We often receive calls from potential clients who note that a loved one had pulmonary symptoms that were later diagnosed as lung cancer. The question asked is “shouldn’t an imaging study have been done that would have diagnosed the lung cancer sooner?”
Tragically, in most of those cases by the time there are common symptoms of lung cancer – persistent coughing and shortness of breath – it is often too late to prove causation. By the time the symptoms are present, metastatic spread of the cancer has often occurred and earlier diagnosis may have had little effect on treatment options or extending the patient’s life.
In many cases, the only viable case involves an imaging study, such as a chest x-ray or CT scan, done for a different purpose, but that by chance discloses a solitary lung nodule. In some cases, that early diagnosis can mean treatment – including surgery — to prolong the patient’s life and, in some cases, result in a cure.
There are three main types of lung cancer: non-small lung cancer, small cell lung cancer, and lung carcinoid tumor. The former comprise about 85% of lung cancers, and includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Small cell lung cancer, comprising about 15% of lung cancers, tends to spread very quickly and has a poor prognosis no matter when it is diagnosed. Many cases involve a very short time from diagnosis to death. The third category grows much more slowly, and comprises fewer than 5% of lung cancers.
Sometimes lung cancer is only diagnosed at a late stage because metastatic spread causes symptoms. It is not uncommon for a patient to experience mental changes that are then diagnosed as brain cancer that started in the lung. Treatment measures may be taken, but rarely will result in substantial extension of life expectancy.
Because so many lung cancers are related to cigarette smoke exposure, some ask why smokers and former smokers aren’t regularly x-rayed to see if there are symptoms present. Unfortunately, the costs – and risks – associated with serial x-ray exposure would not justify the relative benefits of diagnosing a few patients earlier.
