When Missed Lymphoma Symptoms Become Malpractice in Oregon

Most swollen lymph nodes are harmless.¹ But when swollen nodes stick around, and they come with night sweats or weight loss, they can be a sign of lymphoma. When those signs are put down to a simple infection, a cancer diagnosis can be delayed. This article explains what the warning signs are, what a careful workup looks like, and how a delayed lymphoma diagnosis is evaluated under Oregon medical-malpractice law.

What lymphoma warning signs look like

The American Cancer Society describes lymphoma as "a cancer that starts in cells that are part of the body's immune system."² The most common symptom of Hodgkin lymphoma is one or more enlarged or swollen lymph nodes, which might feel like a lump or bump under the skin, often in the neck, underarm, or groin.³ Enlarged lymph nodes are also among the common signs of non-Hodgkin lymphoma.⁴ Nodes swollen from lymphoma usually do not hurt, though a node swollen from Hodgkin lymphoma may become painful after drinking alcohol.³⁴

Doctors also watch for a specific cluster called B symptoms. These are a fever that comes and goes without an infection, drenching night sweats, and unexplained weight loss of at least 10% of body weight over about six months.⁴ B symptoms matter because they can help doctors determine the stage of the lymphoma and the outlook.³ Other signs can include fatigue and shortness of breath or cough,⁴ and Hodgkin lymphoma can also cause itching skin.³

Here is the hard part for patients and doctors alike. Most enlarged lymph nodes are caused by an infection, not lymphoma.³ A node that swells because of infection often hurts when touched and returns to normal size after the infection goes away.³ A node that swells because of lymphoma might get bigger over time, and new lumps might appear.³ Many of these symptoms are much more likely caused by other problems, like an infection.³

When the workup should go further

A review in American Family Physician lays out a framework for sorting harmless swelling from something that needs a closer look. If malignancy is considered unlikely based on the history and physical exam, the review says a localized swollen node can be observed for four weeks.¹ Swelling that lasts less than two weeks, or that has been unchanged in size for more than 12 months, has a low likelihood of being cancer, although the review names exceptions, low-grade Hodgkin lymphomas and indolent (slow-growing) non-Hodgkin lymphoma, both of which typically have associated systemic symptoms.¹

But certain features raise the concern for cancer. The review lists risk factors for malignancy that include age older than 40, a node above the collarbone (the supraclavicular area), and systemic symptoms such as fever, night sweats, and unexplained weight loss.¹ It states: "Supraclavicular adenopathy in adults and children is associated with high risk of intra-abdominal malignancy and must be evaluated promptly."¹

The review's table of malignancy risk factors also includes swelling that has lasted "greater than four to six weeks" and a "Node not returned to baseline after eight to 12 weeks".¹ Fine-needle aspiration and core needle biopsy can aid in the diagnostic evaluation of lymph nodes when the cause is unknown or malignant risk factors are present.¹ After discussing imaging, the review states: "If the diagnosis is still uncertain, biopsy is recommended."¹

How Oregon defines the standard of care

The legal measure is the standard of care. For a physician licensed by the Oregon Medical Board, ORS 677.095(1) provides that the physician "has the duty to use that degree of care, skill and diligence that is used by ordinarily careful physicians in the same or similar circumstances in the community of the physician or a similar community."⁵ Subsection (2) sets a parallel duty for physician associates.⁵

Under that wording, the comparison is to what ordinarily careful physicians would do in the same or similar circumstances. For a missed lymphoma, the facts that bear on that comparison can include how persistent swelling was followed up, how B symptoms were handled, and whether imaging or biopsy was ordered when the risk factors described above were present.

A claim also has to show causation. In Smith v. Providence Health & Services, 361 Or 456 (2017), a case about a missed stroke diagnosis, the Oregon Supreme Court concluded "that a loss of a substantial chance of a better medical outcome can be a cognizable injury in a common-law claim of medical malpractice in Oregon."⁶ The court added that "when the lost chance is the injury in a medical malpractice action, the plaintiff still bears the burden to prove that, more likely than not, the defendant's negligence caused the plaintiff to lose the chance of a favorable medical outcome."⁶ Whether a particular delay made that kind of difference turns on the medical facts in the records.

