Missed Diagnosis of Advanced Colon Cancer

This case involves a fifty-six-year-old male patient with a family history of colon cancer. The patient presented to his doctor for a routine colonoscopy screening and the procedure revealed a small polyp in the cecum. The remainder of the test was inconclusive due to suboptimal preparation. The physician recommended that the patient get another colonoscopy in three years. Nine months after the initial colonoscopy, however, the patient developed abdominal pain and chronic anemia. He was taken in for an additional scope that found a large mass in the transverse colon. A gastrointestinal biopsy confirmed the mass to be an adenocarcinoma Grade III with one positive node.

Question(s) For Expert Witness

1. Was the standard of care breached by the treating physician?

2. Is it fair to assume that a more thorough workup was warranted, given the poor outcome of the colonoscopy and the patient's risk profile?

Expert Witness Response E-005898

If a screening test finds an abnormality, the health care provider must perform additional tests to stage the disease and develop a plan for intervention. The health care provider may order a blood test called a CEA assay to measure carcinoembryonic antigen, a protein that is sometimes detected in greater amounts in patients with colorectal cancer. If an abnormality is found during a sigmoidoscopy, a biopsy or polypectomy may be performed during the test. Additionally, the physician may recommend a colonoscopy. If an abnormality is found during a standard colonoscopy, a biopsy or polypectomy is performed to determine whether cancer is present. In this case, it seems like the patient should have had regular screenings to catch the suspicious lesion before it progressed to a more advanced level. Had his scheduled colonoscopy gone properly, this diagnosis would have (presumably) been made in a more timely fashion