State Consumer Disputes Redressal Commission
Arvind Kumar Singh vs Dr. Yogesh Mishra on 22 July, 2024
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 First Appeal No. A/522/2016 ( Date of Filing : 17 Mar 2016 ) (Arisen out of Order Dated 23/02/2016 in Case No. C/991/2012 of District Lucknow-II) 1. Arvind Kumar Singh Lucknow ...........Appellant(s) Versus 1. Dr. Yogesh Mishra Lucknow ...........Respondent(s) BEFORE: HON'BLE MR. Rajendra Singh PRESIDING MEMBER HON'BLE MR. Vikas Saxena JUDICIAL MEMBER PRESENT: Dated : 22 Jul 2024 Final Order / Judgement Reserved State Consumer Disputes Redressal Commission U.P. Lucknow. Appeal No.522 of 2016 Arvind Kumar Singh, Advocate s/o Shri Krishna Pal Singh, R/o 5/16, Vipul Khand, Gomti Nagar, Lucknow, U.P. ....Appellant. Versus Dr. Yogesh Mishra, Hanumant Endo Surgery Centre, 3/306, Vishal Khand (3), infornt of C.M.S. School, Gomti Nagar, Lucknow U.P. ...Respondent. Present:- 1- Hon'ble Sri Rajendra Singh, Presiding Member. 2- Hon'ble Sri Vikas Saxena, Member. None for the appellant. Sri P.M. Tripathi, Advocate for the respondent. Date 29.7.2024 JUDGMENT
Per Mr. Rajendra Singh, Member: This Appeal has been filed against the judgment and order dated 23.2.2016 passed by Ld. District Consumer Forum-II, Lucknow in Complaint case no.991 of 2012, Arvind Kumar Singh vs. Dr. Yogesh Mishra.
The brief facts of the appeal are that, that the complainant is an Advocate and practicing in the Hon'ble High Court, Lucknow. The mother of the complainant Smt. Krishna Singh, aged about 72 years became ill in the month of November, 2010. She had come to Lucknow from District Bahraich for her treatment. The complainant with his mother went to Hanumant Endo Surgery Centre of Dr. Yogesh Mishra for examination and treatment of his mother Smt. Krishna Singh. The opposite party had examined the mother of the complainant and declared that perhaps she is suffering from breast cancer and also suggested for Biopsy. The complainant's mother was not ready for Biopsy because she was afraid of Biopsy but she became ready for Biopsy due to the advice of Dr. Yogesh Mishra. Dr. Yogesh Mishra directed to deposit Rs.1,000.00 for Biopsy and the appellant deposited the said amount on 15.11.2010. Thereafter, Dr. Yogesh Mishra immediately discharged the complainant's mother on the same day and sent the sample of Biopsy to Nidan Diagnostic Centre, Gomti Nagar, Lucknow.
On 25.11.2010, the Biopsy report of the mother of the complainant was given to the appellant which was positive. The appellant's mother was suffering from breast cancer and now operation had become necessary and in inevitable because after Biopsy growth of cancer is very fast. After receiving the Biopsy report, the respondent referred the matter to the cancer expert/Oncologist. After diagnosis of breast cancer, all the family members decided that operation should be conducted in PGI, Lucknow. The complainant took her mother to PGI, Lucknow for further treatment and examination. After few tests and examination doctors of PGI, Lucknow decided to operate his mother on 9.12.2010. After few days his mother was discharged.
After one month, another process of treatment of breast cancer started and Radiotherapy of the complainant's mother in PGI, Lucknow was started. After few sessions of Radiotherapy, another process for treatment of breast cancer was started and that was 'Chemotherapy'. It was also performed in PGI, Lucknow but unfortunately the complainant's mother could not tolerate the bad effects of Chemotherapy due to old age of 72 years and was expired on 28.8.2011 during the Chemotherapy. It was very shocking incident for the whole family and the whole family suffered sad demise of the complainant's mother due to illegal and negligent act of Dr. Yogesh Mishra.
Dr. Yogesh Mishra has acted in a very illegal and negligent manner and also has acted against the medical values and medical norms. He has done Biopsy though he is not a cancer expert and closed the doors for Homeopathy and Ayurvedic treatment except surgery because after biopsy cancer spreads more faster and surgery is inevitable. Hence Biopsy is the stage of the tests before surgery of affected part of the body but Dr. Yogesh Mishra used last stage as the first stage.
It come to the knowledge of appellant that first stage for the test of Cancer is 'Mommography' and thereafter other tests are conducted but Dr. Yogesh Mishra had finished the life of my mother by doing 'Biopsy' and left no other way of treatment as Homeopathy and Ayurvedic treatment and it become necessary for us to operate immediately and operation took place in PGI, Lucknow on dated 9.12.2010. On the advice of Dr. Yogesh Mishra appellant's mother become ready for Biopsy test. If respondent had not done 'Biopsy' of my mother in a very illegal and negligent manner and had only recommended for 'MOMMOGRAPHY' we would be able to seek Homoeophathy or Ayurvedic treatment and it could be possible the life of my mother could be saved.
