Boyes Turner’s cancer claims solicitors secured a £115,000 settlement for a woman in her sixties who developed vulval cancer following negligent advice and delayed treatment for VIN3, the highest grade of pre-cancerous vulval intraepithelial neoplasia. Urgent referral to NHS hospital gynae-oncologists after VIN2 and focal VIN3 biopsy result Our client visited her GP after developing vulval lesions. She opted to be referred to a private gynaecologist owing to the long wait for an NHS appointment. A week later she was seen by a private gynaecologist who noted whiteness and breakdown of the surface of her vulval skin. A biopsy was taken which revealed VIN2 pre-cancerous skin changes with small ‘focal’ areas of VIN3. The private gynaecologist made a two-week-wait (2WW) referral to the gynae-oncology team at our client’s local NHS hospital, highlighting her need for monitoring, treatment and possible local excision surgery following the VIN2 and VIN3 biopsy result. Hospital gynaecologist fails to advise patient of cancer risk from VIN3 or offer surgery Our client was reviewed at the hospital by a consultant gynaecologist, who noted that her symptoms had improved using Dermovate cream. His examination revealed multiple raised, soft, white lesions. Instead of telling her about her risk of cancer from the VIN3 biopsy result and offering her the option of surgical excision to reduce that risk, he advised her to use emulsifying ointment and soap substitute instead of Dermovate, and arranged to review her six months later. At her next review, the gynaecologist noted that she had diffuse, white, raised, granular lesions with acetowhite staining suggesting high-grade pre-cancerous change. Multiple vulval and perineal biopsies were taken and revealed VIN1/2, VIN2, VIN3 and HPV-related changes. The consultant wrote to our client and told her about the VIN2 diagnosis, but failed to mention the more dangerous perineal VIN 3 result. He continued to review her six monthly, during which he treated her symptoms with medication. Delays in treatment for VIN3 lead to vulval cancer There was then a year within which our client was not reviewed, owing to the hospital’s failure to send her a follow-up appointment. She sought help from her GP, who referred her back to the consultant gynaecologist at the hospital. By the time she was seen she had an area of raised epithelium close to the posterior fourchette of the vulva. The gynaecologist took a punch biopsy under local anaesthesia which revealed moderately differentiated squamous cell carcinoma (vulval cancer). She was referred to a specialist cancer centre at another hospital, where she was seen by a consultant gynaecological oncologist who confirmed the diagnosis of carcinoma of the vulva. Our client needed radical posterior vulvectomy surgery to remove the 4cm x 3cm tumour, and sentinel lymph node assessments involving the removal of lymph nodes from both groins for biopsy. Histology reported that the tumour was a Stage 1b, Grade 2, keratinising, squamous carcinoma of the vulva with lichen sclerosus. Chemotherapy and radiotherapy leave lasting injury In addition to her surgery, our client needed chemotherapy and adjuvant radiotherapy. She suffered post-treatment complications including breakdown of her wound, a lymphocyst, vulvodynia and radiation fibrosis. She needed pain management support from the chronic pain team. She was left with tinnitus (from her chemotherapy) and permanent injury to her vulva and perineum, affecting her bowel and bladder function, and introital stenosis (making sexual intercourse impossible). She suffered a psychological injury. She has a 10% risk of the cancer recurring within five years, and a small but lifelong increased risk of developing a new cancer as a consequence of the pelvic irradiation. Claim leads to admissions of liability and settlement We helped our client pursue a claim against the hospital on the basis that their consultant gynaecologist had repeatedly failed to advise our client of her cancer risk from the VIN3 biopsy findings. He had failed to offer her surgical excision (which she would have accepted) as an alternative to the medication she was receiving for her vulval symptoms. In addition, we alleged that he had failed to investigate the relapse of her symptoms during his regular reviews, and that our client’s cancer diagnosis and treatment was further delayed by the hospital’s administrative failure to provide her with a follow-up appointment . As a result of the negligent advice and delays in treatment for her pre-cancerous VIN3, our client developed vulval cancer and needed more extensive surgery, chemotherapy and radiotherapy, which caused her permanent disability. NHS Resolution’s letter of response made limited admissions of negligence but denied the causation of our client’s injury. We issued proceedings on the same basis as our letter of claim, supported by medical evidence relating to our client’s injury, condition, prognosis and loss. We then received a defence from NHS Resolution fully admitting liability. Their defence was followed by an offer to settle the claim. Further settlement negotiations resulted in a £115,000 settlement for our client. If your child has cerebral palsy or neurological disability as a result of medical negligence, or you have been contacted by HSSIB/MNSI or NHS Resolution, you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
