Cervical cancer negligence claims

Women (and people with a cervix) with suspected cervical cancer or pre-cancerous changes to the cells on the surface of the cervix (dyskaryosis, cervical dysplasia or cervical intraepithelial neoplasia/CIN), have the right to be referred urgently to a cancer specialist (oncologist) for further investigations, diagnosis and appropriate treatment. This is because most grades of CIN carry a high risk of developing into cervical cancer and early-stage cervical cancer will grow, spread and become life-threatening if left untreated over time.

Treatment with surgery at the pre-cancerous or early cancer stage can be very effective, allowing the woman to return to a healthy quality of life. As the cancer progresses, more radical treatment may involve chemoradiotherapy (chemoradiation), radiotherapy or brachytherapy (internal radiotherapy), which can cause painful and distressing disability from bowel, bladder and sexual dysfunction, loss of fertility and psychological injury. Delays in treatment also increase the risk of the cancer recurring after treatment or spreading to other areas of the body (metastasis).

When a patient’s cancer progresses from a pre-cancerous CIN or early cancer condition to a more advanced cancer during negligent delays in their journey from screening or first symptoms to eventual treatment, a cervical cancer negligence claim can provide compensation for any additional severe injury or disability that was caused by the errors in treatment. In most cases, this means that a woman who should have been treated successfully at an early stage with minor surgery but needed radical treatment owing to healthcare errors or delay can claim compensation for the disability caused by more extensive surgery, chemoradiation, or brachytherapy treatment.

A diagnosis of cervical cancer usually includes the type or origin of the cancer, as well as the grade or stage. The two most common types of cervical cancer are ‘squamous cell carcinoma’, which develops from the cells that cover the outside of the cervix at the top of the vagina, and ‘adenocarcinoma’ which develops from cells in the cervical canal. Rarely, a diagnosis might refer to other types of cervical cancer.

The three grades of cervical cancer (1-3) describe the level of abnormality of the cancer cell, how fast it grows and if it is likely to spread. The stage refers to the size of the cancer and how far it has spread from its starting place.

Cervical cancer has four main stages, which are often further subdivided to provide more detailed information about the cancer’s size. The main four stages are:

• Stage 1 - the cancer cells are only within the cervix.
• Stage 2 - the cancer has spread into the top of the vagina or the tissues surrounding the cervix.
• Stage 3 - the cancer has spread to the lower part of the vagina, pelvic wall or lymph nodes.
• Stage 4 - the cancer has spread to the bladder or bowel or to other areas of the body beyond the pelvic area.

Stages 1A to 1B1 are also known as early-stage cervical cancer. Stages 1B2 to 4A are sometimes known as locally advanced cervical cancer, and stage 4B is known as advanced-stage or metastatic cervical cancer. If the cancer returns after initial treatment, this is known as recurrent cancer.

The choice of treatment for a patient with cervical cancer will depend on the cancer’s grade and stage. Early-stage cervical cancer is often treated surgically, such as by large loop excision, cone biopsy, trachelectomy (removal of the cervix) or hysterectomy (removal of the uterus or womb). Patients with more advanced cervical cancers may need treatment with chemoradiotherapy, radiotherapy and brachytherapy (internal radiotherapy).

CIN is an abbreviation of cervical intraepithelial neoplasia and is also known as cervical dysplasia. CIN is not cancer but should be monitored and treated as a pre-cancerous condition, because CIN refers to abnormal changes in the cells on the surface of the cervix which, if untreated, can develop into squamous cell cervical cancer. The main cause of CIN is human papillomavirus (HPV).

CIN does not cause symptoms, which means that women (or people with a cervix) will not know that they have it unless it is detected during cervical screening. CIN is not diagnosed from a smear test, but if a smear test reveals that the patient has abnormal cells on their cervix, a further test called a colposcopy (an internal examination of the cervix often combined with a biopsy) can lead to a CIN diagnosis.