Now it has come to my knowledge that a patient of 72 years old most probably is unable to face the bad effect of 'Chemotheraphy' and one is very lucky who survives after 'Chemotheraphy' at this age. Dr. Yogesh Mishra is not Cancer expert, hence he was not authorised to make 'Biopshy' of my mother. He could only to recommend the matter to Cancer expert but he decided to make treatment of a Cancer patient only for earning money illegally and irregularly.
A patient is always layman about his disease and does not know the consequence and result of the disease but a doctor knows everything about the treatment of the patient' disease and bad consequences and effects of the treatment. A doctor should alwaуs told to the patient about the bad effect of the treatment or any test conducted by him but in the case of my mother Dr. Yogesh Mishra did not do so and conducted in a very illegal and irregular manner. There are some process in which way a cancer patient is examined. A cancer expert/oncologist will follow the process of tests for cancer and a layman or ordinary surgeon will not follow the process of tests in case of cancer and will done 'Biopsy' immediately. A Cancer expert/oncologist will follow the process of the tests before the final text of Biopsy. Before Biopsy, Breast Cancer patient will be examined in following manner, 1- Mommogram 2- Breast ultra sound 3- Blood tests 4- Breast MRI 5- Bone Scan 6- Computerized Tomography(PET) Scan.
7- Removing a sample of Breast cells for testing (Biopsy) The Hon'ble District Consumer Forum-11, Lucknow dismissed the complaint of appellant after hearing the case. Hon'ble Court did not consider the whole facts in a proper way so that Hon'ble Court decided the case in a different manner and dismissed the complaint of appellant without considering the main issue of the case. The main issue of the case is that the respondent Dr. Yogesh Mishra is a Surgeon and he was not authorized to do Biopsy on appellant's mother. He should immediately referred the case to a Cancer expert/oncologist on this day because Biopsy is done only in the case when there is doubt of cancer. The respondent used the last stage of tests as a first stage because he had no knowledge about the treatment of a cancer patient. The respondent had also acted against the rules of medical ethics and medical norms.
The Hon'ble District Consumer Forum has not considered properly the case of Complainant. Complainant has only complaint and grievance about the method of treatment provided by opposite party in the case of mother of complainant. The respondent is not the Cancer expert/ oncologist but he is only a Surgeon and his work is only to make Surgery.
The Hon'ble District Consumer Forum has not considered the fact that respondent is only a Surgeon and Biopsy is done only on the recommendation of Cancer Expert/Oncologist. The respondent had committed Biopsy of mother of appellant on the same day i.e. 15.11.2010 and after seeing the report of Biopsy, he referred the matter to cancer Expert/oncologist after ten days.
The Hon'ble District Consumer Forum has not considered the fact that Respondent not being a cancer Expert/oncalogist, should refer the matter to cancer Expert/oncologist on the same day i.e. 15.11.2010 before doing any experiment on the mother of appellant, when respondent Dr. Yogesh Mishra was not able to treat the appellant's mother then he should not done biopsy of appellant's mother.
The respondent, not being a Cancer Expert/ oncologist did not know the whole process of treatment of cancer. Biopsy is the last test of Cancer and before Biopsy other tests like Momnography, ultra sound MRI, Bone Scan, Blood Test etc. are done on the cancer patient. The Hon'ble District Consumer Forum did not consider the main issue of the case whether respondent Dr. Yogesh Mishra was authorized to make Biopsy of Appellant's mother without recommendation by Cancer expert/oncologist because respondent Dr. Yogesh Mishra is only a Surgeon and he is not a Cancer Expert/oncologist, hence he should immediately refer the case to a Cancer Expert/Oncologist. The respondent has committed medical negligence in the case of appellant's mother and for which he should be punished by the way of compensation to the appellant.
The appellant has suffered a lot of mental tension and mental harassment due to the negligent and irresponsible acts of the respondent. Duo to negligent and irresponsible act of respondent, appellant could not use the other branch of treatment of Breast Cancer as Homeopathy and Ayurvedic treatment which could be more effective in the case of old age person but after Biopsy surgery becomes inevitable and necessary.
The Cancer is a very dangerous and sensitive disease and it should be handled in a very cautious and skilled manner but respondent Dr. Yogesh Mishra did not take any caution and handled it in a very negligent and irresponsible manner. Hon'ble District Forum did not consider this fact and decided the matter in a casual and routine manner without considering the technical aspect of the treatment and test of cancer by the respondent.
Hence, it is most humbly prayed that the order dated 23.2.2016 passed by the Ld. District Consumer Forum-II, Lucknow in Complaint Case No.991 of 2012 (Arvind Kumar Singh Vs. Dr. Yogesh Mishra) be quashed and also the respondent be directed to pay compensation to the appellant as prayed in the complaint.
It is also prayed to remand the case to the ld. District Consumer Forum-II, Lucknow for fresh decision, to issue any other direction to the respondent which this Hon'ble Commission, may deem fit and proper in the interest of justice and to award the cost of appeal in favour of the Appellant.
