Doctor Fails to Share Potential Liver Cancer Diagnosis With Patient

This case involves an elderly patient with a history of alcohol abuse and scar tissue on their liver. The patient underwent an ultrasound after feeling prolonged lower abdominal pain. The ultrasound revealed a large mass on the patient’s liver, but these results were never shared with the patient despite the fact that she called her doctor on multiple occasions. Several months later, the patient went for a follow-up ultrasound and was diagnosed with stage IV intrahepatic cholangiocarcinoma. Chemotherapy was instituted to shrink the tumor, but the patient passed away a few weeks later due to complications from the treatment. A gastrointestinal oncologist was sought to opine on the treatment protocol for patients with intrahepatic cholangiocarcinoma.

Question(s) For Expert Witness

1. What is the treatment for patients with intrahepatic cholangiocarcinoma?

2. Would an early diagnosis change the treatment / outcome for a patient with this disease?

Expert Witness Response E-056213

I am a gastrointestinal oncologist at a referral tertiary care center. I specialize in handling these types of tumors and other gastrointestinal malignancies. I am a lead investigator on one of the intrahepatic cholangiocarcinoma target which is a specific target in intrahepatic cholangiocarcinoma. I am also a lead investigator for a molecular study specific for cholangiocarcinoma.

I have given fellowship lectures and regional talks at the GI Symposium specific on cholangiocarcinoma, and have co-authored several publications on the subject.

Usually, test results should be given in person, not over the phone. The doctor should have documented that several attempts were made to reach out to the patient for a follow-up visit to discuss results and next course of action on how to evaluate the mass. What's more, the doctor could have referred the patient to a surgical specialist in a consultation after the result of the ultrasound.

A patient's treatment depends on stage and location of the tumor. If surgery is possible, then resection followed by possible chemotherapy (Adjuvant) or chemoradiation, all depend on what the surgical pathology (tissue after surgery) stage is. Locally advanced stage (not resectable but involved the liver only), treatment includes chemotherapy with Gemcitabine and cisplatin, or liver-directed therapy like yttrium 90 or TACE (Transarterial chemoembolization) or ablation. Stage IV, extrahepatic disease is treated with systemic chemotherapy. The first-line approved treatment is gemcitabine combined with cisplatin. In terms of early diagnosis changing the treatment for a patient with this disease, it all depends on stage and resecatability. It could be that the mass initially is surgically resected, or early chemotherapy intervention versus liver-directed therapy (embolization), could downstage (shrink) the tumor and this could lead to surgical resection (removal) of the tumor.