third did not  agree.  Worse, some doctors are not only keeping information from their patients, 1 out of 10 are actually lying about it.

In an interview with ABC News Dr. Lisa Iezzoni, lead study author and professor of medicine at Harvard Medical School, said "We don't know the exact reasons for many of these findings, but it is a sign of caution that patients need to be aware of."

What can a patient do when a trusted medical provider adds insult to injury by committing medical malpractice and then lying about it?

In Utah, this kind of conduct may be the basis for a separate claim called "breach of fiduciary duties."  The Utah Supreme Court has unequivocally held that "Doctors stand in a  fiduciary relationship with their patients."  Daniels v. Gamma West Brachytherapy, LLC, 2009 UT 66, 221 P.3d 256; see also Sorensen v. Barbuto, 2008 UT 8, 177 P.3d 614.

As noted jurist Benjamin Cardozo explained, “Many forms of conduct permissible in a workaday world for those acting at arm's length, are forbidden to those bound by fiduciary ties. A [fiduciary] is held to something stricter than the morals of the market place. Not honesty alone, but the punctilio of an honor the most sensitive, is then the standard of behavior.” Meinhard v. Salmon, 164 N.E. 545, 546 (N.Y. 1928).

And the Utah Supreme Court has held that fiduciaries owe several discrete duties, including duties of loyalty and honesty.  See, e.g., McLaughlin v. Schenck, 220 P.3d 146, 153-56 (Utah 2009); Smith v. Fairfax Realty, Inc., 82 P.3d 1064, 1074 (Utah 2003); Lynch v. MacDonald, 367 P.2d 464, 468 (Utah 1962).

Doctors who commit malpractice and then lie to their patients about it are not only liable for negligence, but for breaching their legal duties as fiduciaries as well.  Perhaps worst of all, they are guilty of violating the trust that their patients have placed in them.