Man had teeth, half a lung removed after ‘missed opportunities’ to pick up rare cancer

A man had to have his teeth and half of his lung removed due to a rare cancer which a GP had “two missed opportunities” to diagnose at an earlier stage.

On Monday, Deputy Health and Disability Commissioner Dr Vanessa Caldwell, found a GP’s management of a lump on a man’s neck at two appointments in 2021 breached the patients’ rights code.

The man – then in his 50s – had a lump on his neck for about a year; but it had been increasing in size, become more tender in the preceding three months, and was causing difficulty swallowing liquids.

At the first appointment in February 2021, the GP failed to urgently refer the man to a specialist, or arrange for the lump to be investigated, the report stated.

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The doctor noted that the man was a smoker, and had poor dentition (the condition, arrangement, and/or character of the teeth).

Her initial impression was that the lump was an enlarged lymph node – not uncommon due to dental concerns, the report stated.

It was the last day of the GP’s first week at that medical centre: having moved to New Zealand after studying and practising medicine overseas.

At the second appointment six months later, the lump was still present, and hadn’t “really changed”.

It wasn’t explained by any other symptoms, but again, the GP failed to refer him on to a specialist for review, or provide him with follow-up advice, the report said.

Some months later, the man sought further medical attention before moving overseas.

When the lump was finally biopsied in April 2022, the man was diagnosed with adenoid cystic carcinoma – a rare cancer of the salivary gland.

It had metastasised (spread) to his lung.

The man told the HDC he has undergone two operations to his neck, and had his teeth and half of one lung removed as a result.

He told the HDC his specialist team said lung surgery and the loss of his teeth could have been avoided if the lump had been dealt with appropriately 12 months earlier.

He said his cancer continues to require “aggressive surgical treatment”, and in June 2022, he said he’d been advised he had 3–5 years to live.

Caldwell found the GP breached a patients’ right to have services provided with reasonable care and skill, by failing to urgently refer the man for specialist review and/or investigations of his neck lump in line with accepted practice and relevant clinical guidance.

Although the man’s cancer was a rare, slow-growing type – often hindering early diagnosis – his neck lump was “persistent and significant in size”, with no clear cause at either appointment, Caldwell said.

“There were two missed opportunities to diagnose his cancer at an earlier stage.”

She noted that the GP had only very recently arrived in New Zealand at the time of the first appointment, and the GP told HDC she was still learning the processes of a new country.

Caldwell said, however, that the GP accepted there did not appear to be substantial differences between neck lump guidance in her home jurisdiction, and in New Zealand.

The GP was “truly sorry” for the man’s delayed diagnosis, and pain.

She had made several changes to her practise, would be undertaking an audit, and provided a written apology to the man, the report stated.