Inadequate treatment of bladder cancer

Medical history

A woman in her early thirties was referred to a consultant urologist. She had noticed blood on the toilet paper after passing urine and some discomfort after urination. There was no frequency and no pain on micturition, but there was some pain in the right iliac fossa. No abnormality was found at examination, but an intravenous pyelogram showed a filling defect in the bladder.

At cystoscopy two weeks later, the urologist found two small solid tumours above the right ureteric orifice, which he resected. There was then no palpable mass. Histological examination showed that the tissue removed was a poorly differentiated carcinoma.

The urologist thought that the surgery might have cured the disease and follow-up cystoscopy three months later showed only scar tissue. A biopsy taken at this time was also negative. During examination under anaesthesia the urologist found a small palpable mass on the right that he thought was scar tissue.

Further cystoscopy proposed in another three months was postponed for a month. This showed no tumour in the bladder. There was, however, a mass in the right iliac fossa, which was knobbly and palpable per vaginam. Biopsy of this mass confirmed recurrence of the cancer. The patient was referred for computed tomography and was subsequently treated with chemotherapy and radiotherapy. Despite these treatments she developed recurrence in the lymph nodes and died just over a year later.

Negligence alleged

The patient's husband, who gave up work to look after his children, alleged that the urologist had been negligent in not managing his wife's cancer appropriately at the time of diagnosis and that this had reduced her chances of a cure and had resulted in her life being shortened.

Expert opinion

The MDU sought expert opinions from two consultant urologists and a consultant radiologist. They were of the opinion that while the urologist's diagnosis was correct, his standard of treatment had been inadequate. The patient's tumour was not adequately staged and she did not receive any adjuvant therapy after the initial surgery. Despite this, however, they thought that the patient's disease had probably metastasised at the time of presentation and that earlier treatment with chemotherapy and/or radiotherapy would probably not have made any difference to her survival.

The claim was settled on behalf of the urologist for a nominal sum because the patient had such a poor prognosis irrespective of the treatment she received.

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