We have heard the learned counsel for the respondent Sri Piyush Mani Tripathi and also the respondent Dr. Yogesh Mishra. None appeared for the appellant. We have perused the pleadings, evidences and documents on record.
In the present case, the complainant brought his mother to Hanumant Endo Surgery Centre, Gomti Nagar, Lucknow for examination. Dr. Yogesh Mishra checked his mother and directed for Biopsy of breast region because there was sign of breast cancer. Biopsy report received on 25.11.2010. Thereafter, treatment was done at PGI, Lucknow. After operation next process of Chemotherapy was carried on but the mother of the complainant could not bear the effect of Chemotherapy and she expired. The complainant presented a complaint before the ld. District Consumer Forum-II, Lucknow for compensation on the ground of medical negligence. There was no need to go for Biopsy but Dr. Yogesh Mishra conducted Biopsy with carelessness and in a most irresponsible way.
The respondent/opposite party Dr. Yogesh Mishra has stated in his written statement that the complainant one day visited the opposite party alongwith her mother and the opposite party examined the complainant's mother and diagnosed upon examination a lump in her breast and as per standard norms concluded that Biopsy needs to be necessarily done before further management; as it is a settled and known medical practice. Thereafter, by a most safe and known methodology 'Code Needle Biopsy' was successfully performed as per standard medical protocol. The opposite party admittedly is a practicing lawyer, after fully understanding its significance confirmed and agreed for conduct of Biopsy. Biopsy is an OPD procedure and there is no need to admit the patient. Further treatment, was done at PGI, Lucknow where the complainant's mother expired during Chemotherapy as stated by the complainant. There is no nexus whatsoever with the unfortunate ill effects of Chemotherapy as alleged by the complainant with the opposite party. When a lump is palpable or felt biopsy has to be necessarily done to decide the nature of the lump. He opposite party is a highly qualified and well respected senior surgeon of Lucknow. There is no cause of action against the opposite party. The ld. District Consumer Forum has passed the judgment after considering all the facts of the case.
In this case, it is clear that the respondent only did Biopsy and after pathological report of Biopsy when it detected as cancerous, the appellant took his mother to PGI, Lucknow.
We have heard the learned counsel for the respondent Mr. Piyush Mani Tripathi. The appellant did not turn up to argue the case. However this case has once been heard on 13.02.24 in the presence of both the parties and the case was reserved for judgment but due to poor burden and did some technical issue the judgment could not be passed and occasionally fixed for rehearing. Information has already been given to the appellant by the office as per office note dated 30.11.24.
We have perused the documents, pleadings evidences on record In this case, it is clear that the respondent only did Biopsy and after pathological report of Biopsy when it detected as cancerous, the appellant took his mother to PGI, Lucknow. There is no discharge summary of PGI, Lucknow. There is no treatment prescription or any BHT of PGI on record. So it is not clear as what was the cause of the death of the patient. One thing is clear that the patient was suffering from breast cancer.
First of all we see the following report of WHO regarding breast cancer.
Key facts Breast cancer caused 670 000 deaths globally in 2022.
Roughly half of all breast cancers occur in women with no specific risk factors other than sex and age.
Breast cancer was the most common cancer in women in 157 countries out of 185 in 2022.
Breast cancer occurs in every country in the world.
Approximately 0.5-1% of breast cancers occur in men.
Overview Breast cancer is a disease in which abnormal breast cells grow out of control and form tumours. If left unchecked, the tumours can spread throughout the body and become fatal.
Breast cancer cells begin inside the milk ducts and/or the milk-producing lobules of the breast. The earliest form (in situ) is not life-threatening and can be detected in early stages. Cancer cells can spread into nearby breast tissue (invasion). This creates tumours that cause lumps or thickening.
Invasive cancers can spread to nearby lymph nodes or other organs (metastasize). Metastasis can be life-threatening and fatal.
Treatment is based on the person, the type of cancer and its spread. Treatment combines surgery, radiation therapy and medications.
Scope of the problem In 2022, there were 2.3 million women diagnosed with breast cancer and 670 000 deaths globally. Breast cancer occurs in every country of the world in women at any age after puberty but with increasing rates in later life.
Global estimates reveal striking inequities in the breast cancer burden according to human development. For instance, in countries with a very high Human Development Index (HDI), 1 in 12 women will be diagnosed with breast cancer in their lifetime and 1 in 71 women die of it.
In contrast, in countries with a low HDI; while only 1 in 27 women is diagnosed with breast cancer in their lifetime, 1 in 48 women will die from it.
Who is at risk?
Female gender is the strongest breast cancer risk factor. Approximately 99% of breast cancers occur in women and 0.5-1% of breast cancers occur in men. The treatment of breast cancer in men follows the same principles of management as for women.
Certain factors increase the risk of breast cancer including increasing age, obesity, harmful use of alcohol, family history of breast cancer, history of radiation exposure, reproductive history (such as age that menstrual periods began and age at first pregnancy), tobacco use and postmenopausal hormone therapy. Approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years).
