Failure to follow routine procedures recording the spread of cancer may have cost lives, a Scottish survey reveals.
Surgeons operating on women with endometrial cancer failed to follow the recognised guidelines in assessing how far the disease had progressed in two thirds of Scottish cases studied according to a report published in the British Journal of Cancer1.
And death rates were significantly higher where guidelines were not followed.
The process known as “staging” is vital to enable correct recommendations to be made for the most suitable treatment which will depend on how far the cancer has spread.
The study was based on more than 700 Scottish women with endometrial cancer – cancer of the lining of the womb – who were diagnosed between 1996 and 1997. The recognised “staging” procedure was not followed in 446 patients.
Of these one in five women subsequently died from the disease. Where the proper guidelines were followed in the remaining patients the death rate dropped to one in eight.
The report says that the basic staging procedures are not technically difficult. Sending fluids for cytological examination (looking for cancer cells) “requires no particular skill, only to remember that they should be taken and a belief that it is worthwhile,” the report says.
The study further indicated that gynaecological surgeons specialising in cancer and generalists who had taken a specialist qualification in the last 15 years were more likely to carry out the staging process.
The report, led by Dr Simon Crawford who is a specialist registrar at the Stobhill Hospital in Glasgow, said that younger gynaecologists may have more up to date knowledge of staging procedures.
“There is a growing move towards specialisation,” said Dr Crawford. “It is important that specialists can co-ordinate their knowledge so the right treatment can be prescribed for each individual patient. This is happening more now in Scotland where patient cases are regularly discussed by a range of specialists at interdisciplinary meetings.
“Ten or 20 years ago you didn’t have that option so individuals were managing the disease. I think we are doing things better now than five or 10 years ago.”
Regarding the difference in death rates between women who had undergone the staging process and those who had not Dr Crawford pointed out that other factors such as age and the degree of progression of the tumour would also influence the outcome of survival.
Endometrial cancer is the second most common gynaecological cancer in the UK with approximately 400 cases diagnosed annually in Scotland. It has traditionally been regarded as easy to treat but 25 per cent of women will die of recurrence within five years of diagnosis.
Richard Sullivan, head of clinical programmes at Cancer Research UK, said: “This is yet further evidence of the importance of specialisation in cancer surgery in order to obtain the best patient outcomes.
“This high standard of surgical care should also always be delivered in the context of the multi-disciplinary team approach.”
- British Journal of Cancer86 (12)
In the case of endometrial cancer, staging is obtained from information collected during surgery as well as the analysis of pathological specimens that are obtained at the time of surgery. Basic obvservations should be made as to whether there is any evidence of advanced disease and peritoneal washings should be taken to allow the pathologists to evaluate whether there are any malignant cells in the abdominal/ pelvic cavity.