Early diagnosis is key for pancreatic cancer, says EITHNE DONNELLAN, Health Correspondent
STEPHEN MCGOVERN wasn’t feeling 100 per cent in the summer of 2008. He had heartburn and muscular back pain which seemed to radiate down the side of his leg. He also began to complain of abdominal pain and made several visits to his GP that August and September.
An appointment was made for him to attend Sligo General Hospital. There followed a series of hospital visits at the outpatient and emergency department in October and November and eventually in December, on his sixth visit after he presented again in pain at the emergency department, he was admitted for investigation of his symptoms. A colonoscopy was performed and he was diagnosed with pancreatic cancer. There was already a secondary tumour in the bowel. He died less than two months later, aged just 43.
For the Co Cavan-born musician’s partner and family his death left many questions, not least could his cancer have been picked up earlier and, if it was, would his outcome have been different? His family, says brother Joe, is not looking for an inquiry. Their aim in telling his story is to raise awareness of the signs of pancreatic cancer among patients and doctors so that it might be picked up more rapidly in other cases.
Having reviewed Stephen’s medical file, Joe McGovern says the family “remain concerned at what might have been the failure at a number of checkpoints along the way”. It appears when kidney stones were found following a scan at Sligo General his pain may have been attributed to this, without other possibilities considered. They hope medics, who take a look at his file, will learn something from the way in which his case was managed during five initial presentations to the hospital and several presentations at a GP’s surgery over a five-month period.
Much has been written about pancreatic cancer since Brian Lenihan was diagnosed with the condition. Many have pointed to the fact that more often than not vague symptoms lead to it being picked up late. But the McGovern family wonders could patients be examined more thoroughly on initial presentation to ensure it is picked up earlier.
The family “were certainly at a loss as to how Stephen presented himself to the hospital six times and that it took so long to admit him and make a full proper diagnosis”, says Joe McGovern. Stephen spent his final days in the North West Hospice, Sligo, where care was excellent and his friends have now put together a CD to raise funds for the facility.
He was a public patient. Mr Lenihan is a private one. But the minister, who received his diagnosis within days of presenting for tests at Dublin’s Mater Private, said as far as he could see, the public and private ends of the Mater provided the same standard of service to all. Some of his tests were carried out in the public hospital.
Speaking on RTÉ, he said his diagnosis had brought home to him the need for large multi-disciplinary teams of consultants in a small number of key centres to look after cancer patients. “It leads to rapid diagnosis and treatment for persons affected by cancer and the idea that you can have a first class cancer service which is distributed in small packets all around the country is clearly a wrong idea. I got a rapid diagnosis in the same way as any public patient would have obtained a rapid diagnosis and I’m quite satisfied that a public patient in the same position as myself would have seen a very large number of consultants in the place I was in and would have received a similar diagnosis within the same period of time.”
The Irish Cancer Society says that sometimes a patient may present in a casualty department of a smaller hospital – not one of the eight designated cancer centres – and their symptoms may be relieved but the necessary investigations that might lead to a cancer diagnosis may not take place. But in its experience, if a patient, public or private, presents in a GP surgery or casualty department with acute symptoms that may be representative of cancer, they will be seen immediately.
The National Cancer Control Programme (NCCP) says plans to improve pancreatic cancer services are being finalised. Last May it announced plans to move to centralising pancreatic surgery at St Vincent’s Hospital, Dublin – it is currently performed in just six hospitals – and it’s understood this will be progressed on a phased basis this year.
In its statement last May, the NCCP said “pancreatic cancer is acknowledged as having a poor prognosis, with surgery the only curative therapy for patients. The five-year survival rate for all patients is about 4 per cent, with surgery suitable for only about 15 per cent of patients who may have a 20-25 per cent chance of cure”.
Mr Lenihan, who recently said he had cancerous tissue at the entrance to his pancreas, said doctors were not able to operate on it at this stage because it’s very close to a blood vessel. He will undergo chemotherapy and radiotherapy. Sometimes these therapies are used to shrink the tumour before surgery can be done.
One man who underwent pancreatic cancer surgery in January 2003 and is now living an active life is Joe Mooney (71) from Clontarf in Dublin. He began to feel unwell and became jaundiced, and went to the Mater Private for tests.
A cancerous tumour was found in his pancreas. He underwent a “whipple procedure”, a major operation during which parts of the pancreas, small bowel, bile duct, gallbladder and stomach are removed.
A year later a blood test indicated further problems. He was diagnosed with secondaries on the liver and was told he would need chemotherapy, but this wouldn’t cure him. “I took it as a death sentence,” he said.
After a round of chemotherapy he went to Medjugorje in May 2004, before going for a scan in June. On looking at the scan his doctor said he had had “a very dramatic response” to the treatment. But he was told to continue chemotherapy until November when a further scan gave him “the all clear”. “After what the doctor said in January I have to attribute it to a miracle I think,” he says.
Statistics in relation to pancreatic cancer are depressing. Some 452 new cases were diagnosed in the State in 2006 and 372 were diagnosed in 2007, with the vast majority in people over 55. But there were 240 deaths in 2006 and 453 in 2007.
“Most people die because they are diagnosed too late. The way it manifested in me, it manifested itself very quickly and was therefore picked up, but everybody’s cancer is different,” says Joe Mooney.
- The friends of Stephen McGovern have put together a CD to raise funds for the North West Hospice in Sligo. It is called Love will Lingerand is available to buy online at www.northwesthospiceCD2009.com
