[citation needed]

I will respectfully disagree. Yes, I agree some cancers can be treated in later stages, but I did not say that they can't. As you will see in almost every cancer, there is a precipitous decline in survival based on major staging (denoted by the roman numeral). There are a few *subtypes* in colorectal cancer that have variable survival (likely multifactorial due to changing definitions, evolving treatment protocols, and lower numbers of patients due to the subdivisions of the group), but I think you can see the trend. In fact, let's conduct a little experiment. Look me up when you get a diagnosis of cancer, we'll wait until you're stage IV until treatment is started. And we'll see what your outcome is. Granted the n will be 1, but methinks you will not be happy with _your_ outcome. Now, here are my examples, please cite yours. I will warn you I do not accept data that can not be reproduced or is not peer-reviewed

Breast:

Stage 5-year Survival Rate

0 xxxxxxxxxxxxxx 93%

I xxxxxxxxxxxxxx 88%

IIA xxxxxxxxxxxxx 81%

IIB xxxxxxxxxxxxx 74%

IIIA xxxxxxxxxxxxx 67%

IIIB xxxxxxxxxxxxx 41%

IIIC xxxxxxxxxxxxx 49%

IV xxxxxxxxxxxxxx 15%

Colon:

Stage 5-year Observed Survival Rate

I xxxxxxxxxxxxxxxxxx 74%

IIA xxxxxxxxxxxxxxxxx 67%

IIB xxxxxxxxxxxxxxxxx 59%

IIC xxxxxxxxxxxxxxxxx 37%

IIIA xxxxxxxxxxxxxxxxx 73%

IIIB xxxxxxxxxxxxxxxxx 46%

IIIC xxxxxxxxxxxxxxxxx 28%

IV xxxxxxxxxxxxxxxxx 6%

Rectal:

Stage 5-year Observed Survival Rate

I xxxxxxxxxxxxxxxxxx 74%

IIA xxxxxxxxxxxxxxxxx 65%

IIB xxxxxxxxxxxxxxxxx 52%

IIC xxxxxxxxxxxxxxxxx 32%

IIIA xxxxxxxxxxxxxxxxx 74%

IIIB xxxxxxxxxxxxxxxxx 45%

IIIC xxxxxxxxxxxxxxxxx 33%

IV xxxxxxxxxxxxxxxxxx 6%

Non-small cell lung cancer:

Stage 5-year Survival Rate

IA xxxxxxxxxxxxxxxxx 49%

IB xxxxxxxxxxxxxxxxxx 45%

IIA xxxxxxxxxxxxxxxxx 30%

IIB xxxxxxxxxxxxxxxxx 31%

IIIA xxxxxxxxxxxxxxxxx 14%

IIIB xxxxxxxxxxxxxxxxx 5%

IV xxxxxxxxxxxxxxxxx 1%

Small cell lung cancer:

Stage 5-year Relative Survival Rate

I xxxxxxxxxxxxxxxxxx 31%

II xxxxxxxxxxxxxxxxx 19%

III xxxxxxxxxxxxxxxxxx 8%

IV xxxxxxxxxxxxxxxxx 2%

Similar statistics exist for: bladder cancer, cervial cancer, endomertrial cancer, pancreatic cancer, liver cancer, penile cancer - yes is does exist, and no it is not pleasant, thyroid cancer, and Wilm's tumor. But this is just to name a few.

I will mention prostate cancer qualitatively, as the definitions here are relatively weak for comparison. But suffice it to say distant disease fares much worse than confined or local disease., as with esophageal cancer, and gastrointestinal cancer. Cholangiocarcinoma (bile tract cancer) is a bit harder to classify as the major predictor is location of the tumor as well as the typical TNM staging.

Bone cancer is not described well enough to draw conclusions. Brain cancer survival is based on age at diagnosis as the number of cases is typically low. Liquid tumors, leukemia and lymphoma to cite a few are more difficult to stage and are differentiated by different criteria that may or may not be time sensitive. And as discussed, as not typically treated surgically and are beyond my scope.

Anyways, want me to cite more? And wanna take me up on the little experiment?

I will apologize for the x's in the formatting.....Slashdot has a minimum characters per line rule that this post was violating

Sorry, I am not. I have the usual general surgery training (which includes time on a surgical-oncology service), but I specialize in trauma, emergency general surgery, and surgical critical care. I do not routinely do cancer operations, any cancers that I operate on are incidental or have resulted in a surgical emergency like a perforated colon cancer.

Most "moles" are benign. The suspicious ones (ABCDEs) are removed and sent for pathology to detect if they are cancerous. It would not be possible to remove and pathologically screen all moles on every person.

Actually, most cancers are curable. I can cut out most tumors....the problem is getting to them early enough. Solid tumors are mostly responsive to surgery first, chemotherapy and, for some cancers, radiotherapy are best left to "mop up" residual cells be it tumor-in-situ or micrometastases or out metastatic disease, now there are a few exceptions - especially the "liquid tumors" or hematologic malignancies.

