Posted: 21/10/2024
Over 70% of primary bone cancer cases are initially misdiagnosed, according to statistics provided by the Bone Cancer Research Trust. Only by continuing to improve awareness of the signs and symptoms of this disease - amongst both the general public and the medical profession - can these alarming statistics be addressed.
Primary bone cancer is a rare form of cancer which starts in the bone, as opposed to a cancer spreading from its original location into the bones. While considered rare, the condition still affects hundreds of people every year but remains poorly understood. Oncologists are unsure why bone cancers develop, and this is probably at least part of the explanation for why they are so often missed.
The most common symptom of bone cancer is intense pain in the affected bone, which may increase after physical activity or exercise, depending on where the tumour is located, and be worse at night. Swelling around the affected area is also a common symptom, but often develops after the pain, and sometimes patients can feel a lump or mass.
Bone cancer in the legs can leave patients struggling to walk, while bone cancer in the arms can make day-to-day tasks difficult and frustrating. High grade bone cancers, typically osteosarcoma, Ewing sarcoma and chondrosarcoma, first occur more commonly in the longer bones, such as the legs and arms. They are rare but aggressive and invade soft tissue from the bone. Given their malignant nature and ability to spread quickly (metastasize), prompt and aggressive treatment is required.
The difficulty in diagnosing bone cancers stems from their rarity. Their low incidence inevitably means that many general practitioners may only come across one or two during their careers. Pain and swelling are common symptoms suggesting many potential musculoskeletal diagnoses, but unexplained pain (pain occurring for unknown reasons in the absence of trauma) that lasts for more than six weeks is a red flag and indicates the need for further investigations, starting with X-rays. GPs need to have a low threshold for referring patients for X-rays in these circumstances. Recognition of bone cancers also needs to be greater so that the public is better informed, and patients make GP appointments sooner when they experience unexplained bone pain.
As with all cancers, early diagnosis and treatment are still vital to manage and treat bone cancers before they spread. Survival rates from high-grade bone cancers are reduced significantly after metastasis. Osteosarcomas and Ewing sarcomas respond well to chemotherapy, if diagnosed early, and that has improved survival rates dramatically. The key to successful treatment is suspecting bone cancer, or at least considering it, and thus referring for radiological investigations and then for those X-rays to be considered carefully to look for signs of bone cancer. However, lack of experience or training may impact on a doctor’s decision to refer a patient for further tests and that decision failure may amount to negligence and lead to a delayed diagnosis and a poorer outcome for the patient. We are also aware of occasions where X-rays have not been considered and reported and subtle evidence of bone cancer has been missed or not acted upon.
In the case of X v Chelsea and Westminster Hospitals NHS Trust, a 53-year-old woman was awarded compensation after the NHS trust negligently failed to diagnose bone cancer in her knee. She had fallen on it, broken it and undergone surgery but continued to experience significant pain and swelling long after she should ordinarily have recovered and been fully mobile again. She was subsequently diagnosed with lung cancer, believed to be secondary lung cancer. Her earlier knee X-rays were then looked at again and a diagnosis of a high-grade osteosarcoma made. The bone cancer was the primary cancer and over time had spread to her lungs.
The claimant brought a claim for damages alleging that there had been a negligent delay in diagnosing her bone cancer and that diagnosis could and should have been made before the cancer spread to her lungs. The bone cancer would have been curable had it been treated while it was still localised. The claimant received damages of £2.8 million.
© 2024 Penningtons Manches Cooper LLP.
All rights reserved.
Website design by Frontmedia / Dynamic Pear
Penningtons Manches Cooper LLP is a limited liability partnership registered in England and Wales with registered number OC311575 and is authorised and regulated by the Solicitors Regulation Authority under number 419867.
Return to news headlines 