Case Archive
 
Oncology
Ref. # 70948

A 56 year old North Carolina man complained of urinary difficulties. He was noted to have an enlarged prostate, with probable benign prostatic hypertrophy. A PSA was done one month later, reading 17.9 (a normal reading is 0-4). The doctor stated he would perform an ultrasound but did not. Two years later a PSA was 33. A needle biopsy revealed adenocarcinoma. A bone scan revealed metastasis to the ribs, which was confirmed by a rib biopsy. The patient was required to have an orchiectomy. A medQuest oncologist reported the cancer should have been diagnosed when its symptoms were first reported. When initially examined, the patient was at Stage 2B with no metastasis. Prompt treatment would have yielded a 10-15 year survival rate of at least 60%. The unwarranted two-year delay in diagnosis left the patient with only a five-year survival rate of 15%.

Oncology
Ref. # 56808

A 57 year old Ohio man began seeing his internist approximately twice a year for hypertension and gout. Four years later he complained of blood in his stool. A stool hemoccult test was negative; no further testing was done. The symptom continued for another four years, when the patient consulted another physician, who investigated the etiology of the rectal bleeding. Colonoscopy revealed a large cancer 40 cm from the anal verge. Abdominal CT scan showed an enlarged left adrenal gland. The patient underwent an adrenal resection and partial colectomy. A Stage C2 colon carcinoma which invaded through the muscularis and into the adventitial fat was resected. Two large lymph nodes were also removed. Treatment included adjuvant chemotherapy. A medQuest oncologist opined the internist negligently failed to find the cause of the patient's rectal bleeding. Had the cancer been identified three years into his care or earlier, the tumor would have been discovered at an earlier stage, Duke's A or B. The delay caused the tumor to progress to a Duke's C stage with involved lymph nodes and resulting in an increased risk of harm because of a decreased chance of cure.




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