Delayed diagnosis of pancreatic cancer

20 June 2013

By Dimitra Dubrow, Principal, Medical Law Department, Melbourne

A 59 year-old man was referred in March 2010 for a CT scan of the abdomen and pelvis after presenting to his general practitioner with perennial discomfort.

Although the radiologist reported that there were no abnormalities and that the organs including pancreas were all normal, in fact, the film showed the presence of a 5 centimetre mass in the body/tail of the pancreas.  

In November 2011, the man returned to his general practitioner with a one month history of indigestion. He was referred for an ultrasound which revealed a large primary pancreatic tumour. However, the scan also revealed multiple liver tumours.  The pancreatic tumour was completely excised as were some of the liver tumours.  Chemotherapy followed but in September 2012, metastatic spread to the lungs was diagnosed. The possibility of liver transplant was no longer on the table and the man's condition was diagnosed as terminal. 

As a result of the limited life expectancy, the claim was expedited. The live issue in the case was whether there had already been spread to the liver as at March 2010. The defendant's argument was that regardless of the timing of the diagnosis, the outcome would have largely been the same because liver metastasis would have been present as at March 2010. 

The plaintiff's evidence was that the primary pancreatic cancer could have been completely resected, as it indeed eventually was. Had this occurred in around March 2010, at a time when there was no evidence of metastatic spread, there would have most likely been a complete cure with little possibility of disease recurrence.  

This sad case resolved, but it demonstrates that even in cases where there is agreement that a cancer should have been diagnosed earlier, a plaintiff will have to establish that the delay has had consequences and caused injury which would have been avoided.