Family history of breast cancer increases the risk of breast cancer, but most women diagnosed with breast cancer do not have a known family history of the disease. Lack of a known family history does not necessarily mean that a woman is at reduced risk.
Certain inherited high penetrance gene mutations greatly increase breast cancer risk, the most dominant being mutations in the genes BRCA1, BRCA2 and PALB-2. Women found to have mutations in these major genes may consider risk reduction strategies such as surgical removal of both breasts or chemoprevention strategies.
Signs and symptoms Most people will not experience any symptoms when the cancer is still early hence the importance of early detection.
Breast cancer can have combinations of symptoms, especially when it is more advanced. Symptoms of breast cancer can include:
a breast lump or thickening, often without pain change in size, shape or appearance of the breast dimpling, redness, pitting or other changes in the skin change in nipple appearance or the skin surrounding the nipple (areola) abnormal or bloody fluid from the nipple.
People with an abnormal breast lump should seek medical care, even if the lump does not hurt.
Most breast lumps are not cancer. Breast lumps that are cancerous are more likely to be successfully treated when they are small and have not spread to nearby lymph nodes.
Breast cancers may spread to other areas of the body and trigger other symptoms. Often, the most common first detectable site of spread is to the lymph nodes under the arm although it is possible to have cancer-bearing lymph nodes that cannot be felt.
Over time, cancerous cells may spread to other organs including the lungs, liver, brain and bones. Once they reach these sites, new cancer-related symptoms such as bone pain or headaches may appear.
Treatment Treatment for breast cancer depends on the subtype of cancer and how much it has spread outside of the breast to lymph nodes (stages II or III) or to other parts of the body (stage IV).
Doctors combine treatments to minimize the chances of the cancer coming back (recurrence). These include:
surgery to remove the breast tumour radiation therapy to reduce recurrence risk in the breast and surrounding tissues medications to kill cancer cells and prevent spread, including hormonal therapies, chemotherapy or targeted biological therapies.
Treatments for breast cancer are more effective and are better tolerated when started early and taken to completion.
Surgery may remove just the cancerous tissue (called a lumpectomy) or the whole breast (mastectomy). Surgery may also remove lymph nodes to assess the cancer's ability to spread.
Radiation therapy treats residual microscopic cancers left behind in the breast tissue and/or lymph nodes and minimizes the chances of cancer recurring on the chest wall.
Advanced cancers can erode through the skin to cause open sores (ulceration) but are not necessarily painful. Women with breast wounds that do not heal should seek medical care to have a biopsy performed.
Medicines to treat breast cancers are selected based on the biological properties of the cancer as determined by special tests (tumour marker determination). The great majority of drugs used for breast cancer are already on the WHO Essential Medicines List (EML).
Lymph nodes are removed at the time of cancer surgery for invasive cancers. Complete removal of the lymph node bed under the arm (complete axillary dissection) in the past was thought to be necessary to prevent the spread of cancer. A smaller lymph node procedure called "sentinel node biopsy" is now preferred as it has fewer complications.
Medical treatments for breast cancers, which may be given before ("neoadjuvant") or after ("adjuvant") surgery, is based on the biological subtyping of the cancers. Certain subtypes of breast cancer are more aggressive than others such as triple negative (those that do not express estrogen receptor (ER), progesterone receptor (PR) or HER-2 receptor). Cancer that express the estrogen receptor (ER) and/or progesterone receptor (PR) are likely to respond to endocrine (hormone) therapies such as tamoxifen or aromatase inhibitors. These medicines are taken orally for 5-10 years and reduce the chance of recurrence of these "hormone-positive" cancers by nearly half. Endocrine therapies can cause symptoms of menopause but are generally well tolerated.
Cancers that do not express ER or PR are "hormone receptor negative" and need to be treated with chemotherapy unless the cancer is very small. The chemotherapy regimens available today are very effective in reducing the chances of cancer spread or recurrence and are generally given as outpatient therapy. Chemotherapy for breast cancer generally does not require hospital admission in the absence of complications.
Breast cancers that independently overexpress a molecule called the HER-2/neu oncogene (HER-2 positive) are amenable to treatment with targeted biological agents such as trastuzumab. When targeted biological therapies are given, they are combined with chemotherapy to make them effective at killing cancer cells.
Radiotherapy plays a very important role in treating breast cancer. With early-stage breast cancers, radiation can prevent a woman having to undergo a mastectomy. With later stage cancers, radiotherapy can reduce cancer recurrence risk even when a mastectomy has been performed. For advanced stages of breast cancer, in some circumstances, radiation therapy may reduce the likelihood of dying of the disease.
The effectiveness of breast cancer therapies depends on the full course of treatment. Partial treatment is less likely to lead to a positive outcome.
Global impact Age-standardized breast cancer mortality in high-income countries dropped by 40% between the 1980s and 2020 (1). Countries that have succeeded in reducing breast cancer mortality have been able to achieve an annual breast cancer mortality reduction of 2-4% per year.
