Too young for cancer. Case in the media highlights challenge of diagnosis

The case of a 29 year old scientist who died of bowel cancer has been highlighted in the press because her brother is planning to raise funds for the World Cancer Research Fund.

A doctor who was told she was too young to get bowel cancer died after being sent home and misdiagnosed with bowel disease.” Doctor, 29, died of cancer after being told she was too young to have disease. Daily Telegraph, May 27th 2014

After suffering from stomach pains so severe she was forced to miss part of her brother’s wedding day, Suzanne was initially told by doctors she could not be suffering from bowel cancer as she was so young. She was instead diagnosed with an inflammatory bowel condition.” Tragic former Chatham pupil Dr Suzanne Gould died of bowel cancer after being told she was too young to have disease. Kent Online May 27th 2014

Tragic Suzanne Gould badgered family doctors for six months because of severe stomach pain but was told she had Crohn’s disease. In fact, she had terminal bowel cancer and died 18 months later.”  Brother of tragic doctor ‘too young for cancer at 29’ to raise money in her memory. Daily Express, May 28th 2014.

In 2012, my sister Suzanne, started to have bad stomach pains and other ailments. The doctors refused to believe she had bowel cancer because she was too young, however in November 2012 she was rushed to A&E where a cancerous tumor was removed, and her fight to get better began.” Rob Newton’s JustGiving page.

PhD, married, with kitten called Poppy, fighting bowel cancer previously misdiagnosed as Crohns disease. Hoping to raise awareness in the relatively young” @Dr_SooziG Twitter profile.

These types of cases – and others reported in BMJ Case Reports(1,2,3) – of younger patients presenting with symptoms where the underlying cause is malignancy are a challenge for diagnosis and there is no simple way of addressing it. Clinical examination may be normal which may lead the practitioner to be less likely to investigate. “Raising awareness” is often a phrase that is mentioned when these cases are presented at medical meetings. It helps, but by itself it doesn’t seem sufficient. Fine-tuning your “Index of suspicion” is something that can be achieved by reading more case reports … and seeing more, listening to and learning from patients in your clinical practice.

1. Raghunath Prabhu, Neha Kumar, Sunil Krishna, Rajgopal Shenoy. Primary colonic signet ring cell carcinoma in a young patient. BMJ Case Reports 2014:published online 20 March 2014, doi:10.1136/bcr-2013-200587

2. Syed Tausif Ahmed, Sudipto Kumar Singh, Tanmoy Mukherjee, Manju Banerjee. Breast carcinoma in a prepubertal girl. BMJ Case Reports 2014:published online 15 April 2014, doi:10.1136/bcr-2013-203251

3. Anna Freeman, David Weeden, Jane Wilkinson, Ramesh J Kurukulaaratchy. An unusual bronchial obstruction in a fit young man. BMJ Case Reports 2013:published online 9 January 2013, doi:10.1136/bcr-2012-007766