When ovarian cancer hides behind an endometrioma: can a delayed diagnosis support a negligence claim in NSW?
That account is not unusual. For women with a known endometrioma — a cyst on the ovary formed from endometrial tissue — the presence of an existing diagnosis can become the reason every new symptom is explained away. The endometriosis becomes a diagnostic ceiling. What lies beneath it goes unexamined.
This article examines what the clinical standard of care requires when an endometrioma is under surveillance, what the law in NSW says when that standard is not met, and what a delayed diagnosis of ovarian cancer in this specific context may mean for a legal claim.
What an endometrioma is, and why it creates a specific diagnostic risk
An endometrioma is a cyst that forms on the ovary when endometrial tissue — the tissue that lines the uterus — grows outside the uterus and attaches to the ovary. These cysts are sometimes called “chocolate cysts” because they fill with old blood that becomes dark and thick over time. Endometriomas are a manifestation of endometriosis, a chronic condition affecting approximately one in nine Australian women of reproductive age.[1]
Most endometriomas are benign. The clinical challenge is that a small but significant proportion undergo malignant transformation — meaning cancer develops within or adjacent to the cyst. According to data published by the Australian Institute of Health and Welfare, ovarian cancer is the most lethal gynaecological cancer in Australia, with a five-year survival rate of approximately 46 per cent overall.[2] That survival rate drops sharply with stage at diagnosis: women diagnosed at stage one have a five-year survival rate above 90 per cent; women diagnosed at stage three or four have a five-year survival rate below 30 per cent.[3]
The diagnostic risk specific to endometriomas is this: the cyst itself provides cover. Symptoms that would otherwise prompt urgent investigation — pelvic pain, bloating, changes in bowel or bladder function — are attributed to the known endometriosis. Imaging findings that should trigger concern are read as consistent with the existing cyst. The cancer grows. The window for early-stage intervention closes.
For more information on ovarian cancer and endometriosis, see Healthdirect Australia.
Endometrioma-associated ovarian cancer: Women with endometriosis have an approximately 1.4 to 1.8 times higher risk of developing ovarian cancer than women without the condition, with endometrioid and clear cell subtypes most commonly associated with endometrioma.[4] These subtypes are particularly relevant to the surveillance question because they arise directly from endometriotic tissue.
What the standard of care requires for endometrioma surveillance
The standard of care — the legal benchmark against which a clinician’s conduct is measured — is what a reasonably competent clinician in the relevant specialty would have done in the same circumstances. For endometrioma surveillance, that standard is not vague. It is defined by specific guidelines from the relevant specialist bodies, and it requires more than serial ultrasounds that confirm the cyst is still there.
The IOTA criteria and morphological assessment
The International Ovarian Tumour Analysis (IOTA) group has developed validated criteria for distinguishing benign from malignant ovarian lesions on ultrasound. These criteria — including the Simple Rules and the ADNEX model — assess features such as the presence of solid components, irregular internal walls, acoustic shadows, and blood flow patterns.[5] A gynaecologist or radiologist conducting surveillance of a known endometrioma is expected to apply these criteria, not simply note that the cyst persists.
What it requires: RANZCOG guidance on endometriosis management recognises the malignant potential of endometriomas and supports surveillance imaging with attention to morphological change. Clinicians managing endometriomas are expected to consider the risk of malignant transformation, particularly in women over 40, and to apply validated assessment tools when evaluating cyst characteristics on imaging.
Why this matters: A clinician who conducts serial ultrasounds without applying morphological assessment criteria, or who fails to escalate when cyst characteristics change, does not meet the standard this guidance describes.
CA-125 and the limits of its interpretation
CA-125 is a blood marker elevated in many cases of ovarian cancer. It is also elevated in endometriosis, which creates a specific interpretive trap: a clinician who orders CA-125 in a woman with a known endometrioma and receives an elevated result may attribute that elevation entirely to the endometriosis. That attribution is not always wrong. But it becomes a breach of the standard of care when the clinician fails to consider the result in the context of other clinical features — particularly morphological change on imaging, new or escalating symptoms, or a rising trend across serial measurements.
