GPs Miss 2,000 Bowel Cancer Tumours Every Year

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The Law Of... receiving the correct diagnosis

A report by University College London and Cancer Research UK has suggested that GPs are routinely missing some of the main red flags of bowel cancer, which include weight loss and abdominal pain.

The Law Of... receiving the correct diagnosis

It is claimed that every year, 2,000 bowel cancer patients could have been diagnosed earlier.

With one fifth of bowel cancer sufferers diagnosed at A&E previously being sent away by their GP, Justin Glenister – Senior Associate for Simpson Millar's Medical Negligence team – explains a recent case he handled, which saw a client receive a late diagnosis for colorectal cancer.

NICE Guidelines

The National Institute for Health and Care Excellence (NICE), a public healthcare watchdog, produced guidelines for GPs to help spot symptoms of bowel cancer.

These guidelines included the advice that:

"In patients aged 40 years and older, reporting rectal bleeding with a change of bowel habit towards looser stools and/or increased stool frequency persisting for 6 weeks or more, an urgent referral should be made."

Justin's client met these requirements, but did not receive an urgent referral despite seeing three separate GPs. It was only on a visit to a fourth GP, almost a year after her first appointment, that the patient received her urgent referral.

History Of Abdominal Issues

Our client had a history of irritable bowel syndrome (IBS), suffering with the condition since 2006. She had been referred to see a dietician in January 2007 and had presented symptoms again in April 2009.

In February 2012, our client suffered worsening faecal incontinence associated with loose stools. She had a rectal examination which found a "mild swelling". Taking that finding together with the history of her symptoms; her age and; the family history of bowel cancer, which has been documented on a number of occasions in her medical records, the GP at that time should have made a referral for further investigation by a gastroenterologist surgeon.

On a further deterioration of symptoms, our client had an appointment with a different GP at the same practice on 29th May 2012.

In this instance, there was no rectal examination, as the GP looked to rely upon the results of a bowel screening tests in February, which would not have detected anal cancer; as a result, no referral was made. The GP diagnosed our client with an impacted bowel and prescribed Senna tablets, which made the problem a lot worse.

If the GP at this appointment had followed NICE guidelines, there should have been a suspicion of cancer and an urgent referral.

In September 2012 the symptoms had continued and our client presented to a third GP. Despite her history and the persisting issues with abnormal bowel movements, no further examination or referral was made.

Almost a year after her first appointment, in January 2013, our client was seen by a fourth GP about her persisting symptoms. Once again, an urgent, 2 week referral was mandated and this time was finally agreed with the patient.

Despite the requirement to make an immediate referral, so that the patient would be seen within two weeks, a faxed referral was only made some three weeks later.

Failure To Make An Appropriate Referral

Our client was diagnosed on the 21st March 2013 with an anal tumour: T3 N0 M0, AJCC stage II.

But for the failure to make an earlier referral:

  • The staging of the cancer would likely to have been T1 or T2N0, AJCC stage I;
  • The patient would have received her treatment in the first half of 2012;
  • The cancer would probably not have advanced and spread outside the bowel (as was found on a subsequent MRI scan in April 2013);
  • The patient’s chances of complete response to treatment and cure would have been improved;
  • There would have been less risk of recurrence and spread and;
  • The patient would not have endured 13 months of (often unbearable) symptoms related to her untreated cancer

Discussing the case, Justin says:

"I see an increasing number of cases relating to late diagnosis of all types of cancer and it is often emphasised as a difficult diagnosis to reach in primary care."

"However, there is no requirement of the GP to conclusively diagnose the condition – he/she need only have a reasonable suspicion of cancer and, in addition to their years of training, they have very clear guidelines on what that may look like. I am therefore often dumfounded by inexplicable and indefensible instances of care, such as those provided to my client in this case."

Describing her experiences, our client adds:

"When the cancer was finally diagnosed and I was over the initial shock, I felt very angry at the way I had been treated by the GP surgery. I decided to seek compensation and called three firms who advertised this service, all three said that they couldn’t take it on and it appeared that I had no claim."

"Friends advised me that, even if I found someone to take on my claim, it would take years to settle and that I would have to attend court."

"I was ready to forget the whole idea when I was advised to call Justin and his Firm accepted my case. I came to feel that I had a friend in him and that he empathised with me. Justin worked very hard on my behalf and helped to bring about an out of court settlement."

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