Oregon's deadlines for a malpractice claim

Timing matters, and delayed-diagnosis cases raise a special timing problem, because a patient may not learn about a missed cancer until later. Oregon addresses this with a discovery rule.

ORS 12.110(4) provides: "An action to recover damages for injuries to the person arising from any medical, surgical or dental treatment, omission or operation shall be commenced within two years from the date when the injury is first discovered or in the exercise of reasonable care should have been discovered."⁷ In Gaston v. Parsons, 318 Or 247 (1994), the Oregon Supreme Court held that "injury," as used in ORS 12.110(4), "consists of three elements: (1) harm; (2) causation; and (3) tortious conduct." The court held that the period "begins to run when the plaintiff knows or in the exercise of reasonable care should have known facts which would make a reasonable person aware of a substantial possibility that each of the three elements (harm, causation, and tortious conduct) exists."⁸ For a missed lymphoma, that clock may not start on the day of the visit where the signs were dismissed. It may start later, when a reasonable person in the patient's position would be aware of a substantial possibility that the diagnosis was delayed by tortious conduct that caused harm.

There is an outer limit. The same subsection provides that, notwithstanding ORS 12.160 (which suspends some limitation periods for minors and people with a disabling mental condition), every such action must be commenced within five years from the date of the treatment, omission or operation on which it is based. That five-year period runs from the treatment date, not from discovery.⁷ If fraud, deceit, or a misleading representation is why the action was not filed within five years, the statute allows two years from when that fraud, deceit, or misleading representation is or reasonably should have been discovered.⁷ Because the treatment date and the discovery date can fall far apart, the specific dates matter.

Getting a case reviewed

Every lymphoma story is different, and the presence of B symptoms or a delayed diagnosis does not by itself mean a claim exists. Whether a particular delay fell below the standard of care, and whether it caused added harm, are questions that turn on the specific medical records and timeline. If you are worried that swollen nodes or B symptoms were dismissed and a lymphoma diagnosis was delayed, an Oregon attorney can review the records and the timeline with you.

This article is educational

This article describes Oregon law in general terms. It is not legal advice and does not create an attorney-client relationship.

Time limits matter. Most Oregon personal-injury and auto-accident claims must be filed within two years of the injury or accident. Medical malpractice claims must be filed within two years of when you knew or reasonably should have known of the negligence, with an outer limit of five years from the act itself (with a fraud exception). Wrongful death claims must be filed within three years of the date of death. Claims against public bodies (cities, counties, state agencies, public hospitals) require a notice of claim within 180 days. Missing these deadlines typically ends a case.

If you think you may have a claim, call Huegli Law at 971-317-6436 for a free case review. Todd Huegli is licensed in Oregon and consults on cases in Oregon only.

Footnotes

1. Unexplained Lymphadenopathy: Evaluation and Differential Diagnosis. American Family Physician. https://www.aafp.org/pubs/afp/issues/2016/1201/p896.html ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

2. Lymphoma. American Cancer Society. https://www.cancer.org/cancer/types/lymphoma.html ↩

3. Hodgkin Lymphoma Signs and Symptoms. American Cancer Society. https://www.cancer.org/cancer/types/hodgkin-lymphoma/detection-diagnosis-staging/signs-and-symptoms.html ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

4. Signs and Symptoms of Non-Hodgkin Lymphoma. American Cancer Society. https://www.cancer.org/cancer/types/non-hodgkin-lymphoma/detection-diagnosis-staging/signs-symptoms.html ↩ ↩² ↩³ ↩⁴

5. ORS 677.095 (Duty of care). Oregon Revised Statutes. https://www.oregonlegislature.gov/bills_laws/ors/ors677.html ↩ ↩²

6. Smith v. Providence Health & Services, 361 Or 456 (2017). Oregon Supreme Court. https://ojd.contentdm.oclc.org/digital/collection/p17027coll3/id/5926 ↩ ↩²

7. ORS 12.110 (Actions for certain injuries to person not arising on contract). Oregon Revised Statutes. https://www.oregonlegislature.gov/bills_laws/ors/ors012.html ↩ ↩² ↩³

8. Gaston v. Parsons, 318 Or 247 (1994). Caselaw Access Project. https://static.case.law/or/318/cases/0247-01.json ↩