[Treatment and patient information in the context of uncertain diagnosis]

An 82-year old female patient had an unclear gallbladder finding, and a laparoscopy was performed. The imaging techniques seemed to indicate gallbladder carcinoma infiltrating the liver. With the chosen method it was not possible to prove the actual existence of the cancer. The patient and her family were informed about the "benign" result and the patient was sent home. Three months later she died of gallbladder carcinoma, which was confirmed by liver aspiration during her last stay in hospital. The daughters were taken aback by the unexpected death of their mother. They declared that they would have spent the last three months differently, if they had been informed about the first suspected diagnosis and prognosis. Here we have a discussion about wasted chances. This article deals with the management of the fact that a diagnosed disease was ultimately fatal. It does not deal with the treatment of an advanced carcinoma of the gall-bladder with known lethal outcome. The approach can be twofold: a curative approach neglecting reality and patient communication on the one hand; a palliative approach with the goal of making the 'best' of the situation on the other. Regularly, after thorough clinical and technical examination we have evidence of cancer which we cannot actually prove by pathological confirmation. Very often these tumours are located in the pancreas and the biliary tract. When very old patients are concerned, decisions are even harder to take: how far are we to go with invasive examination methods and what will be the consequences after the existence of the cancer has been proven? What form should patient information take? In my opinion, all doctors are confronted with such situations almost daily.