Cancer not present at first presentation

The patient was first seen in the Royal Berkshire and Reading Hospitals NHS Trust when he was still a teenager. He complained of left-sided testicular pain and, on examination, he was noted to have a right epididymal cyst.

Four years later, in 2002, the patient went to see his GP, a member of the MDU, about a scrotal lump. After careful examination, the GP concluded that the lump was separate from the testicle as he was able to roll his fingers around it. He further concluded, following examination, that both testes were normal in nature. As there was nothing sinister about the lump, the doctor reassured the patient and told him to come back for further examination if he was still concerned.

In August 2004, the patient attended the surgery again, complaining of gastric problems. He was examined by one of the GP's partners, who found a large abdominal mass and referred the young man for an urgent abdominal ultrasound scan. A testicular ultrasound was also performed which revealed a 1.5 x 2.8 cm mass in the right testis. A right orchidectomy was subsequently performed.

Unfortunately, despite undergoing further surgery and chemotherapy, the patient's condition gradually deteriorated and he later died.

Prior to his death, the patient had started proceedings against the GP, alleging negligence in failing to refer the claimant for a testicular ultrasound when he was first examined in 2002. It was alleged that had he done so, the young man's cancer would have been diagnosed sooner and treated by orchidectomy at a much earlier stage, thereby curing him of the illness.

MDU response

 

The MDU obtained expert evidence from a general practitioner who was of the opinion that when the claimant initially saw his GP, the location of the pathology was not in the substance of the testicle itself. It was therefore reasonable, he said, for the doctor to reassure the claimant and not to refer for ultrasound.

An oncologist, instructed to provide expert advice on the causation aspects of the case, stated that as the lump was an aggressive cancer when it was diagnosed, it was highly unlikely that it would have been palpable some 22 months earlier at the initial consultation. The expert also thought that had an ultrasound been performed shortly after the time of the initial consultation, it would not have revealed any tumour within the substance of the testicle.

The MDU also obtained evidence from a consultant urologist who thought that, on the balance of probabilities, the claimant was suffering from a benign para-testicular lesion rather than a testicular cancer when he first saw his GP.

Outcome

The case proceeded to trial in the Royal Courts of Justice where the judge, after carefully weighing the evidence of both parties in this sad case, rejected the allegations of negligence against the GP which asserted that he had not carried out a thorough examination and that his clinical record had been substandard. She also rejected allegations that the doctor had failed to consider a testicular tumour as part of his differential diagnosis.
 
The judge found that the GP had carried out a thorough examination and identified an extra-testicular lesion, and it was therefore acceptable not to have referred the claimant for ultrasound. The judge said that she was not persuaded that ultrasound examination would be likely to have identified the tumour which ultimately developed.

In summing up, the judge said: "[This] is a tragedy, but in my judgment (the claimant's) untimely death was not caused by any negligence on the part of this defendant."
 
The claim was dismissed. The MDU was able to recover the legal costs incurred in defence of this case.

This page was correct at publication on 06/12/2010. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.