Patient wrongfully treated for recurrence of bowel cancer

Our client, Mr H, was told he would need to undergo chemotherapy, chemo-radiotherapy and surgery for what was assumed, by his consultants, to be a recurrence of his bowel cancer.  He suffered a bowel perforation as a result of the chemotherapy and was then told he did not in fact have a recurrence of the tumour.

Mr H was diagnosed with a rectal tumour in 2007 and underwent surgery followed by chemotherapy which was successful.  His care was transferred to the Royal Marsden Hospital where he was seen for regular follow ups.

In 2011 he was reviewed and found to have some increased thickening in the presacral area.  It was noted that they needed to rule out that this was a recurrence of the cancer.  The consultants noted this as highly suspicious.

It was felt that undertaking a tissue biopsy might be difficult and further PET/CT scans were recommended.  Following these further scans it was still felt that the appearance was in-keeping with a local / presacral disease recurrence.

It was noted that “We will discuss with the patient … but it is likely that the patient will require systemic chemotherapy … followed by chemo-radiotherapy and then surgery and then a further 6 cycles of the same.  We do not have histology but it is likely based on the appearances our MDT will not recommend biopsy …”

The MDT agreed that there had been a recurrence of the rectal tumour and this should be treated as above, despite the fact there was no histology result to confirm this.

Mr H underwent his first two cycles of chemotherapy and 8 days after the 2nd round was admitted to hospital with symptoms suggestive of a bowel perforation.  He underwent a laparotomy which confirmed he had a complex perforation which had caused abdominal sepsis.  He required a loop colostomy (where the bowel is brought up through the abdomen, in essence diverting the faeces into an external pouch).

Mr H’s original consultants from his first surgery in 2007 said it would have been preferable to have histological proof of the recurrence, and that in their opinion a recurrence would be unusual given the original staging of his tumour in 2007, and the timing of the surgery.

Subsequently Mr H underwent a colonoscopy, examination under anaesthetic and a biopsy which showed there was in fact no recurrence of the cancer.

The team acting for Mr H, argued that the consultants at the Royal Marsden had been negligent in their failure to consider a differential diagnosis of an inflammatory process, and also to take account of the fact that the nodes had not changed in size and shape since 2010, suggesting they were not malignant.

After obtaining relevant medical reports, the team were able to negotiate an out-of-court settlement for Mr H of £36,250 to compensate him for his pain and suffering.