The Penningtons Manches clinical negligence team has recently settled a claim against Portsmouth Hospital NHS Trust for a client whose ovarian cancer should have been diagnosed sooner.

The client initially presented to her GP with a one year history of intermittent lower abdominal ache. Her GP undertook an abdominal examination, which was normal, and arranged blood tests and an ultrasound scan. Her serum CA125 (a tumour marker) was raised at 61 IU/ml. A transabdominal and transvaginal ultrasound scan was therefore carried out and the report noted that gynaecological referral should be considered.

She was then seen in the gynaecology clinic at the Queen Alexandra Hospital which referred her for a hysteroscopy and endometrial biopsy but made no reference to the referral to the raised CA125 level and did not repeat a serum CA125 test. The procedure was carried out but the conclusion was that no follow up was needed. Those carrying out the procedure had no knowledge of the raised CA125 level.

A few weeks later, the client was reviewed by her GP who noted that, despite the clear hysteroscopy, her pain persisted. The pain was now worse when she opened her bowels, although she had no rectal symptoms or change in bowel habit. She had a history of pain down her right leg as well. A referral was made for a colonoscopy which was undertaken and reported to be normal.

The client’s abdominal pain continued and worsened. She also had pain in her right calf when walking. Eventually, a CT scan was carried out nearly six months after she was referred to the gynaecology clinic and this scan raised concern of gynaecological malignancy. A repeat CA125 also revealed a further raised level to 503 IU/mL. A month later, the client’s diagnosis of either stage III ovarian carcinoma or stage IV endometrial carcinoma was confirmed.

She underwent two courses of chemotherapy and it was noted that the overall appearance was of a good partial response. Unfortunately, a CT scan the following year demonstrated progressive disease.

After carrying out an independent clinical negligence investigation, it became clear that there had been a failure to consider the importance of the client’s raised CA125 levels at the outset. This should have been communicated to the surgical team who carried out the hysteroscopy. At this stage, another CA125 level should have been repeated which would have shown a further increase and led to an earlier diagnosis.

The defendant trust admitted that there was an opportunity to diagnose her cancer five months sooner and that she would have avoided the continued pain and suffering she experienced during the five month delay. Unfortunately, the defendant’s admission of liability was received very shortly after she passed away.

Emma Beeson, who handled the case and deals with claims for delayed cancer diagnosis, commented: “We are pleased to note that our client had received a letter from the trust which acknowledged that there had been failings in her care provided and an apology for these delays had been made. A settlement was negotiated on behalf of our client’s estate and we were able to bring the matter to a swift conclusion for our client’s family.

“I am satisfied to have concluded this matter for our client’s family who have suffered such a great loss. Our expert evidence showed that an earlier diagnosis would not have altered the outcome for our client in terms of her condition and prognosis but she would have avoided a five month period of unnecessary pain and suffering.

“The compensation her family has received will, of course, be no consolation for the loss of a very kind, warm and much loved lady but it is hoped that the compensation for her unnecessary pain will give her family a form of closure.

“It is also hoped that the trust will learn from this claim and reinforce the importance of communicating concerns regarding a patient’s CA125 level and repeating these tests to look for any increase in the level.