The standard does not require CA-125 to be a perfect test. It requires the clinician to interpret it properly — in context, with reference to the full clinical picture, and with appropriate escalation when the picture is ambiguous.
The surveillance interval and escalation threshold
Endometriomas under surveillance require a defined review interval. The appropriate interval depends on cyst size, morphological features, symptom trajectory, and patient risk factors including age and family history. A clinician who places a patient on annual surveillance without reassessing whether that interval remains appropriate — particularly when symptoms change — does not meet the standard.
What it requires: The ESHRE guideline recommends that clinicians managing endometriomas apply a structured approach to surveillance, including assessment of morphological features at each review, consideration of CA-125 in context, and a low threshold for surgical evaluation when features are indeterminate or when the clinical picture changes. The guideline specifically identifies the risk of malignant transformation as a reason to maintain active rather than passive surveillance.
Why this matters: Passive surveillance — repeating the same imaging at fixed intervals without applying structured assessment criteria — does not satisfy the standard this guideline describes, and a departure from it is capable of constituting a breach in a negligence claim.
Now, place the first infographic here — the diagnostic delay timeline for this specific condition.
-
1First presentation — pelvic pain, bloating, dysmenorrhoea
Symptoms consistent with endometriosis. Ultrasound confirms endometrioma. Endometriosis diagnosis made or reinforced. Standard requires: baseline morphological assessment using IOTA criteria; documentation of cyst characteristics; defined surveillance interval. -
2Surveillance phase — serial ultrasounds, symptoms attributed to endometriosis
Repeat imaging confirms cyst persists. Symptoms continue or escalate. CA-125 may be ordered and elevated result attributed to endometriosis. Standard requires: application of IOTA criteria at each review; CA-125 interpreted in full clinical context; escalation if morphological features change or symptoms worsen. -
3Symptom escalation — new features emerge (weight loss, abdominal distension, fatigue)
New symptoms appear that extend beyond typical endometriosis. Clinician continues to attribute presentation to known diagnosis. No malignancy workup ordered. Standard requires: reassessment of differential diagnosis; urgent referral to gynaecological oncology; CT or MRI; repeat CA-125 with trend analysis. -
4Delayed escalation — imaging or blood work finally ordered
CT or MRI ordered, often after patient insistence or change of treating clinician. Findings are now consistent with advanced malignancy. Standard required this step months or years earlier. The delay between step 2 and step 4 is the period under legal scrutiny. -
5Confirmed diagnosis — ovarian cancer, often stage III or IV
Biopsy or surgical staging confirms ovarian cancer. Treatment begins. The question the law asks: what stage would this cancer have been at, had the standard been met at step 2 or 3?
This timeline is illustrative of a common failure pattern. Individual cases vary. The legally significant period is the gap between when the standard required escalation and when escalation actually occurred.
Where care breaks down — specific failure patterns
The failures that allow ovarian cancer to grow undetected behind an endometrioma are not random. They follow recognisable patterns, and understanding those patterns is essential to assessing whether a particular clinical course met the standard the law requires.
Misattribution of all symptoms to the known diagnosis
A clinician who has managed a patient’s endometriosis for years develops a cognitive framework for that patient: she has pelvic pain because she has endometriosis. That framework is not wrong — until it becomes the only framework. When new symptoms emerge, or existing symptoms change in character or severity, the standard requires the clinician to reassess the differential diagnosis. Confirmation bias — the tendency to interpret new information as consistent with an existing diagnosis — is the mechanism by which this failure occurs.
She reported that the pain had changed. It was no longer cyclical. It was constant, and it had spread. Her gynaecologist documented “ongoing endometriosis symptoms” and adjusted her hormonal management. Nobody ordered new imaging with morphological assessment. Nobody considered that a change in pain character in a woman with a known endometrioma is a red flag for malignant transformation.