What I'd really like to see is better screening for cancers - the only universal truth about cancers is that the earlier they are caught, the better the response to treatment. Catch a cancerous growth early before is has spread locally and we can cut it out and you'll likely be cured. When it has a chance to invade locally and especially distally, I can't perform a simple operation to remove it - I have to take out more tissue and sometimes in different places or other organs...sometimes the tumor burden is so great that an operation won't make a difference. This is where chemo can also be used. But responses to chemo are almost universally poorer than surgery. And please bear in mind, most people use "cancer" like its a single entity. It is not. There are a multitude of cancerous transformations for each cell line in the body, each with its own peculiarities.

Don't get me wrong, any improvement in chemotherapy will increase survivor hood of cancer, but I doubt that this will do much to change the initial treatment of most cancers.

The actual situation is very complex and is actually somewhat rooted in the free market system....

Some of the factors involved:

1. anti-trust laws and specific legislation prevent hospitals and doctors for sharing price information (aka Sherman Anti Trust Act)

2. The government demands a discount from hospitals for services.

3. The insurance companies, not to be outdone by Uncle Sam, also demand discounts. (8th paragraph )

4. Different geographic locations have different pricing indexes.

5. Local competition, despite #1 above, can influence prices

6. Different patients have wildly varying medical histories and co-morbidities.

7. Most complex cases (esp surgery and other procedural based care) fall into a class of billing called the DRG (diagnostic related group), which is kind of a set rate for a package of care....so if I take out your gallbladder and you leave in 1 day or 3, the hospital gets paid the same (see side note below)

Taken all together, the hospital is basically free to charge what ever they want....not that they ever get it.

Most insurance companies pay a "regionally adjusted payment", and that's what gets paid....with a few exceptions. Those without insurance, usually get some kind of compassionate coverage from Medicaid (state funded, not Medicare). Those who do not are often eligible for charity care where part or all of the bill is reduced. So why not just bill the uninsured a lower upfront cost? Rule #2. Uncle Sammy wants his discount

The interesting side story....patients who have an exceptionally difficult problem can fall into a group called the outliers (imaginative name, but better I suppose than the untouchables....). These are pts who fall outside of the DRG....as such the hospital may submit a bill for outlier payment. This is typically $0.10 on the dollar of hospital billing. Well that sucks for the hospital....but a less-than-scrupulous Mega-Health-Care-Corp came up with the idea of inflating their outlier billing to be 10x what they had been billing.....the end result is $ for $ reimbursement. This was all well and good for them, for a couple of years....then Uncle Sammy caught on.....10 years later and they still haven't gotten rid of the shit smell after the government came down on them and beat the living shit out of them financially and punitively.

You can't fix stupid.....you can only hope evolution takes care of the problem.

DR;PW (did not read;pay walled)

Why the hell would you spray them with a NSAID (aspirin/ibuprofen) analog that was withdrawn from the market because it had a slightly increased risk of mycardial infarction?

If you want it gone, spray it with FOOF

Hmmm....me thinks you should look into your math...:-) (I'm being purely humorous at this point, not meant to be mean, but with real math)

doubling time is about 20 min in ideal circumstances so 100*20 is 2000 min or ~ 33.3 hrs

100 generations == 2^100 bacteria or 1,267,650,600,228,229,401,496,703,205,376

each bacteria weights about 9.5^-13g

so total bio mass is about 13,343,690,528,718,204g or 13,343,690,528,718kg or 1.3e13kg

for reference, the earth weighs...5.9e24 kg, (moon is merely 7.3e22, the USS Iowa battleship is about 5.2e7kg, a supertanker is 1.1e10 kg)

For a gram of bacteria (that's a lot!) only takes about 40 generations under ideal circumstances....now I'm ignoring lag and standing phases and focusing on the log phase just to give you an idea of the order of magnitude.

Well, there's still the lag for them to grow to culture, again its the in vivo milieu that needs to be discarded.

Looks like its been done. Didn't read too far in, I suspect it is not ost effective tho.

Please see my line about "De-escalated" - that is antibiotic stewardship in action.

Again, where can this be applied in a "noisy" real world scenario? The researcher took an already cultured (i.e. purified) sample to prove the concept. I am trying illustrate the complexity of translating this into a real world application.

They are two sides of the same coin....the bug I treat today with the tightest adequate spectrum of coverage is the bug I do not have to treat with the big guns later, or worse, have the big guns fail.....The situation for my patients really descends into the realm of "life sucks" when we're having the discussion "if we try this antibiotic I can treat his/her infection, but we're going to trash his/her {kidneys | lung | liver} in the process."

No doubt that this is interesting, I again question where this is going to be useful....The best I can see is using it in place of the traditional sensitivity step - replacing the Kirby-Bauer test...but this is going to save hours. I guess that's going to be the "big saving"; still every hour I gain is something. Hopefully they can make this test cost-effective so we can actually persuade the bean-counters that it'll be worth it.

Granted, but in my experience, common and uncommon are anything but....

Also PCR and ELISA are much more expensive and time consuming processes than plating or "brothing", and you also have to have a reasonable clue as to the organism that you expect to encounter (see below) - If I knew the bug before hand, I'd treat for it. Those in my position often get surprised by the organism that finally grows. I once had a case of endocarditis in a cardiac transplant patient, the culture came back with an unusual organism....googl-ing that organism yielded 4 hits (granted not the most scientific process) - sorry can't recall the bug, it was that unusual.

