Delayed diagnosis of esophageal cancer

Esophageal cancer is a devastating diagnosis, partly because this cancer is often diagnosed at a late stage.  By this time, the cancer has spread to lymph nodes or other parts of the body outside of the esophagus.  Sadly, people diagnosed with esophageal cancer often face a poor prognosis.

Missed Opportunities – Identifying Those at Risk for Delayed Diagnosis

But there are still ways doctors can and should get ahead of esophageal cancer before it is too difficult to contain.  Physicians are expected to know which patients are at risk for developing esophageal cancer and perform testing to catch the disease before it is too late.

The most common type of esophageal cancer is known as adenocarcinoma.  Cases of esophageal adenocarcinoma have risen sharply around the world in recent years. The significant increase in esophageal adenocarcinoma is partly related to a rise in two common medical conditions – obesity and gastrointestinal reflux disease, a.k.a. GERD.[1]

Esophageal adenocarcinoma can develop quickly. [2] Therefore, it is critical for doctors to follow medical guidelines which can help identify esophageal cancer as early as possible in patients most at risk.  By following these guidelines primary care doctors can attempt to control GERD and other risk factors which increase a patient’s risk for esophageal cancer.

Failure to Screen for Barrett’s Esophagus

The focus of a potential lawsuit involving the delayed diagnosis of esophageal cancer will typically begin before the patient was diagnosed with cancer.  Specifically, we focus on whether health care providers properly screened and evaluated at-risk patients for a condition known as Barrett’s Esophagus.

Barrett’s Esophagus is a common condition among patients with obesity and GERD.  In Barrett’s Esophagus, the cells lining the lowest part of the esophagus are replaced by cells typically located in the stomach or intestine.  Barrett’s Esophagus has a color and texture distinct from normal esophageal tissue.  Doctors inspect the esophagus for signs of Barrett’s Esophagus during a scope procedure called upper endoscopy.

Atypical cells associated with Barrett’s Esophagus can transform into esophageal cancer.  Doctors around the world understand that containing esophageal cancer begins with identifying patients with Barrett’s Esophagus, testing for signs of precancer cells (dysplasia), and performing surveillance to find esophageal cancer as early as possible.

How we Investigate a Case Involving Delay in Diagnosis of Esophageal Cancer

While gathering the medical history for the cancer patient, our team at Lupetin & Unatin will start by answering the following questions:

• Was the patient screened for Barrett’s Esophagus by performance of an upper endoscopy? If so, did the patient have Barrett’s Esophagus prior to the diagnosis of esophageal cancer?
• If no doctor screened the patient for Barrett’s Esophagus, did the patient have multiple risk factors for Barrett’s Esophagus such as age > 50, obesity, GERD, male sex, relevant family history, or hiatal hernia which should have triggered screening?

Missed Steps, Miscommunication, and Lack of Monitoring Lead to Delays in Diagnosis of Esophageal Cancer

During an endoscopy which reveals Barrett’s Esophagus, physicians should obtain small samples of the abnormal tissue.  This procedure is called a biopsy.  Physicians must follow strict guidelines while performing and interpreting biopsies.  Potential medical errors during this part of the screening for esophageal cancer might include:

• Failing to take the required number of tissue samples;
• Misinterpretation of the biopsy tissue; or,
• Miscommunication of the pathology results 

Depending on the results of the biopsy, doctors may need to recommend repeat endoscopy with biopsies at regular intervals.  Medical guidelines set forth the specific intervals for repeat endoscopy and biopsy, depending on the extent of Barrett’s Esophagus found on the initial endoscopy. When a doctor reads the report of a biopsy positive for dysplasia or esophageal cancer, the doctor should make sure a specialist evaluates the patient and schedules a procedure to remove the precancer or cancer from the esophagus.  Potential medical errors which could lead to delay in the early diagnosis or treatment of esophageal cancer include:

• Failure to offer ongoing surveillance of Barrett’s Esophagus and discuss the risks and benefits with the patient; and,
• Failure to repeat upper endoscopy with biopsies for known Barrett’s esophagus at the proper time interval.

If you or a loved one has battled advanced esophageal cancer, and you feel a doctor failed to take steps which could have led to diagnosis at an earlier stage, we may be able to help.  We will listen to your story and do our best to identify when and how doctors missed an opportunity for an earlier diagnosis. The law firm of Lupetin & Unatin will help you understand what you should do and if we feel a lawsuit is warranted.

^[1] Joseph, A, Raja, S, Kamath, S, Jang, S, Allende, D, McNamara, M, Videtic, G, Murth, S, Bhatt, A., Esophageal adenocarcinoma: A dire need for early detection and treatment, Cleve Clin J Med., May 2022, 89(5), 269-279.

^[2] Stachler, M, Taylor-Weiner, A, Peng, S, McKenna, A, Agoston, A, Odze, R, Davison, J, Nason, K, Loda, M., Leshchiner, I, Stewart, C, Stojanov, P, Seepo, S, Lawrence, M, Ferrer-Torres, D, Lin, J, Chang, A, Gabrial, S, Lander, E, Beer, D, Getz, G, Carter, S, Bass, A., Nat Genet., 2015 September ; 47(9): 1047–1055