To think that GPs are not the best people to spot cancer early enough?

[AnnaPutinoff]

This is a bit personal, hence NC and deliberate vagueness, but basically two family members have been diagnosed with cancer. One of them has something very rare which was only picked up because their spouse used to work in the field and has been bugging the GP for getting on for two years about niggly symptoms that looked trivial but turned out to be anything but. A big operation is required now and the outlook isn't brilliant but they're at the age where 5 years is a real bonus. The other family member has just been told that theirs is very advanced and likely to be terminal. This person is very definitely much too young to die. And the awful thing is that they have been taking medication for years on repeat prescription to mask symptoms that were probably a sign of the illness. No recall from the GP surgery, nothing, until other more alarming symptoms happened.

Now I know that everyone keeps saying please see the GP. But what if you get fobbed off on a regular basis? Or getting an appointment requires something approaching top-level security clearance and a four-week wait? And then when you get there, well, it may be you have something rare enough that a GP used to a regular stream of coughs and colds and jabs and diabetes checks will never have seen it and won't have a clue. Cancer is such a complicated set of diseases, how the hell can a non-specialist (albeit qualified) be able to spot the early signs when they are so vague and non-specific? (I'd be interested to know how other countries manage this as well).

I think often a conservative, watch and wait approach is the best one initially - but it is only safe if the same symptoms aren't repeatedly minimised by different GPs who are not fully aware of the history, and assuming you can get an appointment if there are any changes in symptoms.

I think this sort of thing is why having a named GP who sees you regularly is so important.

From the bbc website: "The "worried well", it would appear, are everywhere: an estimated one in four GP appointments is now taken up by someone who has absolutely nothing wrong with them.

But while the popular view of the hypochondriac is the patient who instantly declares a cold to be flu - those who suffer from health anxiety, as it is now more sympathetically dubbed, rarely concern themselves with such mundane conditions.

For those with health anxiety every twinge can be the latest symptom of a terminal disease. Anxiety exacerbates any ache they have so that their pain becomes real - and potentially debilitating.

Hundreds of thousands of people in the UK suffer from such acute anxiety about their health that they are unable to work.

"They may be at the extreme end of the spectrum, but this is a problem for many people and it has to be seen as condition in itself," says Professor Paul Salkovskis, the director of the Maudsley Hospital Centre for Anxiety Disorders and Trauma.

"Their suffering is genuine, and their pain often greater than if something really was wrong with them."

You have to push and push if you aren't happy with a diagnosis or have symptoms that just won't clear

Agree. Some symptoms aren't obvious at first. And it's unhelpful to suggest that most people who push and push have "fuck all wrong with them".

I had a colleague who had been suffering with back pain for months. She'd had a fall and injured her arm shortly before this started, so the back pain was initially assumed to be muscle strain related to this. She'd also had breast cancer some years previously, but had been given the all-clear by her consultant shortly before the back pain started.

Her GP referred her for physiotherapy for the back pain, which seemed reasonable enough in the circumstances. But the back pain didn't go away. She went back to the GP several times about it before she finally got referred for an X-Ray.

Turned out the back pain was caused by an inoperable tumour in her spine. Subsequent scans showed she had cancer in her lungs, liver and brain too (no new breast cancers though). Impossible for anyone to cure her, despite chemotherapy and radiotherapy, and she's since sadly passed away.

But until she'd had that x-Ray, I bet there'd have been people out there happy to dismiss her as a time waster bothering the GP about her bad back and taking up appointments that "genuinely sick" people might need.

maresesdotes

One in eight women will get breast cancer in their lifetimes. The incidence of ovarian cancer is 2 in a hundred.

I'm v surprised that the GP didn't refer your DM for post-menopausal bleeding. I'd have thought that was routine. Unfortunately, most ov ca patients don't experience such an obvious symptom of something needing further investigation.

I think the problem with a lot of cancers is they are not obvious. My dad wife went to the doctor with a bit of pain in her hip. Otherwise completely well. No other symptoms. It was treated as a deep bruise, the result of a fall that had happened.

A few days later her lung collapsed and she was diagnosed with lung cancer (that had metastasised and got into the bones).

Even if the doctor had sent her for tests straight away it would have been way to late.

Cancer is a bitch. Dodgy moles,.and breast lumps are easy because they are easy to spot and generally a primary cancer.

Random aches and pains caused by a metastasised cancer are a) hard to diagnose B)pointless to diagnose because once it gets I to your bones you are buggered.

GPs have missed 3 cancers in my extended family which turned out to be fatal. And this was after extended visits.

I think they should be paying a lot more attention to those who are good at diagnosis and those who aren't. And assessing whether their training is fit for purpose.

MIL presented to GP with a textbook checklist of the brain tumour that would eventually kill her: headaches, personality change, intermittent zoning in and out, dizziness, blurred vision, confusion.

First trip: depression.
Second trip: 'stubbornness'.
Third trip: depression.

The woman had no history of depression. No anxiety. Nothing to indicate hypochondria etc.

She had to have a brain hemmorhage before anyone took my FIL seriously about there being something very wrong (she was unable to talk coherently by then).

We've just found out this evening that FIL's wife has been diagnosed with cancer. Not sure what type yet - cancerous cells found in a cyst removed from her neck 2 weeks ago. That she'd been backwards & forwards to her GP about. It was only when she saw a locum after Xmas that she got a referral to a specialist and the treatment ball started rolling.

My mum was dx with COPD. A year later going out it wS lung cancer ... She died 6 weeks later !

