Colon cancer, often called colorectal cancer, involves the large intestine, and sometimes the rectum. The American Cancer Society ranks it as the third most common cancer in the United States.  Deaths from colon cancer are decreasing, probably due to cancer screening, during which polyps can be found and removed before they turn into cancers.

How does a Delay in Diagnosis of Colon Cancer Occur?

• Inadequate history taking:

  Too often physicians overlook obvious warning signs because they did not take the time or the thought required to ask the right questions.  Your doctor needs to take the time to talk to you, and you need to clearly express your concerns as well.  He has a duty to inquire about your risk factors for developing colon cancer. Factors that could place you at a higher risk for developing colorectal cancers include:

  • Over the age of 50
  • A previous history of polyps or colon cancer
  • Having had a prostate cancer that required treatment with pelvic radiation
  • Family history of colorectal cancers
  • Certain family syndromes
  • Certain ethnic backgrounds (e.g., Jews of Eastern European descent, Ashkenazi Jews)
  • Diets high in fat, lack of exercise, obesity, smoking, heavy alcohol use.  

  Additionally, many patients present with symptoms of colon cancer, such as:

  • a change in bowel habits (either constipation or diarrhea)
  • the feeling of the need to move ones bowels that is unrelieved with a bowel movement
  • bleeding or blood streaks in the stool
  • abdominal pains, and /or weakness or tiredness.

• Failure to do a complete Physical Examination:

Beginning at age 50, physical examinations should include rectal examinations and testing as follows:

1. yearly stool blood test or fecal immunochemical test
2. flexible sigmoidoscopy every 5 years

(The American Cancer Society recommends a stool blood test or fecal immunochemical test every year plus flexible sigmoidoscopy every five years.)

Or you may have:

3. double contrast barium enema every 5 years
4. colonoscopy every 10 years

At risk patients should begin screening earlier and have more frequent screening.

• Misuse of available technologies: 

Health care providers sometimes become overly reliant on technologies, so that physicians may assume that negative flexible sigmoidoscopy results means there in no cancer; even when the patient is anemic or telling the physician that he has problems.  Sometimes abnormal findings suggest that additional testing is warranted.  Physicians who rely on test results and who do not appropriately consider the patient's complete clinical picture may not perform the next level of testing, such as ultrasound examinations, biopsies, CT scans, MRI scans, PET scans and/or angiograms.

• Administrative errors:

Lost test results, abnormal test results that get filed without notifying the patient, failure to follow-up on inadequate or inconclusive examinations due to miscommunications, mislabeled specimens . . . Mistakes happen, but they happen more with short staffing and substandard procedures in place.

• Cost-saving measures:

In some health plans, physicians are given financial incentives to not refer their patients to specialists or order diagnostic testing or interventions. 

If you are in a health maintenance organization or a health plan with "capitation" you are at risk from a doctor operating under the influence of financial incentives.

Common Issues of Negligence:

The most common allegations of negligence in colon cancer cases are:

• Failing to perform routine health maintenance examinations including a digital rectal examination and test feces for blood yearly over the age of 50 (earlier if the patient is high risk);
• Insufficient surveillance and vigilance of monitoring high risk patients;
• Failing to adhere to established colon cancer screening guidelines;
• Failing to perform appropriate and perhaps, additional testing if a patient develops signs of problems, such as a change of bowel patterns occurs, if the patient develops intermittent abdominal pain, or has evidence of blood in the stool and/or anemia;
• Promoting patient complacency by failing to provide education and support;
• Missing the warning signs of problems in high risk patients;
• Improperly staging the cancer, once it is discovered;
• Providing improper treatment of the colon cancer;
• Failing to provide continuing surveillance to pick-up a recurrence of the cancer or metastasis (Surveillance includes physical and rectal exams, colonoscopies, and blood tests such as Complete blood counts, CEAs and CA 19-9 blood tests);
• Prescribe additional diagnostic testing in response to equivocal or suspicious physical findings or testing.
   

Injuries and Damages:

Diagnostic delays can lead to the need for a colostomy, or worse, for the spread of cancer to other parts of the body.

If the delay is so severe that the tumor causes obstruction and/or perforation of the intestine, infections, delayed healing and severe multi-system problems can result.  Treatments become more complex and dangerous. 

In early stages, treatment may consist only of removal of the segment of involved intestine; in later stages radiation therapy, chemotherapy and disfiguring operations may be needed.  Late diagnosis with a more advanced stage of cancer may lead to a worsened prognosis or death from the cancer.

Conclusion:

Colon cancer is a preventable cancer and is very treatable, if diagnosed in a timely manner.  Late diagnosis can be severely life altering, even deadly.  When a colon cancer is not diagnosed until it is advanced in a person who gets regular health maintenance care, the delay in diagnosis is likely to be due to negligence.

 If you fear that substandard medical care or outright errors resulted in a delay in detecting your cancer, or caused complications in your cancer care that hurt your chance of recovering, I will look at your case free of charge, and tell you if you may have been the victim of medical malpractice.  If your case is outside our jurisdiction, we can help you to find skilled and ethical counsel in your area.

Mark R. Bower, Esq

Law Offices of Mark R. Bower, PC