Ewing's Sarcoma: 患者在接受治療後出現膀胱炎和血尿的情況，是否會導致永久性傷害？-腫瘤科

EWING'S SARCOMA？

Hello，

(Sorry for using English ‘cuz my computer can only read but not type in Chinese. Pls reply in Chinese. Tks.)

One 15-year-old boy felt pain with his left forearm and found it tumid rapidly in two weeks. It was diagnosed as kind of malignancies from the section and was soon removed by surgery after more than one month. Then the doctor said it is Ewing’s Sarcoma according to the removed tumor.

Last Monday the boy took his eighth treatment in the first year of chemotherapy. According to the oversight of nurse (hospital’s saying)， this time he was injected with only “Ifosthamide” (put in “Dextrose & Sodium Chloride Inj.)， without one extra “Dextrose & Sodium Chloride Inj.” for urinary bladder which is essential for every single treatment. The mistake was found after more than 24hrs when the boy felt pain and found blood in his urine.

Thus， the doctor stopped chemotherapy and had the boy injected with “Dextrose & Sodium Chloride Inj.” only to help urinate out the blood liquid and clot inside the bladder. The doctor said no damage to his kidney， but his bladder inflamed and tumid. He must be under tracking with his kidney and bladder afterwards. Only when there’s no more blood in his urine and the condition of his bladder returns normal， he can leave. But it’s been completely 7 days passed， the boy sometimes still finds a bit blood in his urine and additionally， now he feels itching with his penis. The doctor now said he at least still has to take this for five days and then depends on the state of his bladder.

Herewith I’ve got the following questions:
1. According to this case， will it cause any sequela or permanent damage to the boy? I mean his urinary bladder and kidney? Or any other organ or function?
2. Will it possible his kidney yet damaged (as the doctor said) even though his bladder has been severe inflamed and tumid， and he’s took the remedy for so many days already? I mean maybe the doctor lied to cover the mistake they made.
3. Is there any possibility that the doctor mis-diagnosed the illness even though he has studied the section before taking the surgery? I mean if it’s possible that different doctors have different opinions with the same section or same removed tumor?
4. Although he’s been under chemotherapy， his family still have little doubt at the diagnosis. Do you suggest them to bring the boy for another professional doctor just to ensure the result?
5. What action could the family take to sue the hospital (or doctor) or to prevent the hospital from getting rid of their responsibility in the future if any further relevant damage found?

linda，30~39歲女性，詢問日期：2001/02/07

楊友華醫師回覆-腫瘤科

醫事人員經歷：義大癌治療醫院臨床腫瘤科主治醫師

Ewing`s sarcoma是小兒科常見之惡性腫，還好的是它對化學治療反應還不錯，控制率可高達60％。
急性膀胱出血應該是化血治療引起急性反應之一，與他所需要用到之藥物有直接關係，有時候也很難避免，通常化療結束後就過去，較少再發生腎之後遺症，其實跟腎臟也沒有特別之關連性。如果有持續問題倒是要懷疑腎臟是否也有病變，因Ewing`s tumor也好發於後腹腔位置。加強化療過程之Hydration以及適量提高類固醇之用量可減少發生之頻率。
目前病患已接受相當正確之治療，另外應該再考慮局部放射線治療以增加局部控制效果。
尋找第二專家意見是絕對正確的想法，但是要找對人，patient的清況找小兒腫瘤專家就沒錯了，（找我不一定全對，因我處理成人癌症較多）
Ewing`s sarcoma診斷上相當明確，幾乎沒有出錯的機會，請放心！

回覆日期：2001/02/07
資料來源：台灣e院 - EWING'S SARCOMA

彙整補充說明

針對這位15歲男孩的情況，我將逐一回答您的問題，並提供相關的醫學知識與建議。

1. 是否會造成永久性傷害？

在這種情況下，膀胱炎和血尿的出現通常是由於化療藥物（如Ifosfamide）引起的副作用。
這些藥物可能對膀胱造成刺激，導致急性膀胱炎和出血。
一般來說，這些情況在適當的治療下是可以恢復的，並不一定會導致永久性傷害。
然而，若膀胱的炎症持續存在，或出現其他併發症，則可能需要進一步的檢查和治療。
至於腎臟，醫生已表示沒有損傷，但如果膀胱的問題持續，則有必要密切監測腎功能。

2. 腎臟是否可能受損？

雖然醫生表示腎臟沒有損傷，但如果膀胱的炎症持續，仍需定期檢查腎功能。
膀胱的炎症可能會影響尿液的排出，進而對腎臟造成壓力或損傷。
因此，持續的追蹤是必要的，以確保腎臟的健康狀況。

3. 是否可能誤診？

Ewing's Sarcoma的診斷通常是基於組織學檢查，這是一個相對明確的診斷過程。
雖然不同醫生可能會對同一病理切片有不同的看法，但在這種情況下，誤診的可能性相對較低。
如果家屬對診斷有疑慮，尋求第二意見是合理的選擇。

4. 是否應該尋求第二意見？

如果家屬對診斷或治療方案有疑慮，尋求第二意見是非常合適的。
建議尋找專門從事小兒腫瘤的醫生，這樣可以獲得更專業的評估和建議。

5. 如何採取法律行動？

若家屬認為醫療過程中存在疏失，應該首先收集所有相關的醫療記錄和證據，包括診斷報告、治療過程和醫生的建議。
接著，可以諮詢專業的醫療法律顧問，了解如何進行法律行動。
重要的是，必須證明醫療疏失與病人的健康問題之間的因果關係。

總結來說，這位男孩的情況需要密切監測，並在必要時進行進一步的檢查和治療。
家屬的疑慮是合理的，尋求第二意見和專業的法律建議都是明智的選擇。
希望這些資訊能幫助您更好地理解情況並做出適當的決策。