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You are in: Home Page | Personal Injury | Medical Negligence Claims | Clinical Negligence Articles and Clinical Negligence Factsheets | Bowel Cancer

February 2010

Bowel Cancer

In the UK bowel cancer is the second most common cause of death, accounting for 10% of all deaths. Around 35,000 people are diagnosed with it each year. Early detection and treatment is therefore essential. Sadly not all cases of bowel cancer are diagnosed when they should be and this is where we can assist in securing compensation for the effects of the delayed diagnosis.

Bowel cancer is caused by changes to cells in the lining of the bowel, where the cells mutate and become abnormal or grow uncontrollably. Often malignant (cancerous) tumours develop from small, benign (non-cancerous) growths of tissue called polyps that can extend from the lining of the bowel wall. If the cancer is left untreated, it can grow through the wall of the bowel and spread to other parts.

There are certain risk factors which increase the likelihood of a person developing bowel cancer, these include:-

1. being over 60,
2. family history of bowel cancer,
3. history of polyps in the bowel (in particular the large bowel),
4. having a bowel condition such as Crohn’s disease or ulcerative colitis,
5. certain hereditary conditions.

As a result, the NHS now provides screening for all people aged between 60-69 years, and it is recommended that screening is done every two years.

Statistics show that the 5 year survival rate for bowel cancer that is detected at its earliest stage is 90% with complete cure being possible. Early detection and treatment is therefore critical for a good outcome. Any delay in diagnosis can therefore be very serious and in some cases have catastrophic results.

Symptoms and diagnosis of bowel cancer

To make a diagnosis of bowel cancer, the GP will usually start by taking a history of your symptoms and ask about any risk factors such as family history and diet.

Symptoms which should make the GP consider a diagnosis of bowel cancer include:

• A change in bowel habit.
• Blood or rectal bleeding (either bright red or very dark) in the stool
• Diarrhoea faecal incontinence, constipation, feeling the bowel does not empty completely, tenesmus (straining at stool) and passing mucus per rectum.
• Anorexia or Weight loss for no known reason.

Other symptoms may include stools that are narrower than usual, abdominal pain including frequent gas pains, bloating, fullness, or cramps, iron deficiency anaemia, lethargy and vomiting.

However, the above symptoms are often attributed to other conditions such as irritable bowel syndrome, which is a very common diagnosis.

It is therefore very important that the doctor takes a very detailed history and makes a meticulous note of the symptoms the patient is presenting with, the duration of the symptoms and their extent and severity.

If the GP suspects bowel cancer, he/she should start the investigations by carrying out blood and stool sample testing.

The GP may also perform a digital rectal examination, which will check for any lumps or mass inside the rectum.

If following these investigations the suspicion of bowel cancer is further confirmed, an immediate referral should be made to a Gastroenterologist. The referral should be within two weeks at the latest. Gastroenterologists have specific training in all endoscopic procedures and perform colonoscopies routinely. In addition, they are trained to recognize the endoscopic appearance of the various colonic diseases and can make important diagnostic and therapeutic decisions based on these findings

To confirm the presence of cancer in the bowel or rectum, a colonoscopy or sigmoidoscopy is performed by inserting a thin, flexible tube that is attached to a small camera into the rectum. This is used to view the rectum and/or whole bowel and even remove small samples of tissue for a biopsy. A barium enema examination, which is a detailed x-ray of the bowel, can also be used to confirm the presence of bowel cancer.

Types of mistakes which have led to delayed diagnosis or misdiagnosis

We are currently investigating a claim for a 63 year old woman who presented with rectal bleeding associated with bowel movement changes and anaemia for a period of eight months. She regularly sought medical advice, however no action was taken to investigate her symptoms.

Unfortunately the rectal bleeding was attributed to piles, which is another common mistake. The mistake was particularly concerning in this case as the GP simply accepted the patient’s explanation that the bleeding was due to piles. There was no previous reference to piles in the GP notes but the GP did not think to check whether the patient’s self diagnosis was correct.

As the client was over sixty, she received a bowel cancer screening kit via the post. She completed the test and sent it off. The results were abnormal and she was referred for a colonoscopy. The colonoscopy confirmed the cancer and unfortunately this had spread to other parts of the body.

In another case where we succeeded in obtaining damages, the client presented with symptoms indicative of bowel cancer, he was therefore referred for a barium enema x-ray. However there was a failure to identify the presence of the cancer on the examination. This led to a six month delay in diagnosis of the cancer.

When can a legal claim be made?

In order to make a claim for delayed diagnosis or misdiagnosis of bowel cancer, it is necessary to prove that the standard of care provided by the GP/clinician fell below the standard of care expected of a reasonably qualified GP /clinician.

The failure could be on the part of the GP, or the hospital doctors and clinical staff. The GP could fail to take notice of the symptoms of bowel cancer and therefore fail to perform any examinations which may lead to a diagnosis. Conversely, there may have been a failure to perform the standard tests or the clinician may have read the results incorrectly.

It is also necessary to show that the delay caused an adverse outcome. In most cases the delay has to be long enough to affect the outcome.

An Oncologist can map the stage the cancer would have reached at the time it should have been diagnosed and compare this with the stage at the time of diagnosis. He will then be able to look at the statistics for a cure and compare these at each stage. It is necessary to prove that the delay was the cause of the adverse outcome.

Generally the delay has to be in the region of 7 to 8 months to prove that the cancer has developed to the next stage.

Bowel cancer is graded as Dukes, A, B, C or D and each stage has a greater physical effect. If there has been damage to other organs, for example the bladder, because the tumour has pushed out of the bowel and put pressure on the bladder, then it is likely that a claim for compensation for delayed diagnosis of bowel cancer will be successful. The compensation in such a case would be for the more extensive surgery to remove the tumour and the bladder damage, which could result in permanent incontinence and the use of a catheter for the rest of the patient’s life. This clearly has an impact on quality of life issues.

If the delay has affected the chances of cure and survival, the compensation will include a sum to reflect this.

If you have experienced an injury similar to that described above, it is advised that you contact Thompsons solicitors for assessment of your Clinical Negligence case. You should contact Thompsons as quickly as possible due to the strict time limits in place to make a Clinical Negligence claim. If these time limits are not adhered to, the right to make a claim may be lost.