Medical Malpractice — Non-Small Cell Carcinoma Lung Cancer

Lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung. The disease usually shows up in one of two ways:

1. Small-cell carcinoma also called small cell lung cancer. This type of lung cancer is often already widespread by the time it is diagnosed and tends to metastasize (spread) quickly. With the exception of atypical carcinoid tumors which respond well to surgery, small-cell carcinoma has very limited treatment options and cure is quite rare.
2. Non-small-cell carcinoma also called non-small cell lung cancer.Diagnosed correctly and in a timely manner, non-small cell carcinoma can be a treatable form of lung cancer , which is why the late diagnosis and misdiagnosis of non-small cell carcinoma is a critical issue.

The cancer cells of small cell and non-small cell carcinoma grow and spread in different ways, and they are treated differently.

Types of Non-Small Cell Carcinoma

Non-small cell carcinoma is classified by the types of cells found in the cancer, which include: squamous-cell carcinoma (also called epidermoid carcinoma), adenocarcinoma, adenosquamous carcinoma, large-cell carcinoma, bronchoalveolar carcinoma, pleomorphic, sarcomatoid or sarcomatous carcinoma, carcinoid tumor, salivary gland carcinoma and undifferentiated carcinoma. Different treatments and prognoses are indicated for each of these types of non-small cell carcinoma.

The prognosis (chance of recovery) and choice of treatment depend on the type of cancer, the stage of the cancer (whether it is just in the lung or has spread to other places), the size of the tumor or tumors, and the age and health of the patient. Treatment options usually including surgery, radiation, chemotherapy or some combination of the three.

Symptoms

Non-small cell carcinoma lung cancer has a variety of symptoms, depending upon the tumor’s size, location and other factors. Common symptoms include:

1. Chronic cough
2. Bronchitis, pneumonia or other lung infections that do not respond to medication or recur regularly
3. Wheezing
4. Voice changes that may include raspiness, hoarseness (dysphonia), or simply a change in the sound of the voice.
5. Chest pain, including in the area of the lungs, ribs or muscles of the chest wall
6. Back, shoulder or arm pain
7. Shortness of breath (dyspnea)/bloody sputum
8. Coughing up blood (hemoptysis)
9. Clubbing of the fingernails (pulmonary osteoarthropathy)
10. Weight loss, fatigue and loss of appetite
11. Phrenic nerve palsy or pleural effusion
12. Horner’s syndrome
13. Superior sulcus or Pancoast’s tumors
14. SIADH
15. Hypercalcemia
16. Cushing’s syndrome
17. Carcinoid syndrome
18. Hypoglycemia
19. Neuromyopathies, such as Eaton Lambert
20. Swollen neck
21. Swollen face
22. Loss of appetite
23. Weight loss
24. Tiredness
25. Weakness
26. Fatigue

Some possible symptoms indicating the spread of lung cancer:

1. Diaphragm paralysis
2. Breathing difficulty
3. Fluid retention in upper body
4. Facial swelling
5. Neck swelling
6. Upper body swelling
7. Pleural effusion

Diagnosis

Although chest x-rays are not foolproof, they are still the most reliable tool for first line investigation of suspicion of lung cancer. However, since chest x-rays do not always show a cancerous mass, and/or a mass is not always present or visible, they are not completely definitive. However, more errors are made in reading and interpreting these x-rays and in failing to identify what may be an early sign of a problem, than in the failure of the x-ray itself to show evidence of a problem. Bronchoscopy and CT scans are also useful diagnostic tools.

Prognosis

The prognosis (chance of recovery) and treatment options depend on the size of the tumor, the stage of the cancer (see below), whether the cancer has spread beyond the lungs, the type of lung cancer, the severity of symptoms, and the age and health of the patient.

Staging a cancer is the process of determining how far the disease has progressed. This is done through examination, testing, biopsy, evaluation of symptoms, x-rays, CT scans, PET scans, lab tests that include blood and urinalysis, lymph node biopsy: bronchoscopy; mediastinoscopy, and anterior mediastinotomy/ Chamberlain procedure, among others.