The strategies for improving breast cancer outcomes depend on fundamental health system strengthening to deliver the treatments that are already known to work. These are also important for the management of other cancers and other non-malignant noncommunicable diseases (NCDs). For example, having reliable referral pathways from primary care facilities to district hospitals to dedicated cancer centres.
The establishment of reliable referral pathways from primary care facilities to secondary hospitals to dedicated cancer centres is the same approach as is required for the management of cervical cancer, lung cancer, colorectal cancer and prostate cancer. To that end, breast cancer is a so-called index disease whereby pathways are created that can be followed for the management of other cancers.
WHO response The objective of the WHO Global Breast Cancer Initiative (GBCI) is to reduce global breast cancer mortality by 2.5% per year, thereby averting 2.5 million breast cancer deaths globally between 2020 and 2040. Reducing global breast cancer mortality by 2.5% per year would avert 25% of breast cancer deaths by 2030 and 40% by 2040 among women under 70 years of age. The three pillars toward achieving these objectives are: health promotion for early detection; timely diagnosis; and comprehensive breast cancer management.
By providing public health education to improve awareness among women of the signs and symptoms of breast cancer and, together with their families, understand the importance of early detection and treatment, more women would consult medical practitioners when breast cancer is first suspected, and before any cancer present is advanced. This is possible even in the absence of mammographic screening that is impractical in many countries at the present time.
The main concern of the appellant was that, that biopsy was unnecessarily done and it triggered the cancer cell to grow faster. Is it so?
A study of more than 2,000 patients by researchers at Mayo Clinic's campus in Jacksonville, Florida, has dispelled the myth that cancer biopsies cause cancer to spread. They show that patients who received a biopsy had a better outcome and longer survival than patients who did not have a biopsy.
The image shows a pancreas tumor being biopsied with a needle as visualized by endoscopic ultrasound. The endoscope was located within the stomach (passed via the mouth). An ultrasound probe at the tip of the endoscope allows visualization of the pancreas which is located immediately next to the stomach. A long needle is guided through the endoscope and into the tumor under ultrasound guidance.
The researchers studied pancreatic cancer, but the findings likely apply to other cancers because diagnostic technique used in this study - fine needle aspiration - is commonly used across tumor types, says the study's senior investigator and gastroenterologist Michael Wallace, M.D., M.P.H., professor of medicine.
Fine needle aspiration is a minimally invasive technique that uses a thin and hollow needle to extract a few cells from a tumor mass. A long-held belief by a number of patients and even some physicians has been that a biopsy can cause some cancer cells to spread.
While there have been a few case reports that suggest this can happen - but very rarely - there is no need for patients to be concerned about biopsies, says Dr. Wallace.
"This study shows that physicians and patients should feel reassured that a biopsy is very safe," he says. "We do millions of biopsies of cancer a year in the U.S., but one or two case studies have led to this common myth that biopsies spread cancer."
Biopsies offer "very valuable information that allow us to tailor treatment. In some cases, we can offer chemotherapy and radiation before surgery for a better outcome, and in other cases, we can avoid surgery and other therapy altogether," Dr. Wallace says.
Surgery for pancreatic cancer is "a very big operation," and "most people should want to make sure they have cancer before they undergo surgery," he says. One study has shown that 9 percent of patients who underwent surgery because of suspected pancreatic cancer actually had benign disease.
Dr. Wallace and his team have conducted two separate studies to examine the risk of biopsy.
In a 2013 study published in Endoscopy, the researchers examined outcomes in 256 pancreatic cancer patients treated at Mayo Clinic in Jacksonville, Florida. They found no difference in cancer recurrence between 208 patients who had ultrasound-guided fine needle aspiration (EUS-FNA) and the 48 patients who did not have a biopsy.
In the current study, they examined 11 years (1998-2009) of Medicare data on patients with non-metastatic pancreatic cancer who underwent surgery. The researchers examined overall survival and pancreatic cancer-specific survival in 498 patients who had EUS-FNA and 1,536 patients who did not have a biopsy.
During a mean follow-up time of 21 months, 285 patients (57 percent) in the EUS-FNA group and 1,167 patients (76 percent) in the non-EUS-FNA group died. Pancreatic cancer was identified as the cause of death for 251 patients (50 percent) in the EUS-FNA group and 980 patients (64 percent) in the non-EUS-FNA group.
Median overall survival in the EUS-FNA group was 22 months compared to 15 months in the non-EUS-FNA group.
"Biopsies are incredibly valuable. They allow us to practice individualized medicine -- treatment that is tailored for each person and designed to offer the best outcome possible," Dr. Wallace says.
A lump or a mass that shouldn't be a shadow in an X-ray or an unusual-looking mole creates suspicion of cancer. However, for most cancer categories, a confirmation is pending until the biopsy says so.
Cancer Biopsy is a medical procedure that involves taking a small sample of tissue from the body to examine it for the presence of diseases such as cancer. However, some patients and healthcare providers are concerned that cancer biopsy may cause cancer to spread and worsen.
