Man's cancer misdiagnosed as sciatica pain. Are docs to blame?
Key Takeaways
A man in the UK was misdiagnosed with sciatica pain. Three years later, doctors discovered he had sarcoma.
There are a variety of different types and presentations of sarcoma, and some tumors are easier to spot than others—increasing risks for missed or incorrect diagnoses.
Doctors should be sure to reevaluate patients or conduct imaging scans if a patient is not improving from treatment—and look into the possibility of a misdiagnosis.
A malignant mass, or tumor, can be a sign of sarcoma. Sarcoma tumors can present in different sizes and locations on the body, making some easier to find than others. When tumors are on the smaller side or buried deep beneath tissues, they can go undetected, causing doctors to miss or delay a cancer diagnosis.
A man in the United Kingdom recently spoke with the BBC about his experience with a missed sarcoma diagnosis.[] According to the BBC, the man had a sarcoma tumor in the soft tissue of his leg that was initially misdiagnosed as sciatica: pain in the sciatic nerve, which runs from the lower back to the feet. It wasn’t until 3 years later, when they tried to drain what they thought was a “fluid-filled sac” on the man’s leg, that doctors discovered a sarcoma tumor.
The experience was “genuinely terrifying,” the man told the BBC.[] “You think it would happen to someone else,” he said. “It was really hard to hear."
How can sarcoma be misdiagnosed?
Wael Harb, MD, a board-certified hematologist and medical oncologist at MemorialCare Cancer Institute – Orange Coast and Saddleback Medical Center in Orange County, CA, says that sarcoma diagnoses can be missed or delayed due to the rarity of the cancers.
According to the Sarcoma Foundation of America, sarcoma accounts for 1% of all adult cancers diagnosed in the US and 15% to 20% of childhood cancers.[] While it may be seen as a good thing that rates are low, Dr. Harb explains that this can also result in doctors being unequipped to look for sarcoma tumors—or not having the cancer top of mind while evaluating a patient.
Size and placement of the tumor can also impact diagnosis. For instance, a large tumor that protrudes from the body can alert doctors—and patients—to look into the cause and check for cancer. A smaller tumor that is buried deeper in the body, however, may not provide such obvious signs.
“The presentation can be very different, and the average physician might not think about [sarcoma] when they see a patient, but these are some things that we have to think about,” Dr. Harb says. “A lot of sarcoma can present as a lump, but if the tumor is deep, it might not be obvious as a lump,” he adds.
Importance of early diagnosis for sarcoma
As with most conditions, early detection of sarcoma can mean early treatments and interventions. Early detection can also enable doctors to remove tumors before they metastasize, or spread to other places of the body.
Unfortunately, there is not a set timeframe for exactly how “early” is recommended. This is because the rate at which a sarcoma tumor metastasizes can vary greatly due to the range of types of sarcoma, Dr. Harb says.
“Sarcoma really encompasses several—dozens—-of different cancers, and they can have totally different behaviors,” Dr. Harb adds. “Some of them are very slow-growing and some of them are very aggressive and fast-growing and metastasize early.”
With this in mind, conducting proper exams—like MRIs or PET scans—to look for suspected tumors and talking to patients about symptoms can be crucial in catching a rare case before it gets out of hand.
For patients who feel their doctors are not taking their situation seriously or properly evaluating their condition, Dr. Harb encourages them to be their “own advocate[s].”
“It’s important to pursue things further and get a second opinion when no diagnosis is made because there's something causing these symptoms, and it could be cancer, but not always,” Dr. Harb says.
Sarcoma and sciatica confusion
In the case of the man in the UK, Dr. Harb says that the tumor appeared to be buried in a harder-to-detect location. It also seemed to be located near the sciatic nerve, which may have been the reason doctors thought he was experiencing sciatica, Dr. Harb adds.
But while there may have been some reasoning behind the initial confusion, Dr. Harb adds that the doctors should have asked more questions about the patient’s situation and symptoms, and reevaluated him in a timely manner.
Between the man’s incorrect sciatica diagnosis and his eventual sarcoma diagnosis 3 years later, he underwent treatment for sciatica, including physiotherapy, x-rays and shockwave therapy, according to the BBC.
“If you treat the symptoms for several weeks and they’re not improving, then [they] have to consider that maybe it's not sciatica,” Dr. Harb says. “If the pain is persistent, if the pain is not resolving, or if it's increasing, that should trigger [doctors] to do more imaging, and that would help find this cancer earlier.”
What this means for you
If you diagnose and treat a patient for one condition and notice they are not getting better, it is important to reevaluate them in a timely manner. While rare, cancers like sarcomas can be at times mistaken for other conditions, delaying diagnosis and treatment.