CIN is graded from 1 to 3 according to how deeply the cervical surface is affected by abnormal cells:

• CIN1 is the lowest grade. A diagnosis of CIN1 should always be followed up with repeat smear tests or colposcopies but may return to normal without treatment. If treatment is needed to remove or destroy the abnormal cells after a diagnosis of CIN1, it is usually effective.
• CIN2 is sometimes called high-grade or moderate dysplasia and has a higher risk that the abnormal cells will develop into cervical cancer if untreated. Treatment for CIN2 can involve loop electrosurgical excision procedure (LEEP), or cone biopsy.
• CIN3 is also known as high-grade or severe dysplasia, however, CIN3 is not cancer. CIN3 must be treated, such as with loop electrosurgical excision procedure (LEEP) or cone biopsy, to remove or destroy the abnormal tissue and prevent cancer from developing in future.

If negligent delays in monitoring, following up or treating CIN result in the patient developing cervical cancer and requiring more invasive treatment, the injured patient may be able to claim compensation.

HPV or human papillomavirus is an infection that can be passed from person to person by any form of skin-to-skin or sexual contact. HPV infection is very common and affects a large proportion of the population, but because it does not cause symptoms, people who are infected with HPV are often unaware that they have it.

There are hundreds of different strains or types of HPV and, for most people, HPV is harmless. Those with strong immune systems can clear their body of HPV infection within one or two years, but others will remain infected by HPV. Some strains of high-risk HPV cause pre-cancerous changes in the cells of the cervix (dyskaryosis) if they remain in the body over time. If undetected or left untreated, dyskaryotic cells can lead to cervical cancer. Almost all (99.7%) incidences of cervical cancer are now known to be caused by high-risk HPV. In fact, it is very rare for people who do not have HPV infection to develop cervical cancer. Where it happens, this could be because the type of cervical cancer is very rare, or because cervical screening has incorrectly failed to detect or follow up signs of HPV infection.

Cervical screening (smear tests) now include primary testing for high-risk HPV. This helps identify people with high-risk HPV, so that they can be monitored for early signs of dyskaryosis. If a smear test reveals that a patient is infected with high-risk HPV, the same sample is then examined in a laboratory (cytology) for any abnormal, pre-cancerous cell changes. If abnormal cells are found, the patient should be contacted and invited to have their cervix carefully examined via a colposcopy procedure to decide whether further treatment is needed. If the patient has HPV but there are no cervical cell changes, they should be recalled and monitored at closer intervals via further cervical screening.

As high-risk HPV infection is now known to cause most cervical cancers, HPV vaccination is now being used, very successfully, to reduce the number of women who develop HPV-related cervical cancers.

Cervical cancer medical negligence claims often involve one or more of the following mistakes in the patient’s care:

• delayed recognition of red flag, signs and symptoms of cervical cancer;
• delay or failure to refer the patient for investigations or specialist care;
• failures, delays, or errors (misdiagnosis) in the diagnosis of cancer;
• failure to request, carry out, chase up or follow-up tests or investigations;
• misinterpretation or incorrect reporting of test results (smears, scans, biopsies, blood tests);
• delayed surgery or other treatment;
• use of incorrect treatment, dose, or technique;
• communication and follow-up errors (failing to follow up or recall a patient after abnormal screening or test results).

Cervical cancer claims aim to compensate the injured woman for the additional, avoidable injury and long-term disability that she suffers as a result of negligent mistakes and delays in her medical care. In most cases arising from delays in referral, investigation, diagnosis or treatment of cervical cancer, the injury and disability will be associated with the need for more invasive treatment, such as chemoradiation, radiotherapy, or brachytherapy.

Injuries which commonly lead to cervical cancer compensation claims include:

• impaired bowel function or incontinence;
• impaired bladder/urinary function or incontinence;
• sexual dysfunction and/or loss of fertility;
• chronic severe pain;
• PTSD and psychological injury;
• metastasis (the spread of cancer to other parts of the body);
• complications from radiotherapy or chemotherapy (neutropenic sepsis):
• burns, scarring or extravasation injury;
• recurrence of cancer or increased future risk of recurrence;
• fatal injury.

Cervical cancer claims usually involve compensation for one or more of the following injuries, needs and financial losses that were caused by the negligent healthcare:

• additional pain, suffering and disability;
• medical treatment and therapies;
• costs of fertility treatment, such as IVF;
• home adaptations or specialist equipment, e.g. to improve bathroom accessibility;
• costs of care and household assistance;
• psychological counselling;
• financial losses, such as loss of earnings.

Where the negligent care resulted in the patient’s death, their bereaved, dependent family also may be able to claim compensation for funeral expenses, a statutory bereavement payment and the loss of their income or ‘services’, such as childcare, housework, gardening or DIY.

