Mrs H received treatment for cervical cancer in 2009 but she subsequently developed diarrhoea, abdominal pain and bloating and was referred for investigations to determine whether there was a recurrence of the cervical tumour.
A CT scan of the abdomen and pelvis in early 2010 was reported as showing some free fluid within the pelvis but no other significant abnormality. It was noted that Mrs H opened her bowels whenever she passed urine but it was concluded that these bowel changes were secondary to radiotherapy.
Mrs H continued to suffer with bloating and a feeling of fullness after eating which was noted at her oncology outpatient review during the summer of 2010 and also by her GP. A further CT scan of her abdomen and pelvis was carried out in October 2010 and Mrs H was subsequently referred by oncology to gastroenterology. It was noted that she was extremely thin and had ongoing abdominal pain. Although there was no evidence of malignant cells on testing, plans were made for her to have a colonoscopy. The colonoscopy was converted to a sigmoidoscopy and was carried out in March 2011. The diagnosis was radiation colitis.
At a review at the oncology outpatients clinic later in March 2011, Mrs H was noted to be “Unwell, cachectic” and arrangements were made for a repeat abdominal and pelvic CT scan. The scan was performed in April 2011 and was reviewed at the gynaecology cancer MDT meeting in May 2011. It was noted that the CT scan showed “ascites in pelvis. Large mass looks like colonic cancer. To have a sigmoidoscopy…To be discussed at colorectal MDT. Looks as though may obstruct.”
The findings of the CT scan were discussed at the colorectal MDT meeting and summarised as showing “…a mass arising from the left pelvic side-wall producing extrinsic compression of the sigmoid colon…On review of previous CT scans this mass was not present on her scan last March but with hindsight was probably developing on her more recent scan approximately 6 months ago…We agreed that in the first instance we should attempt a CT guided biopsy of this mass…”
Mrs H was admitted to East Surrey Hospital as an emergency on 31 May 2011 with a bowel obstruction. Endoscopic stent insertion was attempted but was unsuccessful and Mrs H underwent laparotomy. By 5 June 2011 Mrs H was failing to make progress in recovery and she had persistent vomiting associated with retraction of the stoma. She was taken back to theatre to undergo a re-laparotomy but died that day.
Having obtained and reviewed Mrs H's medical records and independent medical expert opinion, it was clear that Mrs H had two tumours, the first being a mass in the sigmoid colon and the second being a mass in the gastrohepatic space which was a form of GastroIntestinal Stromal Tumour (GIST).
The medical opinion obtained was critical of Mrs H's treatment in that both tumours were diagnosed late. However, the delay in diagnosis was not responsible for Mrs H's death, which unfortunately could not have been avoided. The delay in diagnosis of the GIST tumour did, however, have an impact upon Mrs H's symptoms and quality of life and, in particular, caused her unnecessary pain, suffering and loss of amenity in the period leading to her death. The delay also meant that she and her family had little time to come to terms with her diagnosis before her deterioration and death.
A claim was presented to the trust which responded with an admission of its breach of duty in failing to identify the GIST tumour earlier but denied that this had affected Mrs H at all. After negotiations, however, the claim was settled on the basis of the increased pain and suffering experienced by Mrs H prior to her death that would have been avoided with a prompt diagnosis and management. The claim was settled prior to the issue of court proceedings.