Failure to Diagnose & Delay in Treatment of Lung Cancer

Evaluate breaches in the standard of care when determining Failure to Diagnose & Delay in Treatment of Lung Cancer

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Chest discomfort / prolonged difficulty in breathing
    Persistent cough / blood in sputum
    Incidental finding of lung nodule / mass
    Hoarseness of voice
    Fatigue / anorexia / weight loss
    Not elicited
    Answer unknown
    Why is this important?
    The symptoms of lung cancer depend on the location of the tumor.
    (2005) 19 EHOCNA 2 219-235

  • Was a medical history obtained? Why is this important?
    Answer this question
    Past medical history (PMH) includes all past and current illness, hospitalizations, surgery, trauma, allergies, and medications. The date, location, and physician / surgeon for each hospitalization and / or surgery should also be included. The PMH is also important for investigating whether the chief complaint (CC) is a manifestation of a previously diagnosed disorder.
    (2011) 55 EDECNA 1 15-28

  • Was a physical examination performed? Why is this important?
    Answer this question
    Physical examination must be focused on the cardio-respiratory system.
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  • Which of the following imaging studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    A chest radiograph commonly is the first step in the evaluation of a patient who is suspected of having lung cancer. However, CT scan detects smaller lung cancers than are not visible on chest x-ray. CT screening detects roughly two to four times more lung cancers than chest x-ray. A solitary pulmonary nodule (also referred to as a coin lesion), is a common clinical problem that is usually detected incidentally on a chest radiograph or CT scan.
    (1999) 20 ECLCMD 4 697-713

  • Which of the following conditions were identified? (Choose all that apply) Why is this important?
    Answer this question
    A number of clinical indicators may be helpful in distinguishing benign from malignant solitary nodules. A number of criteria have been described to help separate benign from malignant solitary nodules, such as size, shape, contour, location, edge definition, the presence of satellite lesions, and cavitation.
    (1999) 20 ECLCMD 4 697-713

  • Which of the following actions were initiated? (Choose all that apply) Why is this important?
    Answer this question
    If a lung malignancy is suspected or confirmed, urgent referral to a pulmonary specialist, thoracic surgeon, or medical oncologist is mandatory.
    (1999) 20 ECLCMD 4 697-713

  • To what type of specialist was the patient referred? (Choose all that apply) Why is this important?
    Answer this question
    If a lung malignancy is suspected or confirmed, urgent referral to a pulmonary specialist, thoracic surgeon, or medical oncologist is mandatory.
    (1999) 20 ECLCMD 4 697-713

  • Which of the following diagnostic studies were recommended? (Choose all that apply) Why is this important?
    Answer this question
    “Various modalities can be used to stage lung cancer including CT, positron emission tomography, transesophageal ultrasound-guided fine needle aspiration, endobronchial ultrasound-guided transbronchial needle aspiration, video-assisted thoracoscopy, or mediastinoscopy.”
    (2009) 4 EULTRC 3 369-384

  • Was a brain MRI performed for the staging work-up? Why is this important?
    Answer this question
    Brain metastases can present in up to 10 percent of patients with Small Cell Lung Carcinoma (SCLC) at the time of presentation, therefore brain imaging should be carried out in all patients.
    (2012) 5 INFPHT S1 S14-S21

  • Was skeletal imaging performed in the staging work-up? Why is this important?
    Answer this question
    Skeletal imaging historically was conducted with technetium, but now more commonly uses 18F NaF PET/CT. It is found to be sensitive and specific for the detection of malignant skeletal lesions. It accurately differentiates malignant from benign bone lesions.
    (2012) 7 EPETCL 3 263-274

  • Was bone marrow aspiration recommended during the staging work-up? Why is this important?
    Answer this question
    The early detection of bone marrow metastases allows for a rapid initiation of therapy and a subsequent reduction in the morbidity rate.
    (2005) 55 ESEUJR 1 41-55

  • With which type of lung cancer was the patient diagnosed? Why is this important?
    Answer this question
    Treatment is contingent upon the biopsy results.
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  • With what stage of non-small cell carcinoma was the patient diagnosed? Why is this important?
    Answer this question
    Staging is done by the Union Internationale Contre le Cancer and the AJCC TNM systems. The latest staging guideline was published in 2009 and became effective in January 2010.
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  • Which of the following treatment options were initiated? (Choose all that apply) Why is this important?
    Answer this question
    Early-stage disease has a much better prognosis than late-stage disease. There are differences in the management and prognosis between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Surgical resection offers the best chance of cure for early-stage non-small cell lung cancer (stages I and II).
    (2002) 11 ESURON 4 191-199

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise. Regular check-ups ensure that changes in health are quickly assessed and remedied.
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  • With which of the following small cell carcinoma types was the patient diagnosed? Why is this important?
    Answer this question
    The TNM staging system is not used typically for patients with small cell lung cancer because the patients usually do not undergo evaluation for surgical resection after the diagnosis is established.
    (2002) 23 ECLCMD 1 225-239

  • Which of the following treatment options were initiated? (Choose all that apply) Why is this important?
    Answer this question
    Small cell carcinoma is rarely treated surgically because small cell lung cancer typically is disseminated at the time of diagnosis.
    (2002) 23 ECLCMD 1 225-239

  • Was Prophylactic Cranial Irradiation (PCI) recommended? Why is this important?
    Answer this question
    Prophylactic cranial irradiation (PCI) for patients without detectable brain metastases can decrease the frequency of subsequent intracranial relapse and improve survival for patients with SCLC.
    (2004) 18 EHOCNA 2 355-372

  • With which of the following paraneoplastic syndromes did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Patients with small cell lung cancer more often have paraneoplastic syndromes. The well-characterized syndromes most frequently are mediated by production of peptide hormones or antibodies.
    (2002) 23 ECLCMD 1 225-239