Why was cancer not spotted?

troubleinparadise

What a sad story for your friend, and for you facing losing him.

I often feel that with hindsight it is so obvious - all the pieces of the jigsaw puzzle are there, and finally fit together.

Sometimes though until you get several pieces of the jigsaw all in one place, and perhaps a fresh eye looks at them, joining them up is not so easy.

Your friend presenting with individual seemingly innocuous symptoms over a period of time to possibly different doctors might not flag up any alarms. That he had a history of cancer that was apparently successfully treated was perhaps overlooked, and a doctor with experience in that area might have been suspicious, but again might have dismissed it.

But I do agree with your stance on fighting your corner - if you feel that something is being overlooked or not taken seriously, then you should keep at it, even in the face of medical scepticism.

I have been in situations where my instinct was that something was very badly wrong, stuck by my guns and was proven right ultimately. In one case it involved bacterial meningitis - that my daughter lived was luck, not judgement.

Continue being a good friend, and use your anger for good, perhaps charity fundraising.

Person_one

Unfortunately, brain tumours are still one of the most commonly missed or misdiagnosed cancers. My dear friend died of one just four days after her diagnosis. The symptoms are often vague and more easily explained by less serious causes, unfortunately.

Have a look around the 'brain tumour charity' website, I can't post a link from my phone but there should be information, support, fundraising if you might be interested in that, and I believe there's an awareness campaign aimed at GPs.

cookie_monster

Sorry to hear about your friend, my MIL is in the same situation and been given about a year at Christmas to live after a scan showed up the big C. She has been to the Dr's several times about a urine infection & a cyst which they kept on treating with anit-biotics. They finally decided to offer her a scan which they said it has progressed to far /spread to other parts of the body for surgery and will just treat with meds.

Was angry and upset at the time as feel let down by the NHS as if this was spotted earlier it could have made a difference but have come to accept that a) Money & status would have made a difference b) Can't count on NHS due to waiting times etc.

Have to accept that my MIL will be housebound for the rest of her life as she is too weak/ill to venture out.

seven-day-weekend

Thanks all for your supportive messages.

You are right in that many of his symptoms could have been explained by something else.

He was a bit 'weird' sometimes....well he had suffered from a mental health problem for years and was often a bit weird.

He had lost a lot of weight - well he was on a diet, just thought he was doing unexpectedly well.

He was always tired - well he had a manual job as a painter and decorator, you expect to be tired when you aer approaching 60.

On the other hand, he knew something wasn't right, he kept going back to the Docs.

I feel better now about how it could have been missed, I understand better now, thanks to everyone and we will just have to support him and his wife in the time they have left, and her later when she is on her own.

Mr_Toad

I agree with what the others have said but there's another possibility.

Doctors are just people, they're not superhuman and like in any other profession there are good ones, average ones and bad ones.

Many GPs spend their lives looking at a generally mundane range of everyday illnesses. Many are overworked and some would argue that they don't have the time to keep up with the latest advances in medicine.

I have a rare brain condition, I discovered that I also have a GP who is quite brilliant. I went to see her on the 11th of Jan 2010 and had a correct diagnosis 3 weeks later following tests. The test that mattered is very specific and very expensive and only one lab in the UK performs it.

After the usual tests she said to me that there was one other thing she could try because my symptoms were very like something she'd read about years ago in the BMJ and had somehow remembered!

In just under 1 month from my visit I was on the correct medication and my condition while incurable and progressive is now under control.

There is a specific website and support network for my condition and there are people on there who have been ill for years before getting a proper diagnosis because most GPs have either never heard of it or read about it then forgot about it. They only get a diagnosis when they have deteriorated to the point of hospitalisation by which time it's too late to regain much quality of life.

The big problem is knowing what kind of GP you have, a brilliant one like mine or a barely competent pusher of tranquilisers and antibiotics who isn't capable of spotting the really important stuff.

securityguy

And yet, life expectancies are increasing year on year, pretty well everywhere in the UK. There are still health disparities by income, region and class, of course, but in each sub-population the trend is up. Cancer survival rates, however you measure them, are improving. Some of those numbers are suspect and just indicate lead-time bias (ie, if your cancer is detected earlier, but you still die on the same day you would have done had it not been detected, then your survival time from detection is longer but your outcome is precisely the same), but the improving life expectancy does represent a real improvement.