Serial ultrasounds without structured morphological assessment
Ultrasound surveillance of an endometrioma is only clinically meaningful if the clinician conducting or reporting the scan applies structured assessment criteria. A report that states “endometrioma unchanged, 4.2 cm” does not satisfy the standard if the radiologist or gynaecologist has not assessed the cyst for solid components, papillary projections, irregular walls, or internal vascularity — the features that distinguish a benign cyst from one undergoing malignant change.
The IOTA Simple Rules classify ovarian lesions as benign, malignant, or indeterminate based on five benign features and five malignant features assessed on ultrasound.[5] A clinician who does not apply these criteria — or who does not request that a radiologist apply them — is not conducting surveillance that meets the standard. The scan happens. The report is filed. The cancer grows. Nobody noticed because nobody was looking for the right things.
CA-125 elevation attributed entirely to endometriosis without further investigation
CA-125 is not a reliable standalone test for ovarian cancer in women with endometriosis, because endometriosis itself elevates CA-125. Every clinician managing endometrioma surveillance knows this. The problem arises when that knowledge becomes a reason to dismiss elevated CA-125 entirely, rather than a reason to interpret it carefully in context.
The standard requires the clinician to consider: Is this elevation consistent with the patient’s baseline? Has it risen over serial measurements? Does it occur alongside morphological change on imaging? Does it occur alongside new or escalating symptoms? A clinician who receives a CA-125 of 180 U/mL in a woman with a known endometrioma, notes “elevated — likely endometriosis,” and takes no further action has not applied the standard. That note, in a set of medical records, is legally significant.
Failure to refer to gynaecological oncology when the picture is indeterminate
Not every ambiguous finding requires an immediate cancer diagnosis. But it does require escalation to a clinician with the expertise to resolve the ambiguity. A gynaecologist managing endometriosis in a general practice setting is not expected to diagnose ovarian cancer. That clinician is expected to recognise when the clinical picture has moved beyond their scope and to refer accordingly.
The failure pattern here is a clinician who holds the management of an increasingly complex presentation rather than referring it. Sometimes this reflects a reluctance to alarm the patient. Sometimes it reflects a genuine belief that the endometriosis explains everything. Either way, the standard does not accommodate it. When the clinical picture is indeterminate — when the cyst has features that could be benign or malignant, when CA-125 is elevated and rising, when symptoms have changed — the standard requires referral to gynaecological oncology.
What happened: The plaintiff alleged that her treating gynaecologist failed to adequately investigate and refer her in circumstances where imaging findings and clinical features were consistent with malignancy. The defendant argued that the clinical picture was ambiguous and that the management adopted fell within a range of reasonable clinical responses.
What the court found: The NSW Supreme Court examined whether the defendant’s conduct met the standard of a reasonably competent specialist in the relevant field, applying the Civil Liability Act 2002 (NSW) framework. The court considered expert evidence about what a competent gynaecologist would have done when faced with the clinical picture presented, and whether the failure to refer constituted a breach of the standard of care.
Why this matters: This case illustrates that NSW courts will examine the specific clinical decision points at which a referral or further investigation should have been made — not simply whether the ultimate diagnosis was eventually reached.
For national data on how failures in gynaecological cancer care are identified and reported, see the Australian Commission on Safety and Quality in Health Care.
The legal framework in NSW
Medical negligence claims in NSW are governed primarily by the Civil Liability Act 2002 (NSW). That Act sets out the legal tests a plaintiff must satisfy to establish that a clinician’s conduct was negligent and that the negligence caused the harm complained of. Understanding how that framework applies to a delayed diagnosis of ovarian cancer behind an endometrioma requires attention to three specific provisions.
Section 5O — the peer professional opinion defence
Section 5O of the Civil Liability Act 2002 (NSW) provides that a clinician does not breach the standard of care if their conduct was widely accepted by peer professional opinion as competent professional practice. In plain terms: if a body of responsible clinicians would have done the same thing, the defendant may not be liable even if the outcome was bad.
