(Possibly triggering) cancers not bring noticed until late stage

[BrieAndOatcakes]

In the past 6 months three women in their 30s who I know have been diagnosed with stage 4 cancer (one ovary, two bowel). Two are still having treatment, one has sadly passed away. It's very sad, and also scary that it wasn't noticed for so long, one of them made several Drs visits and got nowhere. Why does this happen? Do Drs ignore the symptoms in younger people, or are the symptoms very subtle until it's too late?

Yes from anecdotal evidence, doctors do ignore women and especially young women. There's a thread on here somewhere about this.

www.mumsnet.com/Talk/am_i_being_unreasonable/3402449-Aibu-to-ask-you-to-tell-me-your-experiences-of-being-dismissed-by-medics-as-a-sick-woman-I-promise-to-listen

I read an article in an American magazine that had researched how many times a female visited a health care professional compared to male before their health issue was resolved. It was something like 11 times for women and about 6 for a man.
Food for thought

I think there's something to that, yes. If you're young, a woman and don't want to make a fuss you are easily overlooked.

I do think ovarian cancer is often diagnosed late though and some people are reluctant/embarrassed to talk about bowel cancer symptoms until it's late, so that possibly adds to the problem.

Im sorry for your losses op

I think a lot of the time they judge the symptoms by your age because it's more likely to be something else, not that it makes it right of course. One of my DB friends passed away from bowel cancer age 23

They misdiagnosed my nan in her 80s with having ibs when infact it was bowel cancer. By the time they properly looked into it, it was too late

Yep, I found you’re young they are often not actively looking for it and god help you if you have something else wrong at the same time as every symptom will be put down to your existing diagnosis.
I lost my best friend a few years ago, she’d complained to dr for over a yr she didn’t feel well, various complaints. Dr diagnosed gall stones and put her on waiting list for removal but every new symptom she was told gallstone related. Eventually had a dvt, sent to hospital, a week later family told she only had a short time left, less than 2 weeks being in hospital and she passed away, they found the secondary but never found the primary cancer. She was 32
Someone I was at school with has got stage 4 bowel cancer, again only 34.

Unfortunatly both bowel and ovarian cancer often are diagnosed late on, mostly as the symptoms are so vague and can be equally caused by other things. And as the other things are much more common, especially in younger people, the diagnostic process is to work through those first.

I have several close relatives that this has happened to. I can only think that some cancers do not show up apart from on ct scans etc. All the blood tests and various other tests they’d had done had come back “normal”. It’s actually really scary.

My mum has recently been diagnosed with advanced cancer and has been given weeks to live. She is 70 and has spent the last few weeks in and out of hospital with severe anaemia. They kept giving her blood transfusions and sending her home. All her blood tests etc were otherwise okay. She pushed and pushed for a ct scan and it came back that she had cancer on her liver, in her bones and in her spine. She had no real pain anywhere. Everyone was shocked.

It doesn’t just happen with cancers though. I was fobbed off for a year and misdiagnosed as having anxiety when actually I had the potentially fatal condition of Addison’s disease. I had to push to be referred to an endocrinologist before I was taken seriously. Gps etc are very quick to dismiss everything as anxiety.

It’s difficult and multifactorial. There are very clear referral guidelines issued by the CCGs rather than doctors ignoring women. A few might but most over refer.
The only 2WW referral criteria for bowel cancer in someone under 40 is an abdominal mass - which inevitably is going to be at quite a late stage. This is because bowel cancer very, very rarely affects people under forty. The risks of screening (to individuals and the wider community) in this cohort are greater than the risk of not screening.
Similarly the risk of ovarian cancer increases with age. Locally the CCG criteria are
Arrange a (within 2 weeks) CA125 and Ultrasound of abdomen and pelvis (especially if ≥ 50yr) if any of the following symptoms are present persistently or frequently:
• Persistent abdominal distention (bloating)
• Increased urinary urgency &/or frequency
• New onset symptoms suggestive of IBS
• Early satiety &/or loss of appetite
• Pelvic or abdominal pain
Consider CA125 and Ultrasound of abdomen and pelvis
at any age if any of the following:
• Unexplained weight loss
• Changes in bowel habit
• Fatigue

Only if the ultrasound shows abnormalities would there be further investigation under two week rule.

If everyone under 40 who felt a bit bloated or had a bit of abdominal pain was referred to gynaecologists and started on all sorts of investigations, they would be at greater risk as would those who couldn’t be seen but were at much higher risk level simply because low risk women were taking up all the clinic and hysteroscopy places for peace of mind.

Ovariam cancer doesn't give off clear sympoms till it spreads and by then you are almost always too late.

Looking at the statistics one can understand why the exceptionally rare incidence of cancer might be missed. Luckily, those diagnosed at a younger age do,have a much, much higher survival rate.

There are some very sad stories but they are unusual, which is why we remember them. If people are worried about the risks they need to reduce risk factors as much as possible - weight, smoking, alcohol. You can’t cant affect your genes yet but you can reduce your risks.

