LUNG CANCER MEDICAL NEGLIGENCE MISDIAGNOSIS OF LUNG CANCER

John Whelan Solicitor with specialist expertise in Lung Cancer Medical Negligence gives an example of a misdiagnosis of lung cancer, where the failure to properly identify the condition led to delays in treatment and worsened the patient's outcome:

Misdiagnosis of Lung Cancer

Patient: The Patient with a smoking history, presented to his GP with complaints of chronic cough, shortness of breath, and unexplained weight loss over the past 6 months. He also noted a persistent pain in his right shoulder, which he attributed to muscle strain from heavy lifting.

Initial Assessment:

a) The Patient had a significant smoking history, which placed him at a high risk for lung cancer. Despite his age and smoking history, the GP initially diagnosed his symptoms as chronic bronchitis, given the chronic cough and his smoking history.

b) The GP also considered the possibility of musculoskeletal pain for the shoulder discomfort and prescribed muscle relaxants and over the counter pain relievers.

c) No imaging studies were ordered at this point, and the symptoms were attributed to smoking related chronic bronchitis.

Failure to Investigate:

a) As the symptoms persisted and worsened, the Patient returned to his GP for follow-up visits, but the GP continued to attribute his ongoing symptoms to chronic bronchitis and age related musculoskeletal pain. The cough had become more persistent and productive, and he was having increasing difficulty with physical exertion due to shortness of breath.

b) The GP did not consider lung cancer as a potential diagnosis despite the Patient’s risk factors, nor did they order imaging studies such as a chest X-ray or CT scan to evaluate the cause of his persistent symptoms.

Progression and Misdiagnosis:

1. Worsening Symptoms and Delayed Imaging: 

a) After several months of worsening symptoms, the Patient experienced significant chest pain and haemoptysis (coughing up blood), which led to an emergency room visit.

b) The physician in the A&E performed a chest X-ray, which showed a mass in the right lung. However, the radiologist misinterpreted the mass as a benign lesion, possibly a granuloma or inflammatory nodule, and recommended monitoring over time rather than further investigation.

2. Missed Diagnosis of Lung Cancer:

a) Despite the radiologist's recommendation for further investigation, the A&E physician followed up on the assumption that the mass was benign. The Patient was sent home with instructions to return in a few weeks for a follow-up chest X-ray to monitor the mass.

b) Over the next few months, the Patient continued to experience worsening symptoms, including increasing pain, shortness of breath, and fatigue. He also lost an additional 15 pounds.

c) During this period, his weight loss and coughing were still not investigated further, as they were attributed to smoking related respiratory issues. His chronic cough and shoulder pain were still presumed to be related to chronic bronchitis and musculoskeletal strain.

3. Final Diagnosis:

It was only after the Patient sought a second opinion from a pulmonologist that a CT scan was ordered, revealing a large mass in his lung that had metastasised to his lymph nodes and bones. A biopsy confirmed that the mass was non-small cell lung cancer (NSCLC), which had advanced to stage IV.

Outcome of the Case:

a) By the time the correct diagnosis was made, the lung cancer had already spread, and surgical resection was no longer an option.

b) The Patient underwent chemotherapy and radiation therapy, but the prognosis was poor due to the advanced stage of the disease at the time of diagnosis.

c) Despite treatment, the Patient lived for only another 9 months, with a significantly reduced quality of life due to the metastasis.

Important Points of the Case:

1. Failure to Consider Lung Cancer in a High Risk Patient: Despite the Patient smoking history and persistent symptoms, the GP did not consider lung cancer as a potential diagnosis. His symptoms were incorrectly attributed to chronic bronchitis without adequate imaging to rule out more serious conditions.
2. Misinterpretation of Imaging: The initial chest X-ray and subsequent radiological findings of the mass were misinterpreted as a benign condition. The failure to pursue further imaging or a biopsy in the presence of a persistent mass contributed to a delayed diagnosis.
3. Lack of Aggressive Follow Up: Despite worsening symptoms, the failure to pursue further diagnostic steps, such as a CT scan, bronchoscopy, or biopsy, contributed to the delay in diagnosing the lung cancer until it was already in an advanced stage.

Conclusion:

This case shows the importance of early consideration of lung cancer in high-risk patients, particularly those with a significant smoking history.

For more detailed insights into how the Patient Safety Act 2023 impacts you and how Whelan Law can support you, please visit our Lung Cancer Medical Negligence https://www.whelanlaw.ie/news/rising-lung-cancer-medical-negligence-claims-a-reflection-of-modern-medicine/