Delayed Diagnosis of Pancreatic Cancer

By the time her dad was really sick, and his doctor finally thought to get a CT scan, the tumor had grown past the head of the pancreas and was wrapping around the portal vein. A Whipple procedure was no longer an option. Dad started chemotherapy six weeks later. He died fourteen months after that.

The question we get, is some version of the same thing: Could this have been caught sooner? Would earlier treatment have made a difference?  Is there anything that can be done legally?

The answer to the first question is often yes. The answer to the second and third is: it depends on what the records show.

Pancreatic cancer is among the most lethal malignancies a person can face. Its window for curative surgery is narrow, and when that window closes because the right test wasn’t ordered or the right finding wasn’t followed up, the consequences are permanent. When that failure traces back to a doctor who should have known better, it may also be compensable.

This article is for patients and families who suspect that a delayed diagnosis made things worse — and want to understand what actually went wrong, and what their options are.

The Biology of the Disease — and Why Timing Is Everything

The pancreas sits tucked behind the stomach, largely out of reach of the physical exam. It has two functions that matter: it produces digestive enzymes (through its exocrine cells) and hormones like insulin (through its endocrine cells). Roughly 95% of pancreatic cancers arise from the exocrine cells, forming what pathologists call adenocarcinoma.

The disease is the third leading cause of cancer death in the United States. The American Cancer Society estimates approximately 64,000 new diagnoses and 51,000 deaths from pancreatic cancer in 2024 alone. The overall five-year survival rate hovers around 11%, a grim number.  But that low percentage masks the stark difference between Stage I disease (where surgical cure is genuinely possible) and Stage IV disease (where it almost never is).

That gap is the entire medical-legal story. Catch this cancer early, at Stage I or II, and a Whipple procedure may give a patient years. Catch it late and chemotherapy becomes palliative, not curative. The biology of the disease doesn’t forgive diagnostic delay.

What Doctors Are Supposed to Do With Key Information

Not every pancreatic cancer diagnosis represents a missed opportunity. A large percentage of the calls we get about delays in diagnosing pancreatic cancer end with us having to decline for one reason or another.  But certain patients carry documented risk profiles that should heighten clinical suspicion.  When a doctor ignores those profiles, it it may be the basis for a valid medical negligence claim.

The risk factors that matter most from a medicolegal standpoint are the ones that are present in the chart, visible to any clinician who reads it, and yet not acted upon:

• Age over 65, combined with any of the factors below, significantly elevates risk.
• Tobacco use. Smokers develop pancreatic cancer at roughly twice the rate of non-smokers. This is documented. It belongs in every chart.
• New-onset diabetes in a patient over 50 with no family history. This is one of the most underappreciated red flags in primary care. Pancreatic cancer can cause diabetes — not the other way around. A new diabetic workup that doesn’t include consideration of pancreatic pathology is a clinical gap.
• Chronic pancreatitis, particularly in heavy drinkers, substantially increases lifetime risk.
• Family history of pancreatic cancer, or known genetic mutations including BRCA2, Lynch syndrome, or familial atypical multiple mole melanoma (FAMMM) syndrome.
• Obesity with central/abdominal distribution.

The key question in any delayed diagnosis case isn’t just whether the doctor knew these risk factors existed. It’s whether the doctor did anything with them. Documented risk factors that triggered no workup, no referral, and no follow-up are one of the first issues we look for when we evaluate a case.

The Symptoms That Get Dismissed but Shouldn’t

One of the defense arguments we encounter most often is this: ‘The symptoms of pancreatic cancer are nonspecific, and no reasonable physician would have ordered a CT scan based on what the patient reported.” Sometimes that argument has merit. But sometimes it doesn’t.

The symptoms that matter , the ones that should trigger more aggressive workup when combined with risk factors, include:

• Jaundice (yellowing of the skin and eyes): When a tumor obstructs the bile duct, this is the result. Jaundice in an adult with abdominal complaints is a red flag that demands imaging. Full stop.
• Unexplained weight loss: When a patient loses 10, 15, 20 pounds without trying and without a clear explanation, that’s not stress. That’s a symptom.
• Persistent mid-epigastric or back pain: The pancreas sits near the celiac plexus. Pain radiating from the abdomen into the back, particularly in a patient with risk factors, warrants pancreatic consideration.
• Loss of appetite and early satiety: Common, easy to dismiss, and often overlooked in combination with everything else.
• New-onset diabetes (as above): Worth repeating here because it’s one of the most documented early manifestations of pancreatic cancer and one of the most consistently ignored.

In our experience, no single symptom usually triggers a negligence case. What triggers a case is the combination — a patient with three of these symptoms and two documented risk factors, presenting repeatedly over a period of months, and nobody ordered a scan.

How the Diagnosis Should Be Made / Where It Goes Wrong

The diagnostic pathway for pancreatic cancer is not complicated. When clinical suspicion is appropriate, the standard workup follows a logical sequence:

Imaging comes first. An abdominal ultrasound can identify biliary dilation and liver metastases. A contrast-enhanced CT scan of the abdomen and pelvis remains the workhorse.  CT can identify tumors as small as 1 to 2 centimeters, assess vascular involvement, and help stage the disease. For closer evaluation or biopsy guidance, endoscopic ultrasound (EUS) allows direct visualization of the pancreas and can be used to sample tissue.

Blood tests supplement imaging. CA 19-9 is a tumor marker that’s elevated in many pancreatic cancer patients. It’s not diagnostic by itself. But when it’s significantly elevated and the ordering physician files it away without follow-up, that’s a problem.

Where things go wrong, in our experience, is rarely one dramatic failure. It’s a sequence of smaller ones a domino effect: a symptom documented but not acted on, an incidental finding on an imaging report that wasn’t communicated to the patient, a CA 19-9 result that came back abnormal and never triggered a return call, a referral to gastroenterology that was recommended but never made.