Cancer biopsies are critical as they not only help doctors diagnose whether cancer cells are present or not, but their results also help them prepare a treatment plan by revealing the type and grade of the cancer cell. In this article, we will discuss the risks and benefits of biopsies and allay all your concerns.
Can biopsy spread cancer?
One of the biggest concerns regarding tumour removal is the potential for cancer cells to be dislodged during the procedure. This could result in the cancer cells spreading to other body areas through the bloodstream or lymphatic system.
A rare event known as "tumour seeding" or "needle seeding" occurs when a biopsy needle accidentally dislodges and spreads cancer cells inside a tumour. The growth of cancer cells along the needle's tract is why it is sometimes referred to as tract seeding. However, these instances are rare and even in cases of tract seeding, there is no increased risk of local recurrence or death.
Why is it necessary to get the recommended biopsy?
Often, the most accurate method of determining if you have cancer is to get a biopsy. The doctor can determine if an area is suspicious using other technologies, including PET-CT scans, MRIs, and ultrasounds. However, most of the time, a biopsy is the only method available to provide a conclusive cancer diagnosis.
Occasionally, a biopsy shows that there are just benign or non-cancerous cells in a questionable location. This could imply that you do not require medical care, including chemotherapy, radiation therapy, or surgery. A biopsy can also determine the sort of cancer cells inside the tumour. In other cases, a biopsy can reveal to the physician the potential scope of the disease as well as how aggressive the cancer looks. This is a reference to the grade and stage of the cancer. The optimal course of action for treating cancer is determined in part by this knowledge. In rare cases, biopsies can cause bleeding, infection and damage to surrounding areas, but these can be easily taken care of by medical professionals.
What are the benefits of biopsy?
As already discussed, biopsies help in cancer detection. This section will make you aware of other benefits of biopsies and why they are necessary for cancer treatment:
Accurate Diagnosis: Currently, biopsies are the most reliable way of detecting cancer cells. Apart from cancer diagnosis, tissues provided from biopsy procedures are examined to detect infections, autoimmune diseases and inflammatory diseases.
Treatment Planning: Biospies not only confirm the presence of cancer cells but also provide crucial information on the type, subtype and grade of cancer cells. This information proves extremely helpful in treatment planning.
Monitoring Disease Progression: Biospy can be performed at regular intervals to monitor the disease progression. The tissue taken out during biopsy can be examined to see whether the cells have enlarged or contracted.
Research and Development: Biopsy also plays a crucial role in medical research. It helps scientists understand the mechanism of diseases, which will lead to better and more accurate diagnostic and treatment tools.
Conclusion:
Although there is a concern that biopsies can spread cancer, the danger appears to be quite low, according to the research. For most patients, the advantages of the surgery greatly exceed the dangers, making it an essential part of cancer diagnosis and therapy planning. Patients should talk to their healthcare professional about any worries they may have regarding biopsies so that information particular to their case can be given.
Therefore it is a myth that biopsy triggers the cancer cells to grow even faster.
In the present case the complainant is an advocate. He took his mother to the clinic of respondent where the respondent after checking advised for biopsy. The appellant has said that her mother was not ready for biopsy but she became ready for biopsy due to the advice of respondent. The appellant can very well deny the biopsy but biopsy is only the means to confirm the stage of cancer or degree of cancer so it is must for the treatment of breast cancer. Biopsy was done on 15 November 2010. The report was received on 25th November 2010. Thereafter the appellant took her mother to PGI Lucknow. Where the appellant's mother was rated on 9 December 2010. This is very small. This cannot trigger cancer cells to increase. The plant has said that after a few days her mother was discharged nearby everything was okay and she was discharged in good health. The respondent is a surgeon having many years of experience and biopsy can be done by a surgeon because he has degree of surgery and mixing and thereafter master degree of surgery.
After one month of discharge process of radiotherapy started in PGI Lucknow. It was chemotherapy and the appellant has stated that his mother could not tolerate the bad effects of chemotherapy due to old age of 22 years and expired on 28 August 2011 during the chemotherapy. Now first we see what is chemotherapy and what is its adverse effect.
Chemotherapy to Treat Cancer Chemotherapy works against cancer by killing fast-growing cancer cells.
How chemotherapy works against cancer Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used for two reasons:
Treat cancer: Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.
Ease cancer symptoms: Chemotherapy can be used to shrink tumors that are causing pain and other problems.
Which types of cancer does chemotherapy treat Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy with other cancer treatments. The types of treatment that you need depend on the type of cancer you have, if it has spread and where, and if you have other health problems.
How chemotherapy is used with other cancer treatments When used with other treatments, chemotherapy can make a tumor smaller before surgery or radiation therapy (called neoadjuvant chemotherapy) destroy cancer cells that may remain after surgery or radiation therapy (called adjuvant chemotherapy) help other treatments work better kill cancer cells that have returned or spread to other parts of your body Chemotherapy can cause side effects Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.
The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by asking someone to drive you to and from chemotherapy planning time to rest on the day of and day after chemotherapy asking for help with meals and childcare on the day of and at least one day after chemotherapy There are many ways you can help manage chemotherapy side effects.
