Case Study: Cancer Diagnostic Service (CDS) Expedites Next Steps in Care

Louise I. Schneider, MD, a member of the Cancer Diagnostic Service team, discusses next steps with a patient.

For clinically complex patients who present with signs or symptoms of cancer, the Cancer Diagnostic Service (CDS) at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) can expedite a diagnosis and avoid unnecessary testing and delays.

Case Study: CDS Diagnoses Patient with Metastatic Prostate Cancer

A 69-year-old man presented to his PCP with shortness of breath. A chest CT showed a large right pleural effusion, pleural nodules and possible metastatic disease in the liver. He was directed to his local emergency department for further evaluation. The evaluation was notable for the following:

  • Further imaging confirmed liver metastases
  • Exam was notable for prostate nodularity
  • Labs showed an elevated PSA (32) and anemia

The findings were suspicious for cancer—possibly two separate cancers—and the next steps were unclear. The patient was referred to the Cancer Diagnostic Service, where a multidisciplinary team of physicians:

  • Reviewed the patient’s records and imaging,
  • Examined the patient in the clinic,
  • Ordered a PET scan and MRI of the prostate, which revealed metastatic disease, highly suspicious for prostate malignancy,
  • Arranged for an IR-guided biopsy of one of the liver lesions, and
  • Referred the patient to thoracic surgery, who performed a pleural biopsy and a right PleurX™ catheter placement for recurrent pleural effusion.

The biopsy results were consistent with metastatic prostate cancer. The patient was rapidly referred to a genitourinary oncologist at the Dana-Farber/Brigham and Women’s Cancer Center to begin treatment.

Refer a Patient to the Cancer Diagnostic Service

If you would like to refer a patient to the Cancer Diagnostic Service, please call (857) 307-5775. Partners HealthCare physicians may also submit an Epic order to “Ambulatory Referral to DF/BWCC Cancer Diagnostic Service.”