Gastroenterology Expert Discusses Critical Delay in Pancreatic Cancer Diagnosis

This case involves an elderly female patient in Wyoming who developed pancreatic cancer following an alleged delay in it’s diagnosis. The patient first presented to her primary care doctor with complaints of stomach pain, nausea, and cramps. She was treated conservatively at first with medication, however over the next month her condition continued to deteriorate. She eventually developed symptoms of vomiting and diarrhea and was referred out to a gastroenterologist for further treatment and examination. The gastroenterologist performed an endoscopy as well as a colonoscopy, however no suspicious findings were disclosed. Nevertheless, her symptoms persisted and she started to lose weight. She continued on for further evaluation and treatment, however she was turned away. It was eventually discovered that she had developed spindle cell carcinoma of the pancreas which had spread to her lungs, allegedly while she continued to seek treatment.

Question(s) For Expert Witness

1. Please discuss your background in treating patients as described in the case summary.

2. What is the standard work up when a patient presents with symptoms as described in the case summary?

3. What could have been possibly done for the patient to avoid this outcome?

Expert Witness Response E-007577

As a gastroenterologist at a major medical center, I can speak to the work-up of persistent abdominal pain, weight loss, as well as nausea and vomiting. I have diagnosed patients with pancreatic cancer, and there are a few different kinds of presentation depending on the location of the tumor. Abdominal pain, vomiting, and diarrhea are very common symptoms seen in many of my patients. The development of unexplained weight loss is more concerning than these previous symptoms, and abdominal imaging would be the next step if both the EGD and Colon were negative. Depending on the time frame, the tumor may have been detected prior to spreading. Earlier detection would have allowed for chemotherapy, and possibly surgery, which could have improved the patient's outcome.