How much chemotherapy costs The cost of chemotherapy depends on the types and doses of chemotherapy used how long and how often chemotherapy is given whether you get chemotherapy at home, in a clinic or office, or during a hospital stay the part of the country where you live Talk with your health insurance company about what services it will pay for. Most insurance plans pay for chemotherapy. To learn more, talk with the business office where you go for treatment.
How chemotherapy is given Chemotherapy may be given in many ways. Some common ways include oral: comes in pills, capsules, or liquids that you swallow intravenous (IV): goes directly into a vein injection: given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly intrathecal: injected into the space between the layers of tissue that cover the brain and spinal cord intraperitoneal (IP): goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver intra-arterial (IA): injected directly into the artery that leads to the cancer topical: comes in a cream that you rub onto your skin Of all the methods mentioned above, chemotherapy is most often given with an IV, through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.
Catheter: A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood. Be sure to watch for signs of infection around your catheter. See the section about infection for more information.
Port: A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port. See the section about infection for more information.
Pump: Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.
How your doctor decides which chemotherapy drugs to give you There are many different chemotherapy drugs. Which ones are included in your treatment plan depends mostly on the type of cancer you have and how advanced it is whether you have had chemotherapy before whether you have other health problems, such as diabetes or heart disease Where you go for chemotherapy You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor's office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them.
How often you receive chemotherapy Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on your type of cancer and how advanced it is whether chemotherapy is used to cure your cancer control cancer's growth ease symptoms the type of chemotherapy you are getting how your body responds to the chemotherapy You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.
Missing a chemotherapy treatment It is best not to skip a chemotherapy treatment. But, sometimes your doctor may change your chemotherapy schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.
How chemotherapy may affect you Chemotherapy affects people in different ways. How you feel depends on the type of chemotherapy you are getting the dose of chemotherapy you are getting your type of cancer how advanced your cancer is how healthy you are before treatment Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.
How will I know if chemotherapy is working?
You will see your doctor often. During these visits, they will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRI, CT, or PET scans.
You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.
Special diet needs while on chemotherapy Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian.
Working during chemotherapy Many people can work during chemotherapy, as long as they match their work schedule to how they feel. Whether or not you can work may depend on what kind of job you have. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well.
Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.
Chemotherapy affects all cells that grow and divide quickly in the body. This includes cancer cells and normal cells, such as the new blood cells in the bone marrow or the cells in the mouth, stomach, skin, hair and reproductive organs.
When chemotherapy damages normal cells, this causes side effects. Whether or not you experience side effects, and how severe they are, depends on the type and dose of drugs you are given and your reaction from one treatment cycle to the next.
Possible side effects from chemotherapy are explored below, and include:
fatigue appetite changes, nausea or vomiting constipation or diarrhoea hair loss mouth sores thinking and memory changes changes to the blood, including anaemia, infections, and bleeding problems numbness in your hands or feet changes in hearing changes in sexuality and fertility.
Most side effects are short-term and can be managed. They tend to gradually improve once treatment stops and the normal, healthy cells recover.
Sometimes, chemotherapy causes long-term side effects that don't go away. These may include damage to your heart, lungs, nerve endings, kidneys, or reproductive organs.
A frequently observed complication of chemotherapy includes cytopenia, which refers to a drastic reduction in various cells, the most common being red blood cells. Lower levels of thrombocytes (thrombocytopenia) have also been observed in patients on chemo, with older patients being at a higher risk.
Is there an age limit for chemotherapy?
In most cases, it does not. A healthy older person often has the same chances of responding to treatment or being cured than a younger one. Even for patients with more health issues chemotherapy may help decrease cancer symptoms and growth, and help people live better and longer.
Therefore it is clear that old age people are more vulnerable to chemotherapy as compared to young people. As the appellant has not filed any document or treatment of PGI so it cannot be ascertained as to why the death has occurred. No such document of the PGI has been filed showing that the respondent was at fault. There is no medical literature which shows that biopsy of breast cancer triggers the growth of the cancer cells. So it cannot be said that due to biopsy, they can stress cells of the best triggered causing the death of the patient. The patient was operated on in PGI and thereafter chemotherapy was started so there is notion between biopsy and trigger of growth of the cancer cells.
In this case the patient is of 72 years of age so it is clear that she cannot tolerate the after effect of chemotherapy as compared to young people but it is for the doctors of the PGI to decide whether chemo was necessary or not. The respondent has nothing to do with chemotherapy so he cannot be held liable for any negligence or for any deficiency of service in this case.
Breast cancer diagnosis often begins with an exam and a discussion of your symptoms. Imaging tests can look at the breast tissue for anything that's not typical. To confirm whether there is cancer or not, a sample of tissue is removed from the breast for testing.
Breast exam During a clinical breast exam, a healthcare professional looks at the breasts for anything that's not typical. This might include changes in the skin or to the nipple. Then the health professional feels the breasts for lumps. The health professional also feels along the collarbones and around the armpits for lumps.
