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Colorectal Cancer, Delayed Diagnosis, and Litigation

By Margot Heffernan, MLS

Colon, or colorectal cancer originates in either the large intestine (colon) or the rectum (the last 4-6 inches of  the colon). With the exception of skin cancer, it is the third most common cancer diagnosed in men and women in the United States. The American Cancer Society estimates that there will be 103,170 cases of colon cancer  and 40,290 cases of rectal cancer diagnosed in the United States in 2012.

Colorectal cancer is also the second leading cause of cancer deaths for both men and women combined in the United States. However, the death rate from this cancer has been dropping gradually over the past 20 years. This can be attributed, in part, to the use of screening colonoscopy, which is considered to be the most sensitive test for  the detection of colon cancer.

Colonoscopy is a highly effective  screening tool for colon cancer because it allows the physician to actually visualize the entire colon through a lighted instrument called a colonoscope. The ability to view the inside of the colon, or intestine, also enables a physician to detect and remove potentially precancerous growths, or polyps. Colon polyps are extremely common, especially in individuals over the age of 60. Over 75% of all colon polyps are adenomas, which are more likely than other types of polyps to become malignant . Therefore, colon cancer is one of a handful of malignancies that can potentially be detected and arrested while still in a precancerous state.

These and other facts about colorectal cancer have been widely disseminated to the public over the past 10-15 years. It has certainly become a media worthy health issue,  especially since more prominent colon cancer survivors and their families have shared their stories.

However, despite  heightened  awareness among both patients and physicians about the incidence and symptoms of this malignancy, delayed diagnosis of colon cancer represents one of the most common reasons for diagnostic malpractice claims in the United States.  Depending on the stage of the cancer when it is finally discovered, a delay in diagnosis can cause a diminished life expectancy and lead to additional treatment that may not have been necessary had the cancer been discovered when symptoms were first brought to the attention of the physician.

One of the most common causes for delayed colorectal cancer diagnosis is failure of the physician to order the appropriate diagnostic testing when the patient first describes specific symptoms that can be associated with colon cancer. How does this happen? Sometimes the physician is thinking about symptoms that conform to a very narrow range of possible diagnoses.  This is often the case when a patient who is not at high risk for developing colon cancer presents with a symptom or symptoms that coincide with a different pre-existing diagnosis or various incidental findings that can cause the same constellation of symptoms as colon cancer.

When the differential diagnosis is narrow and fixed around an idea that  intuitively “makes sense” in the context of the patient’s overall condition or history,  it might seem unwarranted to change diagnostic course, especially when the symptoms diminish or abate temporarily. Consequently, the patient accepts the alternate diagnosis, sure that it must be the correct one.

When symptoms continue,  resume, or become more severe, the physician will continue down the same diagnostic path, ordering a battery of tests designed to explore or confirm the original erroneous diagnosis or one closely related to it. Further diagnostic delays can occur if the patient is referred to a specialist outside the field of gastroenterology.

Ultimately, though, a much later stage colon cancer diagnosis will be made and the likelihood of cure or long-term remission will be greatly diminished.

For more information on colorectal cancer or colorectal cancer litigation, please contact Heffernan Research.