I do sometimes wonder if the imaging revolution has really been addressed by the funders. GPs should have access to the kinds of diagnostics that specialists have. TBH doesn't it make much more sense for GPs to be able to order some of the diagnostic scans at the same time as making a specialist referral, so that when you see the specialist they have the imaging there?

I'm not sure if GPs have to report missed diagnoses as a compulsory incident to be reviewed at a level above them, say at Health Authority level which has been abolished approximately 16 times since 1974 at huge organisational cost because it sounds brilliant in Parliament to be able to say 'we are getting rid of RED TAPE AND BUREAUCRATS' and less good to be able to say 'we are moving the deckchairs around and getting rid of the only level of monitoring that can build relationships with GP practices while also looking at their standards and practice over time'.

Someone I know recently died from cancer after being fobbed off over a dodgy mole. Very young, leaving young DC behind. Tragic. If I were her DH I could never forgive the GP who dismissed her concerns.

Our (retired now) GP missed every classic sign of my mum's ovarian cancer. She presented several times with abdominal bloating, constipation etc and was dismissed each time as having IBS. No disrespect to anyone who has this condition but I wish that that's what she had. My dad paid for a private consultant appointment who ordered scans which revealed an enormous ovarian mass. In spite of aggressive chemo, she died a few months later.
I think hope that GP's are more alert to ovarian cancer symptoms these days.

The same GP did, however, act quickly with my husband's symptoms. If he hadn't, dh would have died. It was a long haul - surgery, chemo, radiotherapy and a stem cell transplant but on this occasion, the gp was on the ball.

Yanbu, mil felt unwell and in pain for over a year before gp eventually referred her and she was diagnosed with cancer

MIL presented to GP with a textbook checklist of the brain tumour that would eventually kill her: headaches, personality change, intermittent zoning in and out, dizziness, blurred vision, confusion.

:(

The problem is that brain tumours are rare - and most of those symptoms common. I went to my (French) GP this week with a variety of potentially "neurological" symptoms - persistent headache, eye problems, episodes of dizziness, etc. Ruled out elevated blood pressure and a neck/ cervical problem, and now ruling out a sinus infection or other sinus problem (with medical treatment plus an X-ray if necessary). If that doesn't work then she'll refer for a scan.

I've had the same GP for the best part of two decades so she knows that I'm not one of the "worried well", and I trust her to rule out the obvious before ordering expensive tests. But this sort of sensible, conservative treatment only works if the doctor knows the patient's history and there is appropriate follow-up.

I'm a hypochondriac. I wish I could just pull myself together. I was offered three sessions of CBT though, three isn't enough, I need ongoing therapy but I can't get it.

I am doing much better and I have had to work bloody hard at recovery by reading books and doing my own CBT with very little professional support because there just isn't any, and we are just labelled as attention seekers and time wasters by many.

I have been to the GP twice in two weeks but both times were actually needed and I don't rush to the GP like I used to do. I never push for tests, or even ask for them. I am very polite and not a pusher but when I am really ill I believe I have a serious illness and often get many of the symptoms because anxiety mimics a lot of conditions.

Three of my children lost their dad to cancer, he might still be alive if he had gone to the GP sooner, who knows. I don't want my kids to go through the same with me, so I ended up doing the opposite of their dad, seeing the GP for anything that could be a sign of cancer but I lost all rational thought.

It sucks being thought of as a time waster, have I wasted appointments due to my illness? Yes, I have but I keep trying to fight it with everything I have. If there was more support and more therapy was offered it would likely free up more GP appointments but the problem is people like me are left with little professional help and it isn't fair on the GPs or the general public when we can't get the help we need.

Then people rush to A&E because they can't get to see a GP, and on and on it goes.

U2 health anxiety is awful.

annandale

I think GPs can already refer for scans. Mine booked me an ultrasound at the same time as putting me on the 2 week pathway so I'd already be in the queue, as it were. In the event, I got an appointment with the specialist before the scan and the specialist wanted me to have a CT instead.

But I had a v obvious swelling. My dd, who was worried well, also got referred for an ultrasound, which was clear and the results came back to the GP. no specialist involved.

I suppose there would have to be clear guidelines or the radiologists would be swamped.

The reality is that not everything will be caught every time. Sadly, that is not only the NHS, but human nature as well.

For me, it wasn't cancer, but I was repeatedly sent off with "asthma exacerbation" diagnosis due to a troublesome cough.

A month ago, I was diagnosed with idiopathic pulmonary fibrosis, and finding it was only incidental because of a chest x-ray I had due to something unrelated.

Should the x-ray have been done sooner? Maybe. However, I am also not within the typical demographic of someone with IPF, and I do have asthma...

No sense in looking back now... it is more important to make the best of the time I have ahead of me.

YANBU Op, I know of 3 people who have had cancer that was miss diagnosed for an extended period of time,one of them went back & forth for over 2 years but kept getting told they were suffering from depression.

Out of the 3 sadly only one has survived but due to the extent of the vigorous treatments they needed they will suffer still suffer from side effects for the rest of their shortened life.

The scan showed that the lumps were cutaneous metastases (localised cancer spread to the skin)
Jollyphonics this is exactly what happened to my MIL who, after about a year of niggling probably unconnected health problems, went to her GP with links all over her back (she'd already got the all clear from skin cancer years before).

Stupid thing posted before I was ready...

lumps all over her back. The GP told her it was 'because she was thin'. A different GP sent her for tests a few weeks later and she was diagnosed after a few more weeks of tests and given four to six months to live. She struggled on for nine.