Mammogram A mammogram is an X-ray of the breast tissue. Mammograms are commonly used to screen for breast cancer. If a screening mammogram finds something concerning, you might have another mammogram to look at the area more closely. This more-detailed mammogram is called a diagnostic mammogram. It's often used to look closely at both breasts.
Breast ultrasound Ultrasound uses sound waves to make pictures of structures inside the body. A breast ultrasound may give your healthcare team more information about a breast lump. For example, an ultrasound might show whether the lump is a solid mass or a fluid-filled cyst. The healthcare team uses this information to decide what tests you might need next.
Breast MRI MRI machines use a magnetic field and radio waves to create pictures of the inside of the body. A breast MRI can make more-detailed pictures of the breast. Sometimes this method is used to look closely for any other areas of cancer in the affected breast. It also might be used to look for cancer in the other breast. Before a breast MRI, you usually receive an injection of dye. The dye helps the tissue show up better in the images.
Removing a sample of breast cells for testing A biopsy is a procedure to remove a sample of tissue for testing in a lab. To get the sample, a healthcare professional puts a needle through the skin and into the breast tissue. The health professional guides the needle using images created with X-rays, ultrasound or another type of imaging. Once the needle reaches the right place, the health professional uses the needle to draw out tissue from the breast. Often, a marker is placed in the spot where the tissue sample was removed. The small metal marker will show up on imaging tests. The marker helps your healthcare team monitor the area of concern.
Testing cells in the lab The tissue sample from a biopsy goes to a lab for testing. Tests can show whether the cells in the sample are cancerous. Other tests give information about the type of cancer and how quickly it's growing. Special tests give more details about the cancer cells. For example, tests might look for hormone receptors on the surface of the cells. Your healthcare team uses the results from these tests to make a treatment plan.
Staging breast cancer Once your healthcare team diagnoses your breast cancer, you may have other tests to figure out the extent of the cancer. This is called the cancer's stage. Your healthcare team uses your cancer's stage to understand your prognosis.
Complete information about your cancer's stage may not be available until after you undergo breast cancer surgery.
Tests and procedures used to stage breast cancer may include:
Blood tests, such as a complete blood count and tests to show how well the kidneys and liver are working.
Bone scan.
CT scan.
MRI.
Positron emission tomography scan, also called a PET scan.
Not everyone needs all of these tests. Your healthcare team picks the right tests based on your specific situation.
Breast cancer stages range from 0 to 4. A lower number means the cancer is less advanced and more likely to be cured. Stage 0 breast cancer is cancer that is contained within a breast duct. It hasn't broken out to invade the breast tissue yet. As the cancer grows into the breast tissue and gets more advanced, the stages get higher. A stage 4 breast cancer means that the cancer has spread to other parts of the body.
Can a mammogram tell if you have breast cancer?
The procedure allows detection of breast cancers , benign tumors, and cysts before they can be detected by palpation (touch). Mammography cannot prove that an abnormal area is cancer, but if it raises a significant suspicion of cancer, tissue will be removed for a biopsy.
A biopsy is done when mammograms, other imaging tests, or a physical exam shows a breast change that may be cancer. A biopsy is the only way to know for sure if it's cancer.
So it is clear that the respondent after taking the patient came to know that it is just cancer and he needs no mammography but directly followed the procedure of biopsy by which the cancer has been confirmed. The operation was the only way to remove the cancer cells from the body and it has been done in PGI. Thus there is no fault on the part of the respondent. The respondent has given a report only after performing biopsy and there is no report of the PGI that biopsy was unnecessary in this case. It is a great fact that the mother of the complainant was suffering from breast cancer so it cannot be said that she had no breast cancer and biopsy was done unnecessarily. There is no evidence on record to show that biopsy was not necessary. It is clear that ultimatum positive test to confirm the cancer is biopsy which has been done in this case. After confirmation of biopsy, all the procedures were conducted at PGI but the complainant has not made PGI any party stormed there are well qualified doctors in PGI and it cannot be accepted from them that they will show carelessness in the treatment of a patient. So there is no nexus between the chemotherapy and biopsy.
The learned Forum has discussed all these things and dismiss the complaint case as there was no fault of respondent. The appellant has not filed the various medical treatment papers of PGI and did not file a single paper which may prove the carelessness of the respondent, so we are of the opinion that there is no deficiency of service on the part of the respondent and the judgment of the learned Forum is well discussed and there is no need to interfere in this judgment. The present appeal is liable to be dismissed cost.
ORDER The appeal is dismissed.
The stenographer is requested to upload this order on the Website of this Commission today itself.
Certified copy of this judgment be provided to the parties as per rules.
(Vikas Saxena) (Rajendra Singh) Member Presiding Member Judgment dated/typed signed by us and pronounced in the open court. Consign to record. (Vikas Saxena) (Rajendra Singh) Member Presiding Member Dated 29.7.2024 Jafri, PA I Court 2 [HON'BLE MR. Rajendra Singh] PRESIDING MEMBER [HON'BLE MR. Vikas Saxena] JUDICIAL MEMBER