This isn’t about someone who is a bit bloated though. No one really goes to be seen because of a bit of bloating.
Turning women under 40 away because they are lower risk is dangerous and it’s exactly what OP is about. I dislike the culture of handwringing about the inconsiderate women taking up valuable doctor’s time.

I think current funding levels have something to do with it too. My friend died of bowl cancer aged 33, he did ignore for awhile which obviously was the biggest factor, but when he did the waiting list was so long. Even with urgent cancer symptoms. He ended up in agony at A&E one evening and tests were Carried out.

He had gone back and forth several times to the doctors and despite this, the date given for his tests, he was actually dead by. It's shocking really.

Even trying to get an appointment here is a nightmare, and they have a strict one problem policy. Which is actually an issue, I mean I have several issues I probably should raise but I can't go in with a list, so I jus put it off. Plus I can't sit around every morning calling for an appointment to be told to call again the next day. It's Crazy.

No it might not be but my point is it’s not GPs turning women away it’s GPs following guidelines that have been produced by experts in their field and based on saving the most lives. Very sadly, a tiny number of people fall outside the referral criteria.

Would anyone rather large numbers died because of the worried well or to ensure no younger person was missed? Nobody wants younger women to suffer but with finite resources they have to be targeted at where the greatest need is.

Well, funnily enough, I would want young and not so young women to have to deal with a late diagnosis. This isn’t a fight between two groups.

Millions of women in Europe have access to a yearly gynea check up, here the gynaecologists are treated as a luxury. This has to change.

Wouldn’t want.

Sorry. Mistyped.

My DM was diagnosed with cancer while she was on holiday in the USA. She came home, was diagnosed with Stage 4 Signet Cell Adenocarcinoma in her stomach with a football sized tumour thst they thought had been there nine months.

She had no symptoms until six weeks before she died, by which point it was too late and the only things they could offer was palliative care.

I understand that GP's have to follow guidelines and in most cases things aren't too serious, but it's the repeated appointments where people are told it's nothing, told you're being a hypochondriac, like it's trying to get blood out of a stone to get the GP to really listen and actually do something. Perhaps lives could be saved just because you don't fit the profile.

It’s not that GPs are ignoring it’s that there are specific rules regarding suspected cancer and it would be unlikely younger people would meet the criteria. This means they may still be referred but as routine rather than urgent so likely to be months and months to be seen eg for colonoscopy

There are shortages and cutbacks throughout NHS and the idea of annual gynae checks for all women would be impossible without compromising the treatment available for patients who are actually needing to be seen.

I do think that there’s institutional medical bias re women’s health, and that can fall out to not taking young women’s problems seriously. I didn’t notice it until I got pregnant, and despite a positive experience with all that it still makes me go wtf. I think about a lovely young woman I knew who got fobbed off for the best part of a year and it enrages me. She died from a rare and aggressive type of ovarian cancer. The prognosis wasn’t great but I still can’t help thinking ‘what if they’d actually listened and caught it earlier....’

Surely check ups are to determine who needs to be seen?

There are many screening programmes out there, are they all unnecessary?

Young women are a group that’s routinely neglected.

Some GPs actually refuse to deal withnwomen’s problems. Not often, but it happens. Women are told to make an appointment with a female doctor, and we all know just how easy that is.

that there are specific rules regarding suspected cancer and it would be unlikely younger people would meet the criteria.

Exactly. I went to my GP two weeks ago after a couple of episodes of blood in my urine. She did a urine culture to confirm there was no infection & wanted to refer me as a two week patient. Unfortunately I’m 44 & they will only accept referrals if you are >45 - she could only do it urgently which is currently eight weeks plus.

I have health insurance so saw the same urologist she’d have referred me to less than a week later. There are no get arounds when the computer says no.

So sorry to hear you know 3 youngish women with late stage cancer. DH is French and so we have French and UK friends and the difference in when the cancer is picked up in France is scary. It's little wonder their survival rates are so much higher than ours. We know people who died within 6 months as UK system failed to pick it up leaving kids under 5 without a parent, it does make me angry knowing had they picked it up early those people would still be here.

I do find doctors vary, some doctors as soon as you have had anxiety every symptom under the sun is put down to that, even when I've gone with symptoms like bleeding from bladder and/or bowel. Though if you aren't being listened to by one doctor would recommend seeing another. It isn't just cancer either. I spent a year incredibly ill with no treatment despite having all the symptoms of a disease - only got treatment after a year which worked in 2 months but only after had lost my job and a year written off.

I'm an ovarian cancer survivor - if I hadn't been a nurse, and used to palpating people's abdomens, I'd be dead by now. I knew that there was a mass in my abdomen, but the first doctor I saw just said " so you've gained weight ! What do you think I can do about that ?" . He was so patronizing, I felt awful and could have easily gone home and blamed myself for my big tummy. Fortunately I was assertive and demanded that he send me for an ultrasound.....which showed an adenocarcinoma the size of a child's football.

Doctors are often very poorly educated about ovarian cancer. Many women have died because of that.