Lung Cancer Lawsuit News – 1/27/2012:
Lung Cancer Lawsuit: Patients with Lung Cancer (stage I or II disease), bone scanning and CT of the brain are not recommended in the absence of related symptoms. A bone scan should be performed only if the patient complains of bone pain. Plain radio graphic films of the affected area should be obtained to supplement the bone scan. If questions still exist after the studies are completed, magnetic resonance (MR) imaging of the painful area may also be performed. Finally, biopsy of the involved bony area may be required. Similarly, CT or MR imaging of the brain should be performed only if the patient has neurological symptoms or if the diagnosis of SCLC is suspected. It is not cost-effective to perform CT of the brain in an otherwise asymptomatic patient with lung cancer who has no neurological symptoms and is physiologically fit and stage-appropriate for surgery.
In patients with more advanced disease, bone scanning and CT or MR imaging of the brain may have a higher yield in revealing occult metastatic disease. MR imaging is frequently used to complement CT in evaluating the location of these tumors within the chest. Specifically, MR imaging is helpful for evaluating bony invasion of the chest wall or other structures. In patients with superior sulcus tumors and patients with tumors involving the first and second or third ribs, MR imaging may provide additional information beyond that obtainable with CT regarding the extent of the tumor’s involvement of the brachial plexus, thoracic inlet, great vessels, or other structure. Tumor suppressor genes, such as p53, normally provide a negative influence on cell growth. If a tumor suppressor gene is mutated, then this negative influence is removed and the tumor grows unchecked. Gene therapy trials to replace or modify p53 mutation are under way and have shown that gene therapy is safe when used in a clinical environment (Roth et al, 1996; Swisher et al, 1999) (for more information, see chapter 15). Mutations in the retinoblastoma (RB) gene are also associated with poor survival. If both p53 and RB mutations are present, survival is only 12 months, compared to 46 months in patients with normal expression of the corresponding proteins.
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Lung Cancer Lawsuit: Anatomic resection of lung cancer is the gold standard for treatment of early-stage NSCLC. Lobectomy has been shown to be superior to lesser resection even in patients with stage IA disease (T1N0) (Ginsberg and Rubinstein, 1995). Lesser resection, such as wedge resection or segmentec- tomy, is reserved for patients in whom anatomic resection would carry a prohibitive risk of complications. In patients unable to tolerate surgery, radiation therapy can also be used as primary treatment. Potential complications of radiation therapy include esophagitis and fatigue. Radiation- induced myelitis of the spinal cord is devastating; the risk of this complication can be minimized by careful administration of treatment. Three-dimensional radiation therapy may further focus the dose on the target area while minimizing radiation injury to surrounding tissues.
Most patients with advanced-stage NSCLC are treated nonsur- gically. However, some patients with advanced-stage disease may benefit from surgical resection. In deciding whether surgery is appropriate, the surgeon must balance the value of mechanical extirpation of the local disease (e.g., local disease control, pain relief, and the potential for improved survival) with the risks associated with a surgical procedure. Typically, the risks exceed the potential benefits and surgery is not considered; however, in some patients, surgery for advanced-stage lung cancer may provide benefit in the form of local tumor control, palliation of symptoms, improved quality of life, and the potential for improved survival. Surgery may also be used for palliation of the symptoms of advanced disease. Surgery along with laser ablative techniques and stent placement can be used to manage or relieve obstruction of the trachea or main-stem bronchi. We have shown that treatment of recurrent symptomatic pleural effusions with surgical placement of a chronic indwelling pleural catheter (Pleurx; Denver Biomedical Inc., Golden, Colorado) provides excellent relief of dyspnea and allows patients to function independently outside the hospital.
Concurrent chemotherapy and radiation therapy may be better tolerated and result in improved survival compared to sequential chemotherapy and radiation therapy. Patients with inoperable clinical stage HIA or IIIB disease and good pulmonary status and performance status should be treated with chemotherapy and radiation therapy. Trials of these modalities for patients with clinical stage IIIA NSCLC showed a modest but significant improvement in survival compared to survival after radiation therapy alone. An ongoing prospective multi-institutional trial is comparing chemotherapy, radiation therapy, and surgery versus chemotherapy and radiation therapy to define the role of surgery in improving local control beyond that obtained with radiation therapy alone. Although concurrent therapy may improve survival, this approach is associated with greater toxicity.
