By Peter T. Crean, Esq. and Michelle A. Frankel, Esq.
According to the Centers for Disease Control and Prevention, ovarian cancer is the second most common gynecological cancer and causes more deaths than any other female reproductive cancer.
Ovarian cancer diagnosis can be difficult because the symptoms may overlap with those of other conditions. Medical malpractice claims will most likely involve an alleged failure to diagnose or misdiagnose the cancer. Such claims will inherently involve allegations that the physician underappreciated the signs, failed to order necessary diagnostic testing, and/or improperly read or relayed testing results. The alleged impact on the patient will likely involve claims that earlier diagnosis would have enabled better treatment options and/or created a better prognosis if diagnosed when curable. With these claims in mind, physicians should be aware of the most common signs, symptoms and risk factors and document all complaints, tests and results, diagnoses, and treatment recommendations to enable a stronger defense should medical malpractice claims arise.
Physicians and patients should be cognizant of the main signs and symptoms of ovarian cancer including, but not limited to, vaginal bleeding (if there is a change or the patient has gone through menopause), abnormal vaginal discharge, pain or pressure in the pelvic area, abdominal or back pain, bloating, feeling full too quickly or difficulty eating, and/or a change in urination or constipation. Physicians should be particularly careful to discuss and document how the patient’s symptoms changed compared to her personal normal cyclical symptoms.
It is important for physicians and patients to discuss medical and family histories since certain factors may increase the risk of developing ovarian cancer including, but not limited to, being middle-aged or older, having close family members (such as a mother, sister, or paternal or maternal aunt or grandmother) who had ovarian cancer, the BRCA1 or BRCA2 genetic mutation, personal history of endometriosis, breast, uterine or colorectal cancer, or Eastern European or Ashkenazi Jewish heritage.
Depending on the symptoms and history, certain testing (such as genetic testing, rectovaginal pelvic exams, transvaginal ultrasounds, and/or CA-125 blood test) may be appropriate. However, there is no definitive test for ovarian cancer, unlike cervical cancer, which can be tested with a pap smear.
Nonetheless, the test and exam findings may help diagnose unexplained signs or symptoms and lead to a diagnosis of ovarian cancer. If there are negative results, then physicians’ medical judgments and care can more likely be defended if cancer is discovered later, since appropriate efforts were taken to rule out conditions. Alternatively, if a physician discovers a physical abnormality such a cyst and decides that further testing, such as a laparoscopy, is not warranted, then the physician should document his/her reasons for that determination. Details about the cyst’s characteristics and whether there are thickened walls, for example, should be documented to explain why further work-up was not indicated.
Primary care physicians, gynecologists, reproductive endocrinologists and any medical providers working with patients at fertility clinics are most likely to be the first providers to whom patients mention symptoms so the documentation of their findings and recommendations is important. Patients should be referred to gynecologic oncologists when indicated for treatment recommendations such as chemotherapy or surgery. The type of treatment rendered and the long-term impact on the patient’s reproductive abilities will impact the extent of pain and suffering and resulting monetary value of any case. The damages, however, will not matter if a physician was not negligent in his/her findings and recommendations and did not cause any delay or failure in the diagnosis of cancer, which is why documentation is key.
Peter T. Crean, Partner, and Michelle A. Frankel, Associate, are attorneys in the Medical Malpractice Defense Group at Martin Clearwater & Bell LLP. For more information, visit mcblaw.com.