Staging

The following stages are used for non-small cell lung cancer:

1. Occult (hidden) stage- In this stage, evidence of cancer cells has been discovered in the mucus coughed up from the lungs, but no tumor has been found in the lungs themselves.
2. Stage 0 (carcinoma in situ)- In stage 0cancer is limited to the lung and is found only in a few layers of cells. It has not grown through the top lining of the lung.
3. Stage I- In stage I, the cancer is in the lung only, with normal tissue around the tumor. Stage I is divided into stages IA and IB, based on the size of the tumor.
4. Stage II- Is where the cancer has spread to nearby lymph nodes or to the chest wall, the ribs and muscles, the diaphragm, the mediastinalpleura (the thin membrane that covers the outside of the lungs near the heart), or the parietal pericardium (the outer layer of tissue that surrounds the heart). Stage II is divided into stage IIA and stage IIB, based on the size of the tumor and whether it has spread to the lymph nodes.
5. Stage III- In stage III, cancer has either spread to the lymph nodes in the mediastinum (the middle area between the lungs that contains the heart, major blood vessels, and other structures); or spread to the lymph nodes on the opposite side of the chest or in the lower neck.Stage III is divided into stage IIIA (which is sometimes treated with surgery) and stage IIIB (which is rarely treated with surgery).
6. Stage IV- In stage IV, cancer has spread to other parts of the body or to another lobe of the lungs.
7. Recurrent Non-Small Cell Lung Cancer- Recurrentnon-small cell lung cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the brain, lung, or other parts of the body.

Non-Small Cell Carcinoma Malpractice

When early diagnosis could have prevented the spread of the cancer or better treatment options would have been available with earlier diagnosis, malpractice may have existed.

Lung cancer can be difficult to diagnose during early stages, but that does not absolve medical professionals of the responsibility to educate themselves about the symptoms and responsibly respond to likelihood or suspicions. Because the stage of the cancer so dramatically affects the prognosis, and because the disease is treatable in early stages and usually fatal in later stages, early diagnosis is a critical responsibility of doctors, radiologists and oncologists dealing with this number #1 cancer killer of adults.

There are often early indicators of the disease that could have or should have been caught, and the failure to do so has cost the health and life of many. Enough information about the disease exists, and there are enough warning signs and effective test options, that there is hardly any excuse for the missed diagnoses that continue to be a problem in lung cancer care.

Medical malpractice in relation to non-small cell carcinoma takes different forms and can include:

1. Ignoring or dismissing a patient’s complaints
2. Taking an inadequate medical history – A complete and accurate medical history is a crucial element of early diagnosis, and is something doctors or paraprofessionals must not ignore.
3. Failing to order appropriate testing (such as a chest x-ray) or failing to refer to a specialist.
4. Failure to biopsy a suspicious lesion or failure to follow-up on a biopsy
5. A faulty decision to watch and wait
6. Negligent cell sampling, culturing or interpretation of biopsy samples
7. Misreading test results
8. Misreading, misinterpreting or overlooking indicators on a chest x-ray.
9. Failure to pursue, investigate or follow-up on any warning signs or symptoms.
10. Failing to report test results to a patient immediately, and/or failing to follow-up on patient’s response or actions.
11. Failing to warn patients of the consequences of failing to act (for example, failing to schedule a chest x-ray or biopsy immediately)
12. Failing to inform patients of future signs and symptoms to watch for

Screening for cancer, and being properly trained to quickly and accurately pinpoint the signs of the disease, are vital responsibilities of health care professionals. Failure to do so may constitute medical malpractice, and may mean the difference between life and death.

Malpractice Questions

Some important questions in non- small cell carcinoma malpractice cases include:

1. Should have or could have the cancer been diagnosed earlier?
2. Would have or could have a more competent doctor, radiologist or other health care professional have diagnosed the cancer earlier or treated the cancer differently?
3. Would an earlier diagnosis have affected treatment options and/or the eventual outcome?
4. Was a chest x-ray ordered and if so, was it properly read and properly followed up on? Were any abnormalities caught and followed?
5. Was any decision to “watch and wait” done only with an individual who was clearly low risk for cancer, for example was under 50, was and had always been a non-smoker and lived in anon-smoking household, had no known history or family history, was given a baseline CT scan, had no known risk factors, strict follow-up was scheduled at regular intervals, and removal of any suspicious nodules.

The most common cause for non-small cell carcinoma malpractice lawsuits is the failure to follow up a chest x-ray abnormality or to pursue presenting symptoms to an appropriate conclusion, which are unforgivable and negligent medical mistakes.

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