'Sporadic' rectal carcinoma

A patient diagnosed with piles turned out to have a slow-growing cancer

A 32-year old journalist brought a claim against his GP for an alleged delay in the diagnosis of rectal carcinoma.

Solicitors acting for the patient served a letter of claim, alleging that his GP, an MDU member, had failed to heed his rectal bleeding and altered bowel habit. They said there had been an 18-month delay before the correct diagnosis was made, leading to anterior resection, radio- and chemotherapy – treatment that would have been unnecessary if the cancer had been diagnosed on first presentation. Eighteen months earlier, it was alleged, the cancer would have been a simple polyp and snare endoscopy could have excised it completely.

The MDU investigated the claim for the member, obtaining expert opinion from both a GP expert and a colorectal surgery expert.

The MDU's GP expert was supportive of the doctor's management. A year earlier, the claimant had experienced similar symptoms and piles had been noted on proctoscopy. Subsequently the GP had obtained a history of isolated rectal bleeding alone, no other red flag symptoms, and had reasonably considered the claimant was suffering from a recurrence of piles. The doctor disputed the fact that the claimant described altered bowel habit during the consultation. He would have specifically enquired about this, recorded it in the contemporaneous records and managed matters differently if there had been a reported alteration.

The GP expert considered that, given the patient's young age and apparent lack of red flag symptoms, the doctor's diagnosis was reasonable. Furthermore, the doctor had adequately safety-netted in asking the patient to return if his symptoms persisted. In the year following the consultation, the claimant had attended the surgery on a number of occasions about other health issues, but had not mentioned any persistence of rectal bleeding or other bowel symptoms. Breach of duty and liability were formally denied.

The colorectal surgery expert was asked to give an opinion on whether the claimant would have avoided complex treatment with an earlier diagnosis. The expert noted that the clinical features of the case included histology demonstrating no evidence of polyposis or features associated with microsatellite instability. The expert advised that it was most likely that the claimant's cancer fell into the 'sporadic' group of colorectal tumours and would have been slow-growing in nature, developing over many years. This meant that, on the balance of probability, 18 months earlier there would still have been an established carcinoma, requiring an anterior resection. However, at this stage the patient would not have needed post-operative radiotherapy and chemotherapy.

Adult claimants have three years following the date of the alleged negligent act or knowledge thereof in which to bring a formal medical negligence claim. This deadline fell shortly after the MDU served a denial of liability and there was speculation regarding whether the claimant would go forward with the case, despite our robust denial. Ultimately, we were advised that the claim had been discontinued and the doctor was very relieved with this outcome.

Dr Lucy Baird
Senior medical claims handler

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