This defence has real force in genuinely contested clinical situations. It does not protect a clinician whose conduct departs from established guidelines that the profession has formally adopted. A clinician who fails to apply IOTA criteria, who dismisses a rising CA-125 without investigation, or who declines to refer an indeterminate presentation to gynaecological oncology cannot rely on section 5O if no responsible body of gynaecologists would endorse that approach. The defence requires peer opinion that is both widely accepted and rational — the court retains the power to reject peer opinion that is not logically defensible.[6]
Section 5D — causation and the “but for” test
Section 5D of the Civil Liability Act 2002 (NSW) requires the plaintiff to establish that the breach was a necessary condition of the harm — that is, that the harm would not have occurred but for the breach. In a delayed diagnosis case, this translates to a specific question: if the clinician had met the standard of care at the point of failure, what stage would the cancer have been at diagnosis, and what would the treatment outcome have been?
This is where expert oncological evidence is critical. A gynaecological oncologist can give evidence about the likely stage of the cancer at the point when the standard required escalation, the treatment that would have been available at that stage, and the statistical difference in survival outcomes between that stage and the stage at which the cancer was actually diagnosed. That evidence does not need to prove certainty — it needs to establish, on the balance of probabilities, that earlier diagnosis would have made a material difference.
Who holds the duty of care
In the endometrioma surveillance context, the duty of care may be held by multiple clinicians across a care pathway: the GP who manages the patient’s endometriosis and orders surveillance imaging; the gynaecologist who conducts or reviews that surveillance; the radiologist who reports the ultrasound; and, where the patient has been referred, the gynaecological oncologist. Each clinician owes a duty of care to the patient within the scope of their role. A failure by any one of them — or a cumulative failure across the pathway — may give rise to liability.
The question of which clinician breached the standard, and whether that breach caused the harm, is answered by examining the medical records at each decision point. In my view, the records in these cases almost always reveal more than any clinician’s recollection of events. What was documented, what was not documented, and what the imaging reports actually said — these are the materials from which a legal analysis is built.
For a full explanation of how medical negligence claims work in NSW, see Reframe Legal — Medical Negligence.
What happened: The NSW Court of Appeal examined a case involving a failure to diagnose a serious condition in circumstances where the treating clinician had attributed the patient’s symptoms to a known existing condition. The court considered whether the clinician’s failure to investigate beyond the existing diagnosis constituted a breach of the standard of care.
What the court found: The Court of Appeal confirmed that the standard of care requires a clinician to maintain an active differential diagnosis — not to close off investigation once an existing diagnosis is available. A clinician who fails to consider alternative explanations for a changing clinical picture does not meet the standard.
Why this matters: This principle applies directly to the endometrioma context: a clinician who attributes all symptoms to the known endometriosis, without maintaining an active differential that includes malignancy, does not meet the standard the law requires.
When a delayed diagnosis of ovarian cancer behind an endometrioma may amount to negligence
The distinction between a bad outcome and a negligent one is the most important analytical distinction in medical negligence law. Ovarian cancer is a serious disease. Some women with endometriomas will develop ovarian cancer regardless of the quality of their clinical care. The legal question is not whether cancer developed — it is whether the care provided met the standard, and whether meeting that standard would have changed the outcome.
Scenario 1: Morphological change on imaging was documented but not acted upon
If a series of ultrasound reports documents a change in cyst characteristics — the appearance of a solid component, a papillary projection, or increased internal vascularity — and the treating clinician took no further action, that failure engages the breach element directly. The information was available. The standard required the clinician to act on it. The clinician did not act. If the cancer was at an earlier stage at the time of that imaging than at the time of eventual diagnosis, causation is engaged.
Scenario 2: CA-125 was elevated and rising across serial measurements, and no further investigation was ordered
A single elevated CA-125 in a woman with endometriosis may reasonably be attributed to the endometriosis, with a plan for repeat measurement. A rising trend across three or more measurements, particularly in the context of changing symptoms or morphological change on imaging, is a different clinical picture. A clinician who receives that trend and takes no action has not met the standard. The failure to order further investigation — CT, MRI, or referral to gynaecological oncology — in that context is capable of constituting a breach.
