This learning module is focused on the clinician's role in managing the anxiety felt by the patient and the family when a tumor is found.
This learning module describes how the physician should inform the patient about the real potential for malignancy in a soft tissue tumor. If the patient has accurate information about the risk, they are better equipped to make the important decisions about their care. Physicians should not use the fear of cancer to coerce patients into having surgery.
The patient with a tumor in the foot or ankle requires a systematic approach to the diagnosis, not just a fast biopsy. The patient and the family may be overwhelmed by fear of the unknown and worrisome possibilities presented by the tumor.
As outlined in the other modules on this site, a thorough history and exam and appropriate imaging studies may be adequate to completely rule out a malignant tumor in many cases. In these cases the patient should be informed about the real chances of malignancy so as to reduce the level of anxiety and allow the patient to make an informed choice about their care. Allowing the specter of cancer to linger may make it easier to convince the patient that a quick surgical procedure is necessary, but may ultimately lead to over treatment or biopsy related complications. Even if the tumor is very likely to be cancerous, clinician should steer the focus away from worry and speculation and instead lay out a course towards an accurate diagnosis, a comprehensive treatment plan, and a prospect for recovery.
The treating surgeon should actively seek assistance from the radiologist, the pathologist, and other colleagues. It is especially helpful to document any advice or recommendations received from others in the patient's chart. The information gathered should be shared fully with the patient and the patient's family, and presented in an understandable and emotionally sensitive way.
