Lung Cancer Missed as Physician Fails to Place Order for Imaging Study

This case involves a forty-six-year-old female patient that was evaluated at a hospital where doctors found a nodular density on a chest x-ray that projected along the right upper lung lobe. The radiology report recommended that a CT with IV contrast be performed to determine the nature of the mass. The physician on the case neglected to order the CT scan and did not follow-up with any further investigation. Several months later, the patient was worked up for cancer after complaining of back pain and recent weight loss. An MRI performed showed a compression fracture of the spine that was suspicious for metastatic disease. She was ultimately diagnosed with metastatic small cell carcinoma of the lung that proved to be fatal.

Question(s) For Expert Witness

1. What is the prognosis if this condition was diagnosed early in the disease course?

Expert Witness Response

The prognosis of lung cancer depends on the type of tumor, how many nodes it has affected and whether the cancer has metastasized. For example, small cell lung cancer versus squamous cell cancer have different treatment modalities. About 60-70% of patients with small cell lung cancer (SCLC) have extensive disease at presentation. Extensive-stage SCLC is incurable as surgery will not help in prognosis. In the early stages, SCLC can be treated with combination chemotherapy and radiation which can improve their mortality; however it harder to control the disease process as the cancer has metastasized and spread to the other organs.