Organisation we investigated: Royal Devon University Healthcare NHS Trust
Date investigation closed: 22 September 2022
The complaint
Mr Excell complained that the Trust delayed diagnosing his liver cancer and he lost the chance of having life-saving treatment as a result.
Background
Mr Excell’s GP referred him to the Trust under the two-week urgent referral pathway for suspected neck cancer on 16 June 2020. He had an appointment with one of the Trust’s ear, nose, and throat (ENT) consultants on 26 June.
A CT scan of his neck and chest was taken on 5 July. From this scan, radiologists identified an abnormality in the left lobe of his liver. They recommended further imaging in the area or an ultrasound.
Mr Excell attended a follow up appointment at the Trust’s ENT clinic on 13 July. The consultant arranged an ultrasound guided neck biopsy which he had on 21 July and a PET scan which he had on 23 July. The consultant did not mention his liver abnormality or arrange specific imaging to investigate this further.
Mr Excell’s PET scan showed a 12.6 x 7.6 x 6.6 cm lesion occupying most of the left lobe of his liver. The lesion showed a raised uptake in fluorodeoxyglucose (FDG), which is highly suggestive of cancer.
The shape and contour of the lesion, and the raised FDG levels, indicated primary cancer of the liver rather than metastatic disease.
Staff should have recommended further scans focusing on Mr Excell’s liver by 10 August. The Trust’s radiologists did not report liver cancer and flag this up. They reported the lesion as a possible segmental vascular anomaly.
They suggested a triple phase liver CT scan to investigate further. However, it was not treated as urgent and Mr Excell did not have this scan until 15 October following a further appointment with an ENT consultant.
In November, Mr Excell was told they suspected cancer of the liver or bile duct. A biopsy of the liver was done on 8 December.
On 18 December, Mr Excell was told that he had liver cancer and that it had invaded his main portal vein and left portal vein. This meant there was no curative treatment available.
They explained his only option was palliative chemotherapy. They said Mr Excell could expect to live for up to one year without treatment, but it could be longer with palliative chemotherapy.
What we found
We found staff at the Trust should have diagnosed Mr Excell’s cancer around 20 weeks earlier than they did.
We cannot say that Mr Excell’s prognosis would have been different had this happened, but there was a fair chance his cancer may have been treatable at this time, and he lost this chance of having potentially life-saving treatment.
We found the Trust had already taken steps to prevent this from happening again but had not done enough to put right the impact on Mr Excell.
Recommendations
PHSO has recommended that the Royal Devon University Healthcare NHS Trust:
- writes to Mr Excell to acknowledge the failings found
- pay Mr Excell £7,000 in recognition of the hardship he has suffered