Failure to Diagnose Pancreatic Cancer

Evaluate breaches in the standard of care when determining Failure to Diagnose Pancreatic Cancer

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Loss of appetite
    Tiredness and fatigue for more than a few weeks
    Weight loss
    Dark urine or pale stools or jaundice
    Vague abdominal pain
    Black stools or blood from the rectum
    Vomiting bile or blood or ground coffee-like material
    Leg pain / swelling
    Symptoms not elicited / documented
    Answer unknown
    Why is this important?
    Symptoms are usually vague and non specific and thus contribute to delayed diagnosis.
    (2004) 2 CLGAHE 6 510-517

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Risk factors are useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.
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  • Was a physical examination performed? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.
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  • Which of the following diagnostic laboratory studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    Routine laboratory studies can provide important clues to diagnosis.
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  • Were serum levels of CA 19-9 obtained in this patient? Why is this important?
    Answer this question
    CA 19-9 levels correlate with cancer stage and therefore, can be used as a predictor of prognosis, overall survival and in monitoring treatment response to surgery and chemotherapy.
    (2013) 59 EDISMN 11 368-402

  • Which of the following diagnostic imaging studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    Imaging techniques currently used for the diagnosis and preoperative staging of pancreatic cancer include abdominal ultrasound (US), contrast-enhanced computed tomography (CT), Magnetic Resonance Imaging (MRI), MR Cholangiopancreatography (MRCP), Endoscopic Retrograde CholangioPancreatography (ERCP), and Endoscopic Ultrasound (EUS).
    (2013) 59 EDISMN 11 368-402

  • With which type of lesion did the patient present? Why is this important?
    Answer this question
    The precursors to pancreatic adenocarcinoma are cystic lesions, such as pancreatic intraepithelial neoplasia (PanIN), intra-ductal papillary mucinous neoplasms (IPMN), and mucinous cystic neoplasms (MCN), and solid pseudo-papillary tumors.
    (2013) 59 EDISMN 11 368-402

  • To which of the following specialists was the patient referred? (Choose all that apply) Why is this important?
    Answer this question
    Once a diagnosis has been made, and in many cases if a diagnosis remains unclear, referral to the appropriate specialists needs to be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized.
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  • Which of the following advanced investigations were performed to confirm the diagnosis of pancreatic cancer? (Choose all that apply) Why is this important?
    Answer this question
    Endoscopic Retrograde Cholangio-Pancreatography(ERCP), Magnetic Resonance Cholangio-Pancreatography(MRCP) and Endoscopic Ultrasonography (EUS) with biopsy are normally ordered by specialists to obtain definitive diagnosis and to confirm staging.
    (2013) 59 EDISMN 11 368-402

  • Which of the following advanced studies was performed to confirm the diagnosis of pancreatic cancer? Why is this important?
    Answer this question
    Endoscopic ultrasound (EUS)-guided FNA, has become the preferred method for tissue diagnosis. ERCP aids in tissue sample collection through forceps biopsy or brush cytology of the intra-pancreatic bile duct. A biopsy is indicated in unresectable disease to confirm the diagnosis and aid in decision making regarding chemotherapy and radiation therapy.
    (2013) 59 EDISMN 11 368-402

  • What was the result of the biopsy? Why is this important?
    Answer this question
    A tissue diagnosis is always needed in unresectable tumors (representing the majority of tumors) before chemo/radiotherapy.
    (2013) 59 EDISMN 11 368-402

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
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  • Which of the following did the cytology analysis reveal? Why is this important?
    Answer this question
    The goal of investigating the cyst is to identify pre-operatively those patients with pre-malignant or malignant disease who are appropriate candidates for pancreatic resection.
    (2009) 7 IJSURG 1 7-11

  • Was a biopsy recommended? Why is this important?
    Answer this question
    The American Gastroenterological association (AGA) guidelines have recommended FNA only for patients with unresectable lesions.
    (2013) 59 EDISMN 11 368-402

  • Was a staging work - up performed? Why is this important?
    Answer this question
    Pancreatic cancer is staged according to the most recent seventh edition of the American Joint Committee on cancer tumor–node–metastasis classification, which is based on assessment of resectability by means of helical CT.
    (2013) 59 EDISMN 11 368-402

  • Was treatment given to relieve obstruction in the patient with jaundice? Why is this important?
    Answer this question
    Endoscopic Retrograde CholangioPancreatography (ERCP) is currently utilized as a therapeutic modality for patients who present with jaundice due to tumor obstruction of the biliary system.
    (2013) 59 EDISMN 11 368-402

  • Was treatment provided according to the stage of the pancreatic cancer? Why is this important?
    Answer this question
    Choice and order of treatments vary depending on whether the disease is resectable, borderline resectable, locally advanced unresectable, or metastatic.
    (2013) 59 EDISMN 11 368-402

  • With which of the following adjuvant treatments was the patient treated? Why is this important?
    Answer this question
    The findings emphasize the need for universal use of postoperative adjuvant treatment with either gemcitabine alone or gemcitabine with 5-FU, based chemo-radiation, which is currently adopted as the standard of care.
    (2013) 59 EDISMN 11 368-402

  • Which of the following surgical techniques was followed? Why is this important?
    Answer this question
    The first-choice of treatment and the only chance for cure is surgical resection with pancreatectomy or pancreatoduodenectomy followed by adjuvant (post-operative) chemo radiotherapy.
    (2009) 7 IJSURG 1 7-11