Oncology Expert Evaluates Delayed Intervention for Pancreatic Cancer Patient

Joseph O'Neill

Written by
— Updated on October 27, 2017

Oncology Expert WitnessThis case involves a female patient with pancreatic cancer. The patient had an exam with the defendant for cold like symptoms. Some months later, the patient saw the defendant for pain in the abdomen that had persisted for several days. The patient was given a prescription for Prilosec and told to follow up in a few weeks if symptoms persisted. The patient saw the defendant again some months later for continued pain in the abdomen. At this point, the patient’s weight had been declining steadily, which was initially attributed to mismanaged diabetes, so she was switched to Onglyza. During this visit, the patient underwent a colonoscopy which was unremarkable, prompting her physician to order an abdominal CT scan. The scan revealed a mass on the patient’s pancreas, which was followed by a tissue biopsy to confirm malignancy. The tissue sample taken during the biopsy, however, consisted of largely healthy tissue. Additional testing also failed to reveal the presence of malignant cells, however the patient continued to lose weight. Eventually, a rebiopsy was ordered that discovered malignant cells, and the patient died shortly afterwards.

Question(s) For Expert Witness

  • 1. Is it possible the patient could have had an earlier diagnosis?

Expert Witness Response E-000029

I am highly qualified to review this case and glad to assist. If there were symptoms of pain and 21 lbs weight loss, a more extensive work up should have been performed and diagnosis established. I need to see the extent of metastatic disease when it first presented, when the diagnosis of pancreatic cancer was finally made, but it is likely that the delay of 3-4 months could have made the difference between stage IV and III. Unfortunately, the prognosis is poor in either stage. One can make an argument that the prognosis improved with new therapies. For stage IV it is a few percent. For stage III, 10-15 percent.

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