Fatal Cancer Goes Untreated Despite Suspicious CT Scan

This case involves a female patient who presented to a Kentucky hospital ER with difficulty breathing. Her condition stabilized after she was placed on several medications, however the patient later developed severe abdominal pain. As part of the evaluation of her status, a CT scan of the abdomen was ordered. The CT scan showed a suspicious mass in the patient’s abdomen. The radiologist communicated this finding to the defendant doctor immediately, however the defendant did not initiate any follow up. After several months, the patient presented to the hospital with continuing abdominal pain. A CT scan of the abdomen performed at the ER revealed several urological problems. The pathology report revealed the presence of aggressive cancer, and the patient was admitted for surgery shortly thereafter. Chemotherapy was recommended and the patient was discharged home in stable condition. The patient later presented to the hospital with increasing pain. A CT scan revealed extensive metastases in one of the patient’s major organs. She was discharged home and treating physicians recommended palliative therapy. She died several weeks later.

Question(s) For Expert Witness

1. Do you treat patients with the above presentation? If so, how often?

2. What is the standard follow up for a patient with a suspicious mass?

3. Could the cancerous bladder have been treated if it was confirmed at an earlier stage?

Expert Witness Response E-008939

I treat patients with this type of cancer on a daily basis. Eighty percent of my practice is oncology, and I constantly see patients who present with abnormal CT scans like the patient described in the case at hand. Standard follow-up for an undiagnosed mass would include timely referral to an urologist for cystoscopic evaluation as well as urine cytology. Delay in diagnosis of this type of cancer and delay in time to cystectomy have been studied and are associated with worse patient survival. It is possible that this cancer could have been treated if confirmed at an earlier stage. I would be happy to review this matter on behalf of the patient.