Cervical cancer claims and the medical experts’ reports that we use to support them often contain professional terminology (jargon) which can be hard to understand.

Our solicitors will try to avoid using complex medical terminology when discussing your claim with you or will provide a clear explanation where it is necessary to use a specific term.

We have also put together a list of some of the medical terms that are commonly used in cervical cancer claims, with a brief explanation of their meaning and context.

A

Adenocarcinoma – A type of cervical cancer that develops from glandular cells in the cervix.

Adenosquamous carcinoma – A rare type of cervical cancer that features both squamous cells and glandular cells.

B

Biopsy – A procedure in which a small sample of cervical tissue is removed and examined under a microscope for cancer or pre-cancerous changes.

Brachytherapy - A type of internal radiation therapy where a radioactive source is placed inside or near the tumour.

C

Carcinoma in situ (CIS) - Abnormal cells which appear cancerous under a microscope but have not yet spread beyond the surface of the cervix. CIS is also known as Stage 0 cancer.

Cervical Intraepithelial Neoplasia (CIN) - A term for pre-cancerous changes in the cervix, graded as CIN 1 (mild), CIN 2 (moderate), or CIN 3 (severe, high risk for cancer).

Cervical Screening - A screening test that checks for abnormal cervical cells that may indicate cancer or pre-cancerous changes. Cervical screening (or smear test) may also involve primary testing for HPV.

Chemotherapy - A treatment that uses medicines to kill cancer cells.

Chemoradiotherapy (also known as Chemoradiation) – A combination of both chemotherapy and radiotherapy used to treat more advanced cervical cancer.

Colposcopy – A procedure in which a magnifying instrument (colposcope) is used to examine the cervix for abnormalities. Colposcopy procedures sometimes also include taking a biopsy.

Cytology – Laboratory examination of cell structure under a microscope.

D

Dysplasia – Abnormal cell growth that may develop into cervical cancer if left untreated.

Dyskaryosis – Abnormal cells indicating pre-cancerous change.

E

Endocervical Curettage (ECC) – A procedure in which cells from the inner part of the cervix (endocervical canal) are scraped and examined.

Epithelium – The thin layer of cells covering the cervix (where most cervical cancers begin).

Excisional Procedure - A method of removing abnormal cervical tissue, such as LLETZ or cone biopsy.

H

Histopathology – Microscopic examination of changes in cells and tissues to diagnose and study disease.

HPV (Human Papillomavirus) – A common, symptomless infection, passed from person to person by sexual contact, that is the primary cause of cervical cancer.

HPV Test – A screening test that detects high-risk HPV strains linked to cervical cancer.

HPV Vaccine – A preventive vaccine that protects against HPV infection and reduces the risk of cervical cancer.

Hysterectomy – Surgical removal of the uterus (womb). Hysterectomy, with removal of the cervix, is sometimes used to treat cervical cancer.

I

Invasive Cervical Cancer – Cancer that has spread beyond the cervix.

L

LLETZ (also known as LEEP - Loop Electrosurgical Excision Procedure) – A treatment that removes abnormal cervical tissue using a thin, electrically charged wire loop.

M

Metastasis – The spread of cervical cancer cells from the cervix to other parts of the body.

P

Pre-cancerous Lesion – Abnormal cervical cells that are not yet cancerous but may develop into cancer if untreated.

R

Radical Hysterectomy – A surgical procedure that removes the uterus, cervix, parts of the vagina and surrounding tissues.

Radiotherapy – A treatment that uses high-energy radiation to destroy cancer cells.

S

Small Cell Carcinoma – A very rare type of cervical cancer that develops in hormone-producing cells.

Smear Test – A cervical screening test that checks for abnormal cervical cells that may indicate cancer or pre-cancerous changes. Cervical screening may also involve primary testing for HPV.

Squamous Cell Carcinoma – The most common type of cervical cancer, arising from squamous cells in the cervix.

Staging – The process of determining the extent of cancer spread, from Stage 0 (pre-cancerous) to Stage IV (advanced cancer).

T

Trachelectomy – A surgical procedure to remove the cervix.

Tumour – An abnormal mass of tissue that can be benign (non-cancerous) or malignant (cancerous).

Total hysterectomy – The removal of both the uterus and cervix, used to treat cervical cancer.