Case Study: Ovarian cancer; the silent killer

A woman recently contacted Brave Legal to discuss a claim for the delayed diagnosis of ovarian cancer. She had been diagnosed six months prior to speaking with us and the cancer was at its advanced stages. Unfortunately, her situation is not unique and many women with ovarian cancer are diagnosed when the disease has progressed to stage three or four and require extensive treatment including surgery.

Case study

A healthy woman in her 30’s noticed irregularities in her menstrual cycle after stopping the pill to begin a family. When she saw her GP for advice she was told that these irregularities were normal, however after a year of unsuccessfully trying to conceive was referred to a fertility specialist.

Prior to attending the specialist, she underwent a series of scans and tests including a transvaginal ultrasound. The results of the ultrasound identified a dermoid cyst.

Whilst a patient of the fertility specialist, she underwent regular blood tests before beginning the IVF process. During this time, our client began to experience fatigue, bloating and some abdominal pain. Her fertility specialist recommended that she undergo an investigative laparoscopy.

Approximately five months following the transvaginal ultrasound, our client underwent the investigative laparoscopy where she was diagnosed with stage three ovarian cancer. As a result of this diagnosis, our client needed to undergo extensive surgery which required the removal of organs and resulted in a colostomy bag.

Our client contacted us seeking advice as she could not understand why she had not been diagnosed earlier and in particular, at the time of the transvaginal ultrasound.

In our investigation we briefed an expert radiologist to perform a blind review on the transvaginal ultrasound images. The radiologist said that the signs of ovarian cancer on an ultrasound which include rapid growth, neovascularization and irregular solid tissue, were not found on our client’s images and therefore, the disease was not readily identifiable or diagnosable from the ultrasound alone.

Given the opinion of the radiologist, we could not recommend a medical negligence claim to our client.

Ovarian cancer: The facts

Ovarian cancer is a disease where a malignant tumour is found in one or both ovaries and affects either the epithelial, germ or stromal cells. On average, nearly 1,400 cases of ovarian cancer are diagnosed each year in Australia and it is estimated that in 2021, a female in Australia had a 1 in 87 risk of being diagnosed with this cancer by the age of 85.

Ovarian cancer has been colloquially referred to as the silent killer because in many cases, by the time a woman is diagnosed, the prognosis is not favourable and the disease is at its advanced stages. Unlike other cancerous diseases, there are no specific tests or preventative screening measures that women can rely upon to ensure a diagnosis when the disease is at its early stages.

The common signs and symptoms of ovarian cancer are:

• abdominal bloating;
• feeling full quickly;
• frequent urination;
• abdominal pain;
• change in bowel habits;
• fatigue;
• pain during intercourse;
• change in weight; and
• menstrual changes.

There are no symptoms that are unique to ovarian cancer. However, even in some circumstances when a woman recognises the symptoms, seeks medical advice and undergoes investigative tests, diagnosis can still be difficult.

In the United Kingdom a study known as the UK Collaborative Trial of Ovarian Cancer Screening was conducted to gather data on whether screening for ovarian cancer by way of multimodal screening (screening for the CA-125 biomarker) and transvaginal ultrasound screening will help with early diagnosis and mortality rates. The study found that the multimodal screening resulted in a higher incidence of stage one cancer being identified. Conversely, there was not a significant increase in women diagnosed with stage one and two cancers when transvaginal ultrasound screening was used. Unfortunately, the research also found that neither the multimodal nor transvaginal ultrasound screening techniques significantly reduced mortality from ovarian cancer. The findings from the study were not sufficient enough to recommend general population ovarian cancer screening.

From our perspective, the challenge in diagnosing ovarian cancer can make delayed diagnosis cases even more difficult.

Ovarian Cancer Awareness month is held every February and is an opportunity to learn and become more aware of the symptoms of this disease as well as support those who have been impacted. For further information and resources visit Ovarian Cancer Australia.

References:

Cancer Council, Ovarian Cancer
Australian Government Cancer Australia, Ovarian Cancer Statistics in Australia (2022)
Menon et al, ‘Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial (2021) 397(10290) The Lancet 2182.