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Lung Cancer : Fever may result from pneumonia, or it may occur in the absence of frank infection in patients with postobstructive atelectasis. Chest pain commonly occurs in patients whose disease involves the pleura or chest wall. Hoarseness may result from vocal cord paralysis in patients with mediastinal disease affecting the recurrent laryngeal nerve; occasionally, patients with massive mediastinal disease may develop bilateral vocal cord paralysis, resulting in stridor due to upper airway obstruction. Patients with large right-sided central tumors may develop obstruction of the superior vena cava, resulting in a typical syndrome of swelling and venous distension of the face, neck, and chest wall, sometimes associated with shortness of breath, headache, and, in extreme cases, altered mental status.
Liver metastases occur frequently in patients with lung cancer, more commonly with SCLC than with NSCLC. The symptoms of hepatic metastases may include jaundice and right upper quadrant pain associated with the findings of hepatomegaly and liver tenderness on examination. However, these findings usually occur only in patients with very advanced liver disease. More commonly, hepatic metastases present with less specific symptoms, such as anorexia, malaise, and weight loss.
Another form of CNS metastasis from lung cancer is involvement of the spinal cord. This may occur in the form of spinal cord compression (usually due to direct extension of vertebral body metastases into the spinal canal), intramedullary metastases (relatively uncommon), or leptomeningeal seeding of the spinal canal. Spinal cord compression and intramedullary metastases are rarely asymptomatic and should be identified rapidly as they constitute neurological emergencies necessitating immediate treatment. About 90% of patients complain of back pain—either localized or radicular—as their first symptom. At diagnosis, about 75% of patients will note muscle weakness, and 50% will have associated sensory loss below the level of the metastasis. Bowel or bladder incontinence is another less common symptom of cord compression. On physical examination, patients with spinal cord compression typically have back tenderness at the site of metastasis. Other associated findings on physical examination may include sensory loss or paresis below the level of the metastasis, decrease in anal sphincter tone, muscle spasticity, and abnormal deep tendon reflexes.
The clinical evaluation of patients with suspected lung cancer generally includes routine laboratory work, consisting of a complete blood count (including a differential blood count and a platelet count) and a full set of serum chemistry studies. These laboratory tests may be useful indicators of possible sites of metastatic disease (e.g., elevated results on liver function tests or an elevated alkaline phosphatase level might direct the clinician to look for liver or bone métastasés, respectively).
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Lung Cancer Lawsuit: A dedicated CT scan of the abdomen is generally not required in the routine evaluation of lung cancer patients because the chest CT typically includes enough of the upper abdomen to permit evaluation for metastasis to the liver and adrenals. However, if the clinician’s index of suspicion of liver metastasis is high (e.g., if the chest CT suggests hepatic involvement or if the patient has unexplained elevation of the results of liver function tests), then a dedicated CT scan of the abdomen with a contrast agent is warranted to conclusively rule out liver metastases if this finding would affect the patient’s treatment.
In the “routine” staging of lung cancer, additional radiographic studies, including CT and MR imaging of the brain and bone scans, should be dictated by the circumstances of the case. Certainly, in patients experiencing neurological symptoms for which palliative radiation therapy or resection would be considered, CT or MR imaging of the brain is indicated. Similarly, patients experiencing bone pain for which palliative radiation therapy would be offered should have a bone scan with or without plain films. In addition to the roles of MR imaging in screening for brain metastasis and evaluation of suspicious adrenal enlargement, MR imaging also has a role in the preoperative evaluation of patients with superior sulcus tumors and patients with other potentially operable T4 lesions. The presence of chest wall or vertebral body invasion is often difficult to distinguish with chest CT alone. MR imaging of the chest is generally superior in this regard and is helpful to the thoracic surgeon in planning resection.
Positron emission tomography (PET) is able to characterize lung lesions reliably in most cases, failing to detect only very small lesions and tumors of a very indolent nature. PET may therefore play a role in the evaluation of patients with solitary pulmonary nodules. PET scanning is also a useful tool in documenting the presence of mediastinal lymph node metastases, with reported sensitivity and specificity of more than 90%. In this regard, PET is more accurate than CT scanning, although PET images lack the anatomic precision seen with CT scans. PET scans also have potential utility in detecting otherwise undetected widespread metastases in patients for whom curative resection is being considered. At this time, our recommendations regarding the optimal use of PET scans in the staging of lung cancer are still evolving.
