GP reflections: Delayed lung cancer diagnosis in a young, non-smoking patient
This real patient story has been provided by The Roy Castle Lung Cancer Foundation as part of their ‘let go of the labels’ campaign to promote the early diagnosis of lung cancer.
Lucy Woollard
Lucy Woollard, 44, was told she had just months to live after waiting over 12-months to be diagnosed with lung cancer.
Lucy was a young mother caring for her 18-month-old daughter when she started to notice changes in her health.
Early symptoms:
- Late 2008: unexplained knee pain
- 2009: persistent cough
Additional symptoms developed:
- Unexplained weight loss
- Persistent fatigue
- Severe chest pain
- Clubbed fingers
- Recurring high fevers
Diagnostic timeline
“The doctor believed I had acid reflux,” recalls Lucy. “Then two months went by and I started to lose a lot of weight and was exhausted all the time.
“I still wasn’t particularly worried. I just put it down to being stressed about returning to work after maternity leave and losing the baby weight.”
In November, Lucy experienced a severe pain on the left side of her chest that wouldn’t go away. Fearful she was having a mild heart attack, Lucy immediately went to her doctor.
She was reassured that her heart was fine, however the clinician had concerns about her left lung so referred her to A&E for further tests.
After receiving a chest X-ray it revealed that Lucy had a large abscess in her left lung and was put on a two-week course of IV antibiotics.
Lucy was kept in hospital for seven weeks.
“The antibiotics weren’t resolving the abscess. I was still losing weight and my other symptoms (the cough and my painful joints) were worsening. I also developed clubbed fingers and was having regular high fevers, all of which was seen as a result of the lung abscess.”
Incidence
According to Cancer Research UK, there are approximately 49,200 new lung cancer cases each year, and it is the 3rd most common cancer in the UK. Early detection is crucial for patient outcomes with 88% of patients diagnosed at stage 1 survived their disease for at least one year, compared to 16-19% of those diagnosed at stage 4.
Lung cancer symptoms
The common presenting symptoms of lung cancer are:
- Cough
- Fatigue
- Shortness of breath
- Chest pain
- Weight loss
- Appetite loss
Clinical investigations
- Suspected acid reflux - patient put this down to “returning to work after maternity leave and losing baby weight.”
- Chest X-ray revealed large left lung abscess - Lucy was prescribed a 7-week course of IV antibiotics - with no improvement.
- Lung biopsy - abnormal cells attributed to infection. Tests for autoimmune conditions, tropical diseases, HIV.
“It was so bizarre that all of these extreme causes were considered more plausible than lung cancer. It felt like the only reason lung cancer wasn’t being investigated was because I was young and had never smoked.
“I was told repeatedly I didn’t fit the profile and the abnormal cells which showed up on my first lung biopsy were disregarded as infection.” said Lucy.
Diagnosis
It wasn’t until the following January that Lucy’s cancer was found. A second biopsy revealed cancer cells and Lucy underwent emergency surgery where a ‘cricket ball’ sized tumour was removed from her left lung.
A month later Lucy’s symptoms returned and her prognosis was terminal. She was offered palliative chemotherapy to prolong her life.
During a follow up scan Lucy remarkably showed signs of remission, and remains cancer free 14 years later.
Charity chief executive, Paula Chadwick, said: “It is vital we share stories like Lucys, not to point fingers or blame but to help educate and stop this from happening to anyone else.
“Lucy’s story is exactly why we need to let go of the labels and simply recognise that lung cancer, like other cancers, can happen to anyone whether they have smoked or not.”
GP Reflections
Our GP Fellow, Hannah Ward from West Timperley Medical Centre, has reflected on this patient with practical advice for primary care staff to help diagnose lung cancer earlier.
“A significant message of this case is that the absence of the typical risk factors for lung cancer does not exclude the disease.
“This case re-iterates that when a patient presents with a seemingly benign symptom, it is important to ask about any associated symptoms and adopt a robust safety netting approach.
“It is helpful to outline a time in which we would expect the symptom to have resolved or improved, so this gives the patient a clear plan of knowing when to return to the GP.
“Adopting a ‘three strikes and you’re in’ mentality can be useful in cases such as these, if a patient recurrently re-presents with non-specific symptoms that are not improving, further tests should be considered.”
You can read Lucy's full story here.