Cancer diagnosis is hard. The problem with the "screen everyone, intervene on suspicion" approach which some people appear to want is that (1) the screening isn't without risk and (2) the intervention isn't without risk. MRI scans are probably safe, but CAT scans, which are needed for some cancer screening, certainly aren't if used routinely.

I forget the exact number of excess cancers that would be caused by routine CAT scanning, but it's certainly more than the number of treatable and progressing cancers that would be detected (ETA over those that would be detected without such screening): such screening would kill more people than it would save. There was a ludicrous article in the Guardian a few weeks ago claiming the NHS was saving money by not X-Raying broken ribs; no, it's trying to avoid killing people. Shoe-shops haven't stopped X-Raying children's feet to save money, either. It always strikes me as ironic that when so many people scream blue murder about low-power, non-ionising radiation with no credible harm mechanism (mobile phones) there is such an enthusiasm for increased exposure to high-power, ionising radiation which is a known carcinogen (X-Rays).

The other problem with screening is that you end up treating people who either don't have cancer or won't die of it. A fifty-ish man has a near 50/50 chance of having, if tested for it, the early signs of prostate cancer. He's got a very low risk of dying of it, and there will be symptoms between a positive PSA test and it being risky. If you adopted the "intervene on warning" policy, you would perform an operation with a massive risk of impotence and urinary incontinence on about 50% of men of sixty and essentially all men of seventy-five, in exchange for delaying the death or a handful of men and changing what's written on the death certificate of a few others (ie, they'd die of a heart attack or whatever around the time they'd have died of prostate cancer, but they'd have been incontinent and impotent for ten years). Even if you wait for early physical signs (up in the night to urinate, trouble urinating) and only intervene then, you'll probably kill or harm more people than have their death delayed.

The problem with diagnosis of many cancers (cf. the study published today on breast cancer screening) is not that people are operated on (with attendant chemo- and radio-therapy) who don't have cancer, it's that they have a cancerous growth that will not be dangerous before they die of something else.

We could CAT-scan everyone, and then operate on everyone who has the slightest sign of a tumour. That would stop the "NHS saving money" meme. It probably wouldn't improve life expectancies, it would certainly kill some people who would not otherwise have died (as well as the CAT-scan induced cancers, there will be deaths on the operating table and deaths from radio- and chemo-therapy side-effects) and it will result in wide-scale aggressive treatment of people who were not actually at risk.

Cancer diagnosis and treatment is hard. There will always be cases where you can say "had they been scanned and treated they might have lived", and those people have names and faces. But there will be at least as many, and probably more, people who had they been scanned and treated would have died needlessly. If you think you know how to resolve this issue, medical research is screaming out for good people to work on this very topic. Just going "huh, it's all about money" helps no-one.

It's like the row (for older readers) over daylight savings time in the early 1970s. The children who died because of darker mornings had names and faces. The children who didn't die because of lighter evening were a statistical abstraction: they definitely existed, and in larger numbers, but we don't know who they are. Emotionally, it's easier to worry about one person adversely affected, than knowing that two people out there somewhere have benefitted.

lostinrates

Mr_Toad wrote: »

I agree with what the others have said but there's another possibility.

Doctors are just people, they're not superhuman and like in any other profession there are good ones, average ones and bad ones.

Many GPs spend their lives looking at a generally mundane range of everyday illnesses. Many are overworked and some would argue that they don't have the time to keep up with the latest advances in medicine.

I have a rare brain condition, I discovered that I also have a GP who is quite brilliant. I went to see her on the 11th of Jan 2010 and had a correct diagnosis 3 weeks later following tests. The test that mattered is very specific and very expensive and only one lab in the UK performs it.

After the usual tests she said to me that there was one other thing she could try because my symptoms were very like something she'd read about years ago in the BMJ and had somehow remembered!

In just under 1 month from my visit I was on the correct medication and my condition while incurable and progressive is now under control.

