Abstract
Our aim in this prospective study was to identify those patients who were found to have a colorectal cancer after a delay we considered unacceptable; this was taken as 6 months or more from initial presentation to a physician to diagnosis. It was then possible to determine the presenting complaints (always multiple) and the reasons for delay, in the hope that recommendations could be made regarding appropriate, rapid and thorough investigation of patients suspected of having a colorectal cancer. Of the total of 141 patients with colorectal cancer (108 elective, 33 emergency cases) under the care of one consultant during the period studied, 17 patients (12%) (10 men and 7 women), satisfied the criteria for late diagnosis. The mean age was 72.4 years (range 43-86 years). Five common presenting complaints were identified. They were, symptomatic iron deficiency anaemia, rectal bleeding, change in bowel habit, abdominal pain and weight loss. Incomplete imaging of the colon in patients with sinister presenting symptoms was the most commonly identified factor in delay of diagnosis. Inappropriate iron therapy and false-negative reporting of double contrast barium enema investigations were both seen in a number of cases. Other causes were, inappropriate surgical treatment and both clerical error and delay. The mean time for delay was 17.6 months (median 15 months). Late diagnosed cancers were most commonly found in the caecum and least commonly in the rectum. Colonic tumours of each Dukes' stage were identified, Dukes' B most common and Dukes' A least.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Barillari P., de Angelis R., Valabrega S., Indinnimeo M., Gozzo P., Ramacciato G., Fegiz G. Relationship of symptom duration and survival in patients with colorectal carcinoma. Eur J Surg Oncol. 1989 Oct;15(5):441–445. [PubMed] [Google Scholar]
- Barloon T. J., Shumway J. Medical malpractice involving radiologic colon examinations: a review of 38 recent cases. AJR Am J Roentgenol. 1995 Aug;165(2):343–346. doi: 10.2214/ajr.165.2.7618553. [DOI] [PubMed] [Google Scholar]
- Brady A. P., Stevenson G. W., Stevenson I. Colorectal cancer overlooked at barium enema examination and colonoscopy: a continuing perceptual problem. Radiology. 1994 Aug;192(2):373–378. doi: 10.1148/radiology.192.2.8029400. [DOI] [PubMed] [Google Scholar]
- Church J. M. Complete colonoscopy: how often? And if not, why not? Am J Gastroenterol. 1994 Apr;89(4):556–560. [PubMed] [Google Scholar]
- Curless R., French J., Williams G. V., James O. F. Comparison of gastrointestinal symptoms in colorectal carcinoma patients and community controls with respect to age. Gut. 1994 Sep;35(9):1267–1270. doi: 10.1136/gut.35.9.1267. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fuchs C. S., Giovannucci E. L., Colditz G. A., Hunter D. J., Speizer F. E., Willett W. C. A prospective study of family history and the risk of colorectal cancer. N Engl J Med. 1994 Dec 22;331(25):1669–1674. doi: 10.1056/NEJM199412223312501. [DOI] [PubMed] [Google Scholar]
- Holliday H. W., Hardcastle J. D. Delay in diagnosis and treatment of symptomatic colorectal cancer. Lancet. 1979 Feb 10;1(8111):309–311. doi: 10.1016/s0140-6736(79)90718-9. [DOI] [PubMed] [Google Scholar]
- Kemppainen M., Räihä I., Rajala T., Sourander L. Delay in diagnosis of colorectal cancer in elderly patients. Age Ageing. 1993 Jul;22(4):260–264. doi: 10.1093/ageing/22.4.260. [DOI] [PubMed] [Google Scholar]
- Neugut A. I., Garbowski G. C., Waye J. D., Forde K. A., Treat M. R., Tsai J. L., Lee W. C. Diagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding. Am J Gastroenterol. 1993 Aug;88(8):1179–1183. [PubMed] [Google Scholar]
- Rex D. K., Rahmani E. Y., Haseman J. H., Lemmel G. T., Kaster S., Buckley J. S. Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice. Gastroenterology. 1997 Jan;112(1):17–23. doi: 10.1016/s0016-5085(97)70213-0. [DOI] [PubMed] [Google Scholar]
- Robinson E., Mohilever J., Zidan J., Sapir D. Colorectal cancer: incidence, delay in diagnosis and stage of disease. Eur J Cancer Clin Oncol. 1986 Feb;22(2):157–161. doi: 10.1016/0277-5379(86)90025-8. [DOI] [PubMed] [Google Scholar]