Scenario 3: New symptoms were reported and attributed to endometriosis without reassessment
When a patient with a known endometrioma reports symptoms that are new in character — constant rather than cyclical pain, abdominal distension, unexplained weight loss, early satiety — the standard requires the clinician to reassess the differential diagnosis. These are recognised symptoms of ovarian cancer.[7] A clinician who documents these symptoms and attributes them to endometriosis without ordering further investigation has not applied the standard. If the cancer was at an earlier stage when those symptoms were first reported, the failure to investigate at that point is causally connected to the harm of a later-stage diagnosis.
Scenario 4: Referral to gynaecological oncology was not made despite an indeterminate clinical picture
A gynaecologist managing endometriosis is not expected to diagnose ovarian cancer. That clinician is expected to recognise when the clinical picture requires specialist oncological assessment and to refer accordingly. When the cyst has features that cannot be classified as clearly benign on IOTA criteria, when CA-125 is elevated and the clinical picture is ambiguous, the standard requires referral. A clinician who holds that presentation without referring it has not met the standard — and if the cancer was at an earlier stage at the time the referral should have been made, that failure is causally connected to the harm.
The three elements of negligence applied to this condition
For a medical negligence claim to succeed in NSW, three elements must all be established: duty of care, breach of that duty, and causation of harm. In the context of ovarian cancer missed behind an endometrioma, each element has a specific application. All three must be present. A breach without causation — for example, a failure in surveillance that would not have changed the outcome because the cancer was already advanced — does not give rise to a successful claim. Conversely, a bad outcome without a breach — a cancer that was appropriately surveilled but grew rapidly between review intervals — is not negligence.
An endometrioma that was appropriately surveilled with IOTA criteria, with CA-125 monitored in context, and that transformed to malignancy rapidly between review intervals — this is a known risk of the condition, not a failure of care.
Serial ultrasounds that documented morphological change without triggering further investigation, combined with a rising CA-125 attributed entirely to endometriosis, resulting in a stage III diagnosis that expert evidence establishes would have been stage I had the standard been met.
This is a general educational framework only. Each case depends on its individual facts and circumstances.
Long-term and permanent harm when diagnosis is delayed
The harm from a delayed diagnosis of ovarian cancer is not confined to the cancer itself. It extends across every dimension of a person’s life, and it compounds over time in ways that are directly connected to the stage at which the cancer was diagnosed.
Physical consequences
A woman diagnosed with stage III or IV ovarian cancer faces a treatment pathway that is substantially more aggressive than the pathway for stage I disease. Cytoreductive surgery — the surgical removal of as much tumour as possible — at advanced stages typically involves removal of the uterus, both ovaries, the fallopian tubes, the omentum, and potentially sections of bowel or bladder. The surgical morbidity of this procedure is significant: bowel resection may result in a temporary or permanent stoma; bladder involvement may cause long-term urinary dysfunction; extensive pelvic surgery causes adhesions that produce chronic pain.
Chemotherapy at advanced stages is more intensive and more prolonged than at early stages. Platinum-based regimens cause peripheral neuropathy — nerve damage in the hands and feet — that may be permanent. Fatigue, cognitive impairment, and immune suppression persist well beyond the active treatment period. Many women do not return to their pre-diagnosis level of physical function.
Psychological consequences
A diagnosis of advanced ovarian cancer carries a survival prognosis that early-stage diagnosis does not. The psychological impact of that prognosis — the knowledge that the cancer was present and growing while clinicians attributed symptoms to endometriosis — is distinct from the psychological impact of cancer itself. Research published in the Psycho-Oncology journal has documented elevated rates of PTSD, depression, and anxiety in women with gynaecological cancers, with rates of clinically significant psychological distress above 40 per cent in women with advanced disease.[8] The additional layer of harm — the knowledge that the diagnosis was delayed — adds a specific dimension of distress that is recognised in the assessment of general damages.
Financial consequences
The financial impact of an advanced ovarian cancer diagnosis is substantial and long-term. Treatment costs for advanced disease — including surgery, chemotherapy, targeted therapy agents such as PARP inhibitors, and ongoing surveillance — significantly exceed the costs of treatment for early-stage disease. Lost income during treatment and recovery, and the permanent reduction in earning capacity for women who cannot return to full-time work, represent economic losses that are quantifiable and recoverable in a negligence claim. Unpaid carer burden — the time family members spend providing care that would otherwise be provided professionally — is also a recognised head of damage.