But also please reference my statement about amplification of the dominant organism above the ambient noise.

Sorry, just looked down and saw the reply by the.original.drg, basically the same argument, but with some personal experience thrown in

As a clinical (critical care, if you care to know) physician, I too am a bit puzzled by the description.

Patients in septic shock are very sick and the prescription of antibiotics is a delicate subject....antibiotics need to be started within a few hours of diagnosis, and getting it wrong (prescribing an antibiotic to which the bacteria is resistant) and the patient has a 50% increase in mortality. To this end we use the broadest spectrum antibiotics available, and most hospitals develop an "Antibiogram " specific for their institution and their pt population. These antibiotics are so powerful, it is rare, but not unheard of, for organisms to be resistant to them.

The process goes like this:

The cultures are sent to the lab after being draw and in a process that (time-wise) parallels the above:

A you can see, there really isn't anywhere to rush the process. And I would be very interested to see how they can speed this up with their technology....the who purpose of the plating is to amplify the bacteria from the milieu of the body fluids and to find the dominant organism growing.

In addition, some cultures are already "contaminated" with body flora (e.g. upper respiratory and stool) and the purpose of the culture is to amplify pathological bacteria from the benign-normal flora.

Longer video that gives a better front to back description

To address the AC who started this thread:

Active alcoholism is a contraindication to transplant, however, damage due to alcohol related diseases is not:

Except from UpToDate (requires subscription)UpToDate.com

INTRODUCTION — After initial reluctance to transplant patients with alcoholic liver disease, it is now clear that transplantation offers an excellent survival advantage in appropriately selected patients, equal to that for other disease indications. The original reluctance stemmed from the perception that the disease was self-inflicted and from the possible presence of alcohol-mediated damage to sites outside the liver [1,2]. There was also concern that compliance with postoperative recommendations would be suboptimal and that recidivism would lead to graft failure. Opposing opinions and accumulated data have addressed these reservations [3]. Liver transplantation appears to be cost-effective for alcoholic liver disease, albeit possibly less so than for transplantation for some other indications such as primary biliary cirrhosis and primary sclerosing cholangitis [2,4-6].

snip

Alcohol abstinence and psychosocial factors — Sobriety and adequate social support are essential. No absolute interval of sobriety is required because some patients who are otherwise suitable candidates will not survive a six-month period. However, a period of six months of sobriety is used widely for predicting recidivism and also allows for hepatic recovery from ongoing alcohol-related injury [31], but accurately determining which patients are abstinent can be difficult. One study that included 40 patients with alcoholic liver disease who were admitted for an assessment for liver transplant found that 38 percent of patients had urine tests that were positive for alcohol (20 percent) and/or illicit drugs (30 percent) [32]. However, only 3 percent of the patients admitted to using alcohol.

Not entirely. You can have HCC (hepatocellular concinoma) and get a transplant:

Also from UpToDate

INTRODUCTION — Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis. (See "Epidemiology and etiologic associations of hepatocellular carcinoma".)

The only potentially curative treatment options are resection and liver transplantation Among patients who are not candidates for liver resection, some who have cirrhosis and HCC are candidates for potentially curative liver transplantation. Unfortunately, the majority of patients are not eligible for either resection or transplantation because of tumor extent, underlying liver dysfunction, and lack of donor organs.

(extra link mine)

The liver makes a good candidate because it is a "nice" organ to transplant. It is very tolerant of ABO incompatibility. It also has a decent survival outside of the body, IIRC, it is exceeded only by the kidney for durability outside of the body.

My concern is that this "liver-in-a-box" makes bile. Bear with here.....

RBCs (red blood cells) are primarily broken down in the spleen, not the liver. The hemoglobin is then broken down in macrophages (which do exist in the liver, but typically aren't involved in this part) into bilirubin which is transported to the liver by binding with albumin. Once in the liver, it is conjugated (chemically linked) to a sugar to increase its solubility, it is then excreted into the bile (which gives the bile the golden brown coloring). If there is no spleen in this circuit, what's breaking down the RBCs(now granted the liver can assume some of this function in asplenic patients, but I'm not sure it can take over this quickly)? This sounds like a fundamental problem with their system....guess if they can solve that they can keep a liver on the shelf for a week or more.

Could just imaging the Monty Python skit coming out of that!

As a physician, I agree.

The problem is that we are now subject to an "objective" review, where the MBA CEO's of hospitals and health care systems have to measure and quantify everything. The problem is this is not a normal customer-seller relationship....this is more like going to the lawyer for advice (Gawd, did I just compare physicians to lawyers????), you are seeking "expert advice" and when it may not be what you want or expect, a rift develops. The physician (rarely) denies something because they are being a jerk, they are (usually) doing it in the patient's best interest. However, with the need to maximize your PG scores, people are acquiescing. Yes, I know this is not a new problem and pre-dates the PG score, but this is a perfect example of "market forces" in medicine, and why people who think medicine is a business like manufacturing cars are dead wrong....it IS a business, but unlike just about any other out there.