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28 September 2018
Dr Kathryn Leask, MDU medico-legal adviser
Gynaecological cancers including ovarian, cervical, womb, vulval and vaginal cancer, kill 21 British women every day. September is gynaecological cancer awareness month with charities aiming to make women more aware of the symptoms to look out for such as abdominal bloating or abnormal bleeding and encourage them to visit their GP if they have concerns.
While vaginal and vulval cancers are rare, there are 3,000 new cases of cervical cancer a year. Ovarian cancer is also the leading cause of death from gynaecological cancer in the UK.
Diagnosing gynaecological cancers can be challenging as symptoms are often non-specific and can be similar to those of more common conditions, such as irritable bowel syndrome or anaemia.
In the MDU's experience of looking at 52 incidents reported to us involving ovarian cancer during the years 2014 to 2017, a common cause of complaints is an allegation of missed or delayed diagnosis. Patients and relatives are understandably upset if they believe their doctor missed an opportunity to ensure prompt treatment and if this in turn leads to a poorer prognosis. The findings from the incidents we examined included:
Dr Sharon Tate, Head of Primary Care Development at Target Ovarian Cancer, said: "Awareness of ovarian cancer among women and GPs is low. Just one in five women is able to name bloating as one of the main symptoms of the disease. Two-thirds of women are diagnosed once the cancer has already spread, and early diagnosis is crucial. At Target Ovarian Cancer, we work with GPs and GP practice nurses to make sure more women are diagnosed at the earliest possible stage by providing training tools, information on guidelines, and awareness resources."
Target Ovarian Cancer has two GP education modules available which contribute to CPD points. Visit www.targetovariancancer.org.uk/GP
Failure to diagnose cancer is not necessarily negligent but a claimant may have a case if they can show that a doctor's management fell below the expected standard, for example by not actively considering this diagnosis if a patient presents with persistent or frequent symptoms or failing to carry out the appropriate tests in a reasonable timescale.
Common symptoms reported in the incidents we reviewed included nausea, bloating including feeling full or having a distended abdomen, abdominal pain, lower back pain, urinary symptoms including dysuria and increased frequency, loose stools, reduced appetite and weight loss.
Alternative diagnoses offered included:
The NHS screening programme for cervical cancer covers women aged 25-64.
The MDU recently carried out research into the reasons for complaints against nurses from cervical screening. Although the numbers of complaints was small (23), a common theme was that patients felt they hadn’t been given enough information before and after screening and therefore hadn't properly consented. It's important that patients are provided with full information about cervical screening and allowed to ask questions.
There are steps that GPs can take to ensure that patients with a gynaecological cancer receive appropriate care and minimise the risk of an avoidable delay:
1 Ovarian cancer: Quality standard [QS18], NICE, May 2012 www.nice.org.uk/guidance/qs18
This guidance was correct at publication 28/09/2018. It 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.
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