Symptom Misattribution
Surveillance Without Assessment
CA-125 Dismissal
These failure modes are not mutually exclusive. In many cases, two or all three occur across the same care pathway.
What compensation covers in NSW
A successful medical negligence claim in NSW can recover compensation across several heads of damage. The Civil Liability Act 2002 (NSW) sets a threshold for non-economic loss — pain, suffering, and loss of enjoyment of life — under section 16. That threshold requires the harm to represent at least 15 per cent of a most extreme case before non-economic loss damages are recoverable. For a woman diagnosed with advanced ovarian cancer as a result of a delayed diagnosis, that threshold is almost invariably met.
The limitation period under the Limitation Act 1969 (NSW) is three years. Critically, for latent harm — harm that was not discoverable at the time it occurred — the limitation period runs from the date of discoverability, not the date of the negligent act. A woman who was not diagnosed with ovarian cancer until years after the surveillance failures occurred does not necessarily lose her claim because more than three years have passed since the first failure. The date from which time runs is a question of fact that requires careful legal analysis.
| Severity of harm | Indicative range (NSW) | Key factors |
|---|---|---|
| Moderate injury with recovery | $50,000–$150,000 | Duration of pain, treatment required, time off work |
| Serious injury with lasting effects | $150,000–$500,000 | Permanent impairment, ongoing treatment, care needs |
| Severe or life-changing injury | $500,000–$2,000,000+ | Catastrophic loss of function, lifetime care, lost earnings |
These figures are general reference ranges only. Each case turns on its own evidence — medical records, expert clinical opinion, and economic reports that quantify the actual loss. In advanced ovarian cancer cases involving significant lost earning capacity, lifetime treatment costs, and care needs, claims at the upper end of the severe range are not uncommon.
How to think about your own situation
The questions below are not a legal test. They are prompts to help you think clearly about whether your experience may warrant further examination. Write every question to be specific to this condition — a reader should recognise their own experience in these prompts.
These questions are not a legal test. But the pattern they reveal — when several of them point in the same direction — is often the starting point for a proper examination of whether the standard of care was met. The question is not whether the cancer was missed. The question is whether it was missed because the standard was not applied.
For a detailed explanation of how these claims proceed in NSW, see Reframe Legal — How Medical Negligence Claims Work in NSW.
Uncertainty is normal — and it does not mean nothing went wrong
Most people who have lived through a delayed cancer diagnosis carry a version of the same doubt: maybe the doctors did everything right and the cancer was just hard to find. Maybe I am misremembering how many times I reported those symptoms. Maybe the endometriosis really did explain everything, and the cancer was just bad luck.
That doubt is a rational response to a confusing experience. It is not evidence that nothing went wrong. The legal analysis does not depend on how certain you feel. It depends on what the medical records show, what the imaging reports documented, what the blood results recorded, and what a competent clinician in the relevant specialty would have done when faced with that clinical picture.
The standard of care is an objective test. It asks what a reasonably competent gynaecologist — not this particular gynaecologist, with their particular pressures and beliefs and habits — would have done. That question is answered by expert clinical opinion, not by the patient’s certainty or uncertainty about what happened. Many people who seek a legal examination of their records discover that the records tell a clearer story than their own memory does. Sometimes that story supports a claim. Sometimes it does not. Either answer is more useful than continuing to wonder.
Where a delayed diagnosis also involved a failure to disclose the risk of malignant transformation in an endometrioma — a risk that a patient has a legal right to know about when making decisions about surveillance or surgery — a separate consent-based claim may also arise. For more on that framework, see Reframe Legal — Informed Consent and Medical Negligence.
Clinicians in Australia are registered with and regulated by AHPRA — Australian Health Practitioner Regulation Agency. A complaint to AHPRA and a civil negligence claim are separate processes with different purposes and different outcomes. Both may be relevant depending on your circumstances.