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Lung Cancer: AH patients who are being considered for surgical treatment of their lung cancer should undergo complete pulmonary function testing, including analysis of the diffusing capacity of the lung for carbon monoxide and arterial blood gas analysis, to identify patients at increased risk of postoperative pulmonary complications of lung resection. Generally, patients with a forced expiratory volume in 1 second (FEVj) of greater than 2 L and a maximum voluntary ventilation of greater than 55% of predicted can tolerate a pneumonectomy A lobectomy is considered feasible in patients with FEVj of more than 1 L and a maximum voluntary ventilation of at least 40% of predicted. If results on routine pulmonary function tests are borderline, then a xenon ventilation perfusion scan and oxygen consumption studies may be done to further evaluate a patient’s suitability to undergo potentially curative resection of lung cancer.
Sputum cytology is a simple, noninvasive way to confirm cancer, but this approach is often nondiagnostic and is highly dependent on factors such as the location and size of the tumor with respect to the major airways and the patient’s ability to produce adequate sputum specimens. Thus, the yield with sputum cytology is less than 20% for patients with small peripheral lesions. The usefulness of sputum cytology is further limited by the necessity of a thorough head and neck examination to rule out head and neck primary lesions in patients in whom findings on sputum cytology are positive for squamous cancer.
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Lung Cancer Lawsuit: Flexible fiber-optic bronchoscopy is a useful tool for diagnosing suspected lung cancer, although this method is somewhat dependent on the size, location, and accessibility of the primary tumor. Endobronchial lesions that can be directly visualized are sampled with the use of biopsy forceps, washings, and brushings; the yield of bronchoscopy for such lesions is greater than 80%. More peripheral lesions may be sampled with transbronchial biopsy, washings, and brushings, with the diagnostic yield highly dependent on the size of the lesion. For example, the yield is about 25% for lesions smaller than 2 cm but may be as high as 80% for lesions larger than 4 cm. Submucosal tumors (e.g., small cell carcinoma) may be sampled with transbronchial biopsy as well.
Twenty to 30% of patients with lung cancer present with a solitary lung opacity on thoracic imaging. Assessment of morphologic features and growth rate can be useful in differentiating malignant from benign solitary lesions. However, often the nature of a solitary lung opacity cannot be determined with conventional anatomic imaging (radiographs and/or routine nonenhanced and contrast-enhanced computed tomography [CT] and magnetic resonance [MR] images). In such cases, the opacity can be further evaluated with dynamic contrast-enhanced CT or with positron emission tomography (PET) using a radioactive glucose analog, fluo- rodeoxyglucose F IS (FDG), the metabolism of which is typically increased in malignant cells compared to benign cells. Lesions with indeterminate etiology after comprehensive radiologic assessment are observed, biopsied, or resected.
Once a diagnosis of non-small cell lung cancer (NSCLC) has been established, the disease is staged according to the International System for Staging Lung Cancer. This system describes the extent of NSCLC in terms of the primary tumor (T descriptor), lymph nodes (N descriptor), and metastases (M descriptor). The T descriptor defines the size, location, and extent of the primary tumor. Because the extent of the primary tumor determines whether the disease will be treated with surgical resection or with palliative radiation therapy or chemotherapy, CT is usually used to assess the degree of pleural, chest wall, and mediastinal invasion. MR imaging has superior soft-tissue contrast resolution and multiplanar capability and is thus particularly useful in the evaluation of superior sulcus tumors.
Screening for lung cancer—efforts to detect lung cancer before symptoms develop—has been advocated as a means for improving the prognosis of patients with this disease. The concept is supported by 2 main observations; most patients with lung cancer have advanced disease at the time of clinical presentation, and the diagnosis of lung cancer at an early stage is usually associated with improved prognosis. However, the role of imaging in screening is not clearly defined.
Recently, there has been renewed interest in evaluating lung cancer screening, in part because of a belief that the older trials were flawed in design and methodology and also because of advances in radiologic imaging that have occurred in the interim (Kaneko et al, 1996; Strauss, 1997; Henschke et al, 1999). In particular, the advent of computed tomography (CT) has allowed detection of small lung cancers not apparent on conventional chest radiographs. Two recent small studies have confirmed that there is increased detection of small lung cancers when CT is used to screen patients considered to be at high risk for developing lung cancer (Kaneko et al, 1996; Henschke et al, 1999). In one of these studies, the Early Lung Cancer Action Project, low-dose helical CT was used to screen for lung cancer in 1,000 patients (Henschke et al, 1999). Lung cancer was detected in 2.7% of these patients with CT but in only 0.7% with chest radiography.
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Our use of the term or terms Lung Cancer and Lung Cancer Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.
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