Liver Cancer Diagnosis Delayed for 9 Months

This case involves a 64-year-old male patient admitted to the hospital for severe abdominal pain. A CT-abdomen done at this admission showed an ill-defined infiltrated mass in the interomedial portion of the right hepatic lobe within the gall bladder that was concerning for malignancy. The CT with contrast revealed several fluid collections near the liver and a possible abscess in the right lobe of the liver. Interventional radiology placed drains and infectious disease consulted for medication options. The patient was reassured and was told he only had gallstones and needed to return for an elective cholecystectomy. He began to self-medicate with homeopathic remedies, hoping that milk thistle supplements would help his liver recover on his own. Approximately 9 months later, the patient again had severe abdominal pain and experienced a syncopal episode. He was again worked up for all possible causes and it was at this point the delayed diagnoses of metastatic carcinoma was uncovered.

Question(s) For Expert Witness

1. Could the cancer have been diagnosed at the initial admission or shortly thereafter during his normal followup care?

2. Would the 9-month delay have made a difference in the prognosis?

Expert Witness Response E-000233

This patient's cancer could have absolutely been diagnosed earlier and from the summary, it seems like it was and the physicians managing this patient did not fully work up the patient to rule out an underlying malignancy. The original imaging reports stated that there was a mass "concerning for malignancy"; therefore it is the duty of the physician to treat this suspicious lesion as cancer until proven otherwise. The delay in making the diagnosis for a whole 9 months absolutely altered the outcome for the patient.