Dr Rosemary Listing is a lawyer with a PhD in law, specialising in medical negligence. Her legal practice concentrates on cases where clinical care in NSW failed to meet the standard the law and the profession require. Her doctoral research and legal practice have given her a rigorous command of the clinical standards against which negligent conduct is measured, and of the evidentiary requirements those claims must satisfy in NSW courts.
Cases involving ovarian cancer missed behind an endometrioma sit at a particularly demanding intersection of clinical and legal complexity. The endometrioma provides a ready explanation for every symptom and every abnormal result — which is precisely what makes the surveillance standard so important, and so legally significant when it is not met. Establishing whether the standard was met requires a clinician-by-clinician analysis of each decision point in the care pathway, measured against the specific guidelines the profession has adopted for this situation.
The cases that have reached NSW courts, and the complaints recorded by the Health Care Complaints Commission, reveal a consistent pattern in how these failures occur: symptoms attributed to the known diagnosis without reassessment; imaging conducted without structured morphological analysis; CA-125 results dismissed without trend analysis or contextual interpretation; and referral to gynaecological oncology delayed or never made. That pattern is not unique to any one clinician or institution. It reflects a systemic tendency to treat an existing diagnosis as a sufficient explanation for everything that follows.
The people who seek a legal examination of their records in these cases are not looking to blame anyone. They want to understand whether the cancer had to be found this late — whether the surveillance they received was what the standard required, or whether the standard was not applied. Many waited a long time before seeking any examination of the facts, often because those around them — including other clinicians — discouraged them from asking questions.
Dr Listing examines medical records alongside expert clinical opinion and applies the legal standard — not to assign blame, but to give people an honest answer about whether what happened to them met the benchmark the profession sets for itself. That answer, whatever it is, is what most people are actually seeking.
- Australian Institute of Health and Welfare (AIHW). Endometriosis in Australia: prevalence and hospitalisations. AIHW, Canberra, 2019.
- Australian Institute of Health and Welfare (AIHW). Ovarian cancer in Australia: an overview. Cancer series. AIHW, Canberra, 2023.
- Australian Institute of Health and Welfare (AIHW). Cancer in Australia 2023. AIHW, Canberra, 2023. Five-year relative survival by stage at diagnosis for ovarian cancer.
- Pearce CL, Templeman C, Rossing MA, et al. Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. The Lancet Oncology. 2012;13(4):385–394.
- Timmerman D, Ameye L, Fischerova D, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 2010;341:c6839.
- Civil Liability Act 2002 (NSW) s 5O(2): the court is not bound to find that a risk was not foreseeable, or that a professional opinion was widely accepted, merely because a body of professional opinion supports the defendant’s conduct, if the court considers that the opinion is irrational.
- Cancer Australia. Ovarian cancer: symptoms and signs. Australian Government, 2022. Recognised symptoms include abdominal bloating, pelvic or abdominal pain, feeling full quickly, and urinary urgency.
- Stafford L, Judd F, Gibson P, Komiti A, Quinn M, Ward B. Screening for depression and anxiety in women with gynaecologic cancer over time. Psycho-Oncology. 2013;22(9):2052–2061.
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Endometriosis: Management. College Statement C-Gyn 24. RANZCOG, Melbourne, reviewed 2021.
- European Society of Human Reproduction and Embryology (ESHRE). Endometriosis Guideline. ESHRE, 2022.
- Rogers v Whitaker (1992) 175 CLR 479 (High Court of Australia).
- Dobler v Halverson [2007] NSWCA 335 (NSW Court of Appeal).
- Tabet v Camp [2019] NSWSC 1182 (NSW Supreme Court).
- Civil Liability Act 2002 (NSW) ss 5D, 5O, 16.
- Limitation Act 1969 (NSW) s 50C (date of discoverability for personal injury claims).
This article contains general legal information only. It does not constitute legal advice, and reading it does not create a lawyer–client relationship. The law discussed applies to New South Wales, Australia. Each person’s circumstances differ. Time limits apply to legal claims in NSW, and these limits may affect your position. You should seek independent legal advice about your specific situation.