Thursday 14 December 2017

Woman diagnosed with uterine cancer year after being told she had Irritable Bowel Syndrome, inquest hears

The Dublin Coroners Court, Store St. Pic Tom Burke.
The Dublin Coroners Court, Store St. Pic Tom Burke.

Gareth Naughton

The son of a woman who was diagnosed with a rare uterine cancer a year after being told she had irritable bowel syndrome has called on doctors to be more vigilant for the disease.

Stephen Desmond was speaking following the second day of the inquest at Dublin Coroner’s Court into the death of his mother Maureen Desmond (74) of Willow Park Crescent in Glasnevin, Dublin 11. She died on September 4, 2011 at the Mater Hospital from a pulmonary embolism secondary to a rare and aggressive form of cancer in the endometrium diagnosed in July 2010.

The inquest heard that there was evidence she had developed metastatic cancer on a scan taken in 2009 but this was not identified because the radiologist had been asked to evaluate the colon.

Mr Desmond said that he hopes that the inquest into her death will highlight the need for doctors to be more vigilant for gynaecological cancers.

“If at the end of this inquest that was something that was more widely understood by the lay people and the doctors; that we could all learn to look out for this in a way that we may not have been trained to do before, that would be a very positive outcome,” he said.

The inquest heard that the first signs that there was something wrong with Mrs Desmond’s endometrium was in 2007 when there was evidence of thickening and distension. Dr Arthur Grey, a consultant radiologist from the Musgrave Park Hospital in Belfast, invited to re-examine the radiology scans by Dublin coroner Dr Brian Farrell, said that there were a number of reasons that the endometrium could be distended including fluid, blood, polyps or a tumour but it was not possible to say which without more specific testing.

She subsequently underwent a hysteroscopy at the Mater Hospital in August 2008 which found no abnormalities. An attempt was made to carry out at Pipelle endometrial biopsy but no sample was obtained.

In June 2009, she underwent a CT colonogram. Dr Grey said that abnormalities were less conspicuous because of the image technique used but there was evidence of “small volume metastatic disease”. He said that radiologists look at scans with a pre-test bias based on what they have been instructed to look for and may not identify other issues.

Consultant radiologist at the Mater Hospital, Dr Michelle McNicholas said that she was not disputing that there was evidence of cancer on the colonogram. She said that the clinical indication was for rectal bleed and she as focussed on finding the cause of this. “All I have to go on is the information that is given to me,” she said. While looking at a scan she would look out for “gross abnormalities” but not “minutiae”, she told the court. The cancerous nodules were not a gross abnormality.

“If I found that study in a pile next week with the same clinical information, I highly doubt that I would comment on it,” she said. 

Consultant Obstetrician and Gynaecologist at the Musgrave Park Hospital Dr John Price was also asked to review the case by the Dublin coroner. He said the type of cancer she had developed had a “very poor prognosis” compared to other forms of the disease. It was likely that Mrs Desmond had already developed an endometrial cancer at the time of her first presentation but that her care at the time was “appropriate and standard care pathways were followed”, he added.

However, he said that in his opinion her presentation was unusual and she should have been given a review appointment for six months after her first presentation to observe endometrial thickness.

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