Bowel/Colorectal Cancer
What is it?
There are very many forms of cancer, which is the generic name given to a group of diseases which can occur virtually anywhere in the body. Cancers are growths of cells which proliferate uncontrollably, forming tumours. These cells possess identifiable abnormalities, and in some cancer types, the disease can spread (metastasise), causing the proliferation of still more cancer cells, with potentially catastrophic consequences. Cancers are identified both by structural features (e.g., "goblet cell carcinoma") and by the location in which they form - lung cancer is identifiable as such because it starts in one or both of the lungfields, even though these cancers often spread far beyond the lungs.
Colorectal cancer is a relatively common cancer in both men and women. Risk factors include age, a diet rich in fat and cholesterol, inflammatory bowel disease (especially ulcerative colitis), and genetic predisposition. The disease is associated with the presence of rectal polyps, which may become cancerous.
Patients suffering from the onset of this cancer usually present with one or more of the following symptoms:
- abdominal pain
- abdominal distension/ascites (i.e., fluid build-up in the abdomen)
- altered bowel habits
- pain on passing stools
- weight loss
- rectal bleeding (either red or black in colour, although a finding of bright red bleeding is more alarming. Because this finding is nearly always based upon the patient's own account, it can be quite a subjective factor, and some physicians have resorted to using colour charts to aid diagnostic accuracy. If you experience this, please do not suffer in silence - it is vitally important that you tell your GP!)
These are all fairly non-specific findings in themselves, but a cluster of these symptoms may indicate the presence of cancer. If a doctor suspects a patient to be at risk of colorectal cancer, he or she may decide to obtain a family history of colon cancer, polyposis (i.e., the development of numerous polyps), or ulcerative colitis. He or she may proceed to undertake a digital rectal examination, and/or refer the patient for diagnostic investigations including colonoscopy or flexible sigmoidoscopy. It is imperative for any GP presented with such symptoms to investigate and, if they persist or worsen, refer patients on to a specialist unit.
Provided that the disease is caught early enough, preferably before it spreads beyond the region of the colon, the prognosis may often be reasonably good. It is likely that surgery and chemotherapy will be needed. However, if matters are left for longer, the prognosis may be more worrying, not least because colorectal cancer cells can spread to the region of the liver. If this has occurred, far more radical surgery may be required and the prognosis is likely to be significantly worse.
How do we investigate the claim?
In order to win a bowel cancer claim, we need to prove that contemporaneous clinical guidelines were not followed (breach of duty), and that if they had been, then on the balance of probabilities the condition would not have developed (causation). It follows from this that we need to find out what was most likely to have caused the condition, and whether the relevant guidelines were followed.
In our experience, these claims often require at least two experts. In the majority of cases which come to us, the complaint stems from a significant delay in diagnosis by the treating GP or other primary care clinician. Assuming that this is the case, it is likely that we would need the input of an expert General Practitioner to investigate the issue of whether there has been a breach of duty of care. We would normally expect to ask the instructed expert whether the care was adequate and whether it was given within an acceptable timeframe: this latter judgement could well depend largely upon the symptoms the patient was experiencing, and also clinical picture he or she presented at the time: one might reasonably expect any GP to be concerned for a patient suffering from persistent rectal bleeding, weight loss over a period of months and altered bowel habits and severe abdominal pain.
In order to assess what damage has been caused by treatment given (causation), we would probably instruct an expert working in the field of oncology. Following a recent ruling in the case of Gregg - v - Scott (2005), the issue of proving causation in cancer cases generally has become considerably more awkward. In this case, an action for negligence against a GP was dismissed, even though a considerable delay in diagnosis of a cancer was admitted. This ruling was on the basis that the delay had not deprived the Claimant of the prospect of a cure, because, when he was misdiagnosed, he had less than a 50 per cent chance of survival anyway. In light of this ruling, it may well not be enough to prove that misdiagnosis adversely affected a given patient's chances of survival: rather, we would need to allege that had this misdiagnosis not happened, then the patient probably would have survived. For this reason, oncological reports on the issue of causation have necessarily become intricate documents, relying heavily on statistical data as well as the facts of the case. In these cases, we customarily go through the expert evidence adduced thoroughly, paying great attention to the statistical analyses provided and the academic studies cited.
Contact
Angelina Rigby Head of Clinical Negligence
Steve Duddell Partner
Nye Moloney Trainee Legal Executive
Jane Beresford-Huey Assistant
Angela Konstanz Assistant
Related Issues