Delayed Diagnosis of Colorectal Cancer

The delayed diagnosis of any type of cancer can have disastrous effects on a patient yet, it is, in fact, the most prevalent cause of all medical malpractice cases. 

This is no less true when it comes to colorectal cancer, also known as rectal or colon cancer. This cancer, specifically, is the third most common cause of cancer related deaths in the United States. 

Barriers to Early Detection

In 2019, the American Cancer Society predicted that roughly 101,000 people per year will receive a new diagnosis. Though colorectal cancer is more prevalent in adults, it is possible for anyone, at any age, to develop it. In fact, cases are currently on the rise in younger individuals, who are less likely to be screened.

Additionally, with the onset of the Covid-19 pandemic, regular screenings and testing were largely put on hold as many were not able to see a physician in person. This has meant increased numbers around delayed or missed diagnosis as the routine preventative measures were more difficult to implement. 

Between these realities—rising numbers of cases, lack of education and knowledge of symptoms, and delayed or missed diagnosis—there are a few things that can help ensure patient safety and prevent this potentially deadly cancer from developing. 

What is Colorectal Cancer?

The colon is also known as the large bowel or large intestine. It is an organ central to the digestive system―also called the digestive tract. 

Cancer within this system usually begins as small, noncancerous clumps of cells known as polyps that form on the outside of the colon. Physicians do not know why these form, but over time, some of these polyps can become cancerous. 

Polyps themselves cause very few symptoms, if any. It is for this reason that physicians recommend regular screenings. During screenings, tests and procedures may be performed to prevent cancer by identifying and removing polyps before they mutate and metastasize. 

Colorectal cancer includes both colon and rectal cancers, which are sometimes referred to individually if both organs are not involved. Because colorectal cancer can move rapidly throughout the body, it is one of the more dangerous diseases, and awareness around symptoms needs to be improved. 

Symptoms of Colorectal Cancer

Missed or delayed diagnosis are all too common because symptoms of cancer are congruous with other diseases. Not only are the symptoms hard to correctly identify, they are often so minor they go unnoticed. 

However, symptoms become increasingly more severe the longer the cancer goes untreated. And though it can be difficult to diagnose, it must be done quickly.

Some of the Symptoms of Colorectal Cancer may include:

• diarrhea or constipation
• changes in stool consistency
• loose, narrow stools
• blood in the stool, which may or may not be visible
• abdominal pain, cramping, bloating, or gas
• continual urges to defecate despite passing stools
• weakness and fatigue
• unexplained weight loss
• irritable bowel syndrome
• iron deficiency anemia

If the cancer spreads to a new location in the body, such as the liver, it can cause additional symptoms in the new area.

The Stages of Colorectal Cancer

The different stages indicate how far the cancer has spread within the body, and size of tumors. It is a diagnostic tool that can help inform treatment. The stages develop as:

• Stage 0: The cancer has not grown farther than the inner layer of the colon.
• Stage 1: The cancer has grown into the next layer of tissue, but not spread to lymph nodes or other organs.
• Stage 2: The cancer has reached the outer layers of the colon, but has not spread beyond the colon.
• Stage 3: The cancer has grown through the outer layers of the colon, and reached one to three lymph nodes. 
• Stage 4: The cancer has reached tissues beyond the wall of the colon and reached distant parts of the body.

Younger Adults Are Being Diagnosed with Later Stage Colorectal Cancer

Between stage 0―an easily treatable stage of colon cancer―and stage 4, where the cancer has possibly reached distant parts of the body, are a wide range of outcomes. This span in staging also accounts for the increase of pain and intensity of treatments if the cancer is not caught early. 

Recent research surveyed 1,195 colorectal cancer patients and survivors ranging in age from 20 to 49.  The research indicated an interesting strata of data. The respondents reported that 57 percent of them were diagnosed between the ages of 40 and 49, a third were diagnosed between the ages of 30 and 39, and roughly 10 percent were diagnosed with colon cancer before the age of 30.

Ultimately, most colorectal patients over the age of 50 are diagnosed in the early stages of the disease, while 71 percent of younger patients were diagnosed in later stages. This phenomenon occurs for a few different reasons. 

