Delayed Cancer Diagnosis Raises Questions About Recognising Warning Signs in Primary Care
A Scottish healthcare watchdog has criticised an unnamed medical practice in the Highlands after finding that a patient who later died from pancreatic cancer experienced an unreasonable delay in receiving appropriate investigation and referral.
The case has raised concerns about how warning signs of serious illness are recognised in primary care, particularly when symptoms can initially resemble more common conditions. The Scottish Public Services Ombudsman, or SPSO, said there were several missed opportunities to identify the significance of the patient's symptoms before an urgent cancer referral was eventually made.
Concerns began with unexplained weight loss
According to the case reported in August 2026, the patient, referred to as "A" in the watchdog's report, initially sought medical attention after experiencing unexplained weight loss. They were diagnosed with diabetes.
However, their symptoms continued over the following months. The patient subsequently raised the possibility that pancreatic cancer could be responsible for their illness.
Rather than receiving an immediate cancer-focused investigation, the patient was referred to specialists dealing with stomach and digestive disorders. Blood tests later contributed to the diagnosis of pancreatic cancer.
The diagnosis came relatively late in the patient's illness. They died approximately six weeks after the cancer was identified.
The SPSO concluded that the practice had taken too long to recognise the significance of symptoms that should have prompted further investigation.
Watchdog identifies missed opportunities
The ombudsman obtained independent advice from a GP as part of its investigation into the care provided.
Its findings were particularly significant because the symptoms were considered to include warning signs associated with pancreatic cancer. The investigation found that relevant clinical guidance was clear that the patient had symptoms that should have raised concern.
The SPSO said there were opportunities throughout the patient's care to recognise the potential seriousness of the symptoms and arrange further investigation.
This does not necessarily mean that an earlier diagnosis would certainly have changed the patient's outcome. Pancreatic cancer can be aggressive, and its prognosis varies considerably depending on the stage at which it is discovered, whether it has spread and a person's general health.
However, the watchdog's concern was that the pathway followed by the patient did not meet the standard that should reasonably have been expected.
The practice has been asked to apologise to the patient's family for what the SPSO described as an unreasonable delay in recognising symptoms that could indicate cancer.
Why pancreatic cancer can be difficult to identify
Pancreatic cancer is often challenging to diagnose because its symptoms can be vague and may overlap with numerous other health conditions.
The NHS lists unexplained weight loss, loss of appetite, tiredness, digestive problems, nausea, vomiting, changes in bowel habits, abdominal or back pain and jaundice among possible symptoms. Not everyone with pancreatic cancer will experience these symptoms, and many can also be caused by illnesses that are not cancer.
This makes diagnosis particularly difficult in primary care, where doctors regularly see patients with common conditions that can produce similar symptoms.
The difficulty is also reflected in the NHS guidance on pancreatic cancer. The NHS says the disease can be difficult to treat and that treatment options can include surgery, chemotherapy, radiotherapy and supportive care. The appropriate approach depends on factors including the size and location of the cancer, whether it has spread and the patient's general health.
The important issue in cases such as this is therefore not simply whether one particular symptom means cancer is present. Instead, doctors need to consider the combination of symptoms, how they develop over time and whether they persist despite treatment for an initial diagnosis.
Investigations can involve several different tests
When pancreatic cancer is suspected, a diagnosis normally requires further investigation.
NHS guidance states that tests can include blood tests and imaging such as ultrasound, CT, PET or MRI scans. In some circumstances, specialists may also use a biopsy, endoscopic ultrasound or other procedures to establish what is happening in the pancreas and surrounding organs.
The process can take time because pancreatic symptoms are not always straightforward and other conditions need to be considered.
That makes communication between patients, GPs and specialists particularly important. If symptoms persist, worsen or change, the original explanation may need to be reassessed.
The NHS advises people to contact their GP if they have noticeable unexplained weight loss or symptoms associated with pancreatic cancer that worsen or do not improve. It also stresses that having these symptoms does not automatically mean a person has cancer.
Concerns about end-of-life care
The SPSO's criticism extended beyond the delay in recognising the possible cancer.
The watchdog also found that the assistance provided around end-of-life and palliative care was unreasonable. It criticised what it described as an unreasonable standard of support and an excessive reliance on telephone consultations.
For someone approaching the end of life, good communication and appropriate support can be just as important as the medical investigation itself. Patients and families may need help understanding what is happening, managing symptoms and making decisions about treatment and comfort.
The NHS says that people with advanced pancreatic cancer may be referred to a specialist palliative care team. Such teams can help control symptoms and provide support to patients and their relatives.
A wider lesson for healthcare
The case illustrates one of the difficulties facing modern primary care. Doctors must make decisions based on symptoms that may have several possible explanations, while ensuring that serious conditions are not overlooked.
A diagnosis such as diabetes may explain some symptoms, but if a patient's condition continues to deteriorate, clinicians may need to reconsider the original diagnosis.
The SPSO said the Highland practice had responded constructively to the family's complaint and to the ombudsman's inquiries. The recommendation for an apology is intended to acknowledge the shortcomings identified in the investigation and provide some recognition to the family.
Cases investigated by healthcare watchdogs do not necessarily mean that an individual clinician acted deliberately or negligently. They can instead highlight weaknesses in clinical decision-making, communication or systems that need to be addressed.
For patients, the case also demonstrates why persistent or unexplained symptoms should not simply be ignored. Anyone worried about ongoing symptoms should seek medical advice and explain clearly if symptoms are changing or failing to improve.
Ultimately, the investigation is a reminder that early recognition of serious disease can depend on noticing patterns rather than focusing on a single symptom. Pancreatic cancer remains difficult to detect, but persistent unexplained weight loss and other warning signs warrant appropriate medical assessment.
Sources
- Scottish Public Services Ombudsman, Decision Report 202401263, August 2026. Case concerning delays in recognising pancreatic cancer symptoms at a medical practice in the Highland NHS Board area.
- NHS, Pancreatic Cancer: Symptoms. Information on symptoms and when patients should seek medical advice.
- NHS, Pancreatic Cancer: Tests and Next Steps. Information about investigations used when pancreatic cancer is suspected.
- NHS, Pancreatic Cancer: Treatment. Information about treatment options and the challenges associated with pancreatic cancer.
- STV News, GP mistook pancreatic cancer symptoms for diabetes, leading to treatment delay, August 2026.
- BBC News, Unreasonable delay in spotting cancer in patient who later died, August 2026.
Disclaimer
This article is intended for general informational purposes only and should not be considered medical advice. The patient and medical practice discussed in the report have not been identified by name. The findings described are those of the Scottish Public Services Ombudsman and should not be interpreted as establishing that an earlier diagnosis would definitely have changed the patient's outcome.