The cases that haunt us most aren’t the ones where a doctor missed an obvious finding. They’re the ones where a flag was raised, documented in the chart but just didn’t act on.

What’s Lost When Diagnosis Is Delayed

Surgery is the only potentially curative option for pancreatic cancer, and it’s only viable when the tumor is localized and hasn’t involved major vascular structures. The Whipple procedure (pancreaticoduodenectomy) is the most common operation for tumors in the head of the pancreas; distal pancreatectomy addresses tumors in the body and tail; total pancreatectomy removes the entire organ.

When a tumor is caught early, resection rates run upward of 80 to 90% with curative intent. Five-year survival after successful Whipple resection of Stage I disease can exceed 30%. These are meaningful, realistic outcomes for patients whose cancer is found in time.

When diagnosis is delayed and the disease advances to Stage III or IV, chemotherapy becomes the primary tool. Regimens like FOLFIRINOX or gemcitabine/nab-paclitaxel can extend survival and manage symptoms, but they don’t cure. Targeted therapies like erlotinib and immunotherapy options exist for patients with specific molecular profiles, but the responses are modest.

The central causation argument in a delayed diagnosis case is this: had the diagnosis been made six, eight, twelve months earlier, would the patient have been a surgical candidate? Would they have had a meaningful chance at curative resection? Answering that question requires a detailed review of the tumor’s growth rate, the imaging timeline, and the expert opinion of a surgical oncologist or pancreatologist. It’s not a simple analysis but at Lupetin & Unatin, we know how to put this case together.

When a Delayed Diagnosis Becomes a Legal Case

Medical malpractice in Pennsylvania requires proof that a healthcare provider deviated from the standard of care and that the deviation caused the patient’s harm. In delayed diagnosis cases, the causation analysis runs through the increased risk of harm doctrine established in Hamil v. Bashline, 481 Pa. 256 (1978).

Under Hamil v. Bashline, when a defendant’s negligence increases the risk that a specific harm will occur and that harm later occurs, the plaintiff does not need to prove that the negligence was the sole or even the primary cause. The jury is permitted to find causation if the negligence was a substantial factor in bringing about the harm. In delayed cancer diagnosis cases, this matters enormously: the plaintiff need not prove that earlier diagnosis would have guaranteed survival, only that the delay substantially increased the risk of a worse outcome.

This is not a ‘loss of chance’ doctrine.  Pennsylvania courts have been clear on that distinction. It is an increased risk of harm framework, and it gives plaintiffs in these cases a viable path to recovery even when the cancer was, by nature, a difficult disease to beat.

The conduct that typically gives rise to a claim includes:

• Failure to work up a symptomatic patient with documented risk factors, particularly when those symptoms were reported across multiple visits.
• Failure to order imaging or tumor marker studies when the clinical picture warranted them.
• Misinterpretation of imaging: a radiologist who reviewed an abdominal CT and failed to identify or report a pancreatic mass.
• Failure to communicate abnormal test results to the patient, or failure to ensure appropriate follow-up occurred.
• Failure to refer to gastroenterology or surgical oncology in a timely manner after a finding was identified.

The defense in these cases almost always argues that pancreatic cancer is uniformly fatal regardless of timing. That argument has some force when the biology supports it, and it sometimes wins. But it doesn’t always reflect the clinical reality, particularly for patients who were resection candidates at the time of negligent delay and were not by the time of actual diagnosis. That’s the gap we focus on.

What These Cases Have Looked Like Around the Country

Results in prior cases don’t predict outcomes in future ones, every case turns on its own facts, its own expert opinions, and its own jury. But the following examples illustrate the range of what these claims can look like when they go to resolution:

A $1.8 million settlement involved a 69-year-old man whose physician failed to respond to significantly elevated CA 19-9 tumor marker levels documented in January 2018. By the time the cancer was treated in April 2019, it had become borderline resectable. He died in January 2020. The theory was straightforward: the marker was there, the physician saw it, and nothing happened.

A $1 million settlement arose from a radiologist’s failure to report a 4 to 5 millimeter lesion on an abdominal CT in April 2006. That lesion grew to nearly 5 centimeters by February 2007, a ten-month delay during which the patient received no treatment and no warning. The defense argued the outcome would have been the same regardless. The plaintiff argued that a 5mm lesion in a resectable location is a very different clinical picture than a 5cm locally advanced tumor.

A $300,000 verdict in a Pennsylvania case involved an emergency department radiologist who failed to identify a pancreatic mass on CT, attributing the patient’s severe back and abdominal pain to back strain. More than a year later, the patient was diagnosed with Stage IV disease that had spread to the liver. This verdict is instructive not for its size but for what the plaintiff overcame: a defense built on pre-existing health conditions and the argument that earlier detection wouldn’t have changed the outcome. The jury disagreed.

The Lupetin & Unatin Process

When we evaluate one of these cases, we’re asking a set of specific questions: Were there documented symptoms and risk factors present in the record before the diagnosis? Did the provider who saw those symptoms and risk factors have an obligation under the standard of care to do more? Is there a credible expert willing to say so? And critically, based on the tumor’s characteristics and the imaging timeline, was the patient likely a surgical candidate at the time of the negligent delay?

We take a limited number of cases, and we’re selective for a reason. Medical malpractice litigation is expensive, complex, and hard. We don’t take cases we don’t believe in. When we do take a case, we commit to it completely,  building it around the right experts, the right theory, and a trial strategy designed to make the standard of care failure undeniable.

If you believe a delayed diagnosis of pancreatic cancer cost you or someone you love an opportunity for curative treatment, we want to hear from you. The consultation is free. The evaluation is honest. And if we can help, we will.