One of these reasons is that there is much lower awareness of symptoms and less screening performed in people under the age of 50. Physical symptoms of the cancer are being missed in early stages simply because of a lack of education and resources for both patients and physicians.

On top of not knowing which symptoms to look for, 63 percent of respondents indicated waiting up to twelve months before visiting their physician for symptoms related issues, again, largely because they were not aware that those symptoms may indicate colorectal cancer. 

Unfortunately, after an overall decline in mortality rates from colorectal cancer between 1970 to 2004 among 20-54 year olds in the United States, mortality rates began to rise, again. They increased by 1 percent each year starting in 2004, according to a 2017 study in The Journal of American Medicine JAMA. 

And though that increase may seem small, the impact over time is profound. It means that a person born in 1990 would now have double the risk of colorectal cancer than a person born in 1950.

Screening Guidelines

The American Cancer Society updated its colorectal screening guidelines in 2021 to compensate for so many younger people having their colorectal cancers go undiagnosed. 

The new guidelines suggest that adults with an average risk start screening at age 45 instead of 50, but will it be enough to turn the tide?

Screenings can range from a highly sensitive fecal test performed on an annual basis,  to undergoing a colonoscopy every ten years. 

Those at higher risk, such as those who are overweight, do not exercise or eat certain types of diets heavy in red meats are still advised to get screenings regularly starting at an even younger age. These are risk factors that can change over time.

At Home Tests

In addition to formal screening, there is now an at-home test that is as accurate as a colonoscopy. And similar to the rise in telehealth during the 2020 pandemic, so too has the demand for at home tests increased. 

An at home fecal immunochemical test (FIT) test acts as an effective step between experiencing symptoms and needing a physical exam. The test is able to detect blood in the stool that can’t be seen with the naked eye, called occult blood, which can be a sign of several conditions, including hemorrhoids, ulcers, inflammatory bowel disease (IBD, Crohn’s disease, or ulcerative colitis), and colon and rectal cancer. 

Colon polyps, some types of which can become cancerous over time, may also bleed. If a FIT test result is positive, meaning that there is blood in the stool, there should be a follow-up with a physician to find out why bleeding is occurring.

If the test is negative, there are many possible causes that can be safely ruled out.

Treatment

If cancer does develop in the colon, there are many treatments available to control the growth and spread of the cancer. Some of these treatments include surgery, radiation therapy as well as drug treatments such as chemotherapy, targeted therapy and immunotherapy.

What are Survival Rate Estimates Over Time?

The “survivability rate” estimates the likelihood of surviving the cancer, over time.

If the tumor is limited to the inner layers of the colon, the expectation is the patient will live free of cancer recurrence 5 years or more 80-95 percent of the time, depending on how deeply the cancer was found to invade the wall.

If the cancer has spread to the lymph nodes adjacent to the colon, the chance of living cancer free for 5 years is 30-65 percent, depending upon the depth of invasion of the primary tumor and the number of nodes found to have been invaded by colon cancer cells.

If the cancer has already spread to other organs, the 5-year survival rate drops to 10-15 percent.

In the case the cancer has reached the liver but no other organs, removing a portion of the liver may prolong life expectancy. This is true for as many as 20-40 percent of patients living cancer free for 5 years after such surgery.

The use of non-steroidal anti-inflammatory drugs in long-term colorectal survivors is associated with an approximate 25 percent reduction in mortality, increasing life expectancy.

Early Detection is the Key

Screenings for colorectal cancer, alone, dropped a stunning 90 percent since the onset of the global Covid-19 pandemic. The healthcare system is now behind on preventative care, and catching up is a paramount to the health of U.S. residents. 

Even with guidelines now recognizing routine screenings as recommended starting at 45, statistics are showing that we are leaving too many vulnerable to what does not need to be a devastating diagnosis, any longer.

A physician who negligently treats a patient with colorectal cancer symptoms, either causing treatment to be delayed or missed altogether, can be held liable for medical malpractice. 

A missed or delayed diagnosis of colorectal cancer can be incredibly dangerous, but early detection saves lives.

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