There is a specific website and support network for my condition and there are people on there who have been ill for years before getting a proper diagnosis because most GPs have either never heard of it or read about it then forgot about it. They only get a diagnosis when they have deteriorated to the point of hospitalisation by which time it's too late to regain much quality of life.

The big problem is knowing what kind of GP you have, a brilliant one like mine or a barely competent pusher of tranquilisers and antibiotics who isn't capable of spotting the really important stuff.

I want this gp. Ten years in and a new condition was just mooted yesterday on the phone. I am in for a lumbar puncture later for something else and have to grovel myself to ask if they will run a particular analysis test in the gp's advice. They feel I am in a better situation to ask for it there and then than they are calling and asking. :eek: This is mainly because my husband called my gp and mentioned things we have been mentioning for the last few years and a random spot on google potentially joining a dot no one has even tried to before.

securityguy

cookie_monster wrote: »

Sorry to hear about your friend, my MIL is in the same situation and been given about a year at Christmas to live after a scan showed up the big C. She has been to the Dr's several times about a urine infection & a cyst which they kept on treating with anit-biotics. They finally decided to offer her a scan

Give 10000 people a CAT scan and within ten years six of them will have cancers they would not otherwise have had. Quite a lot of people have urine infections and cysts. Most of them don't have cancer. Should you scan people who present with urine infections and cysts? How many of them will have cancer that was not otherwise detectable? We don't know: if you fancy a PhD in epidemiology, there's your research topic. How many of them will get cancer that they didn't have? Six in ten thousand.

(Yes, I realise the study I'm citing is young people. But the fact that it's only looking at cancers within ten years, rather than lifetime risk, makes me reasonably happy about extrapolating it over older people).

There were 866,580 CT scans given to 680,211 people in this cohort of 10.9 million young people. Of 60,674 cancers diagnosed, there were 3,150 among those who had received one or more CT scans, compared with 2542 cancers that would have been expected if there was no effect of CT scans on subsequent cancer risk. This gave 608 extra cancers associated with CT scan exposure for an average follow up period of almost 10 years.

'In a group of 10,000 young people, we would expect 39 cancers to occur during the next 10 years,' explains Professor Sarah Darby, a Cancer Research UK-funded researcher at Oxford University and a co-author on the study, 'but if they all had one CT scan, up to 6 extra cancers would occur.'

http://www.ox.ac.uk/media/news_stories/2013/130521.html

mumps

I do feel sorry for your friend but to be fair the NHS doesn't always get it wrong. A couple of weeks ago my son had been feeling unwell for a few days, he woke one morning feeling much worse, got an emergency appointment within 30 minutes so had to quickly get dressed, fortunately the surgery was just round the corner. He was seen immediately and GP quickly contacted hospital and got a taxi to get him there, the quickest option. Within half an hour, so just over an hour after he woke up, he was being admitted and prepared for surgery. He has recovered well and needs further surgery, we already have the date and all the details which he received in the post within a week of his discharge. I know we were lucky but I am grateful to the NHS, even though the ward he was on wasn't particularly nice but he is well and alive and hopefully the second op will mean this never happens again.

Gra76

Cancer isn't always easy to spot as mentioned, and some GP's can have the symptoms waved in front of their face and still not spot the obvious. I was diagnosed with stage 2b Hodgkin's Lymphoma in Sept 2011 after going to see my GP displaying a number of 'classic' cancer symptoms (rapid unexplainable weight loss, tiredness, night sweats, being out of breath very quickly among others) and he sent me for a chest X-Ray as a precaution after listening to my breathing (and that was only after I'd badgered him for another 10 mins.) The X-Ray picked the cancer mass up and the rest is history. He almost didn't send me. I dread to think of the consequences had I not persuaded him I needed further investigation.

Cancer is a scary journey. I've met quite a few terminally ill people along the way and always been grateful that mine was treatable.

Make the most of the time you have left with your friend. If his cancer is as agressive as it sounds then there's a good chance that it wouldn't have been picked up on before it was too late anyway. I'm sure that's no consolation at all. You're right to be angry, but don't be angry with the NHS as it doesn't sound like there was much they could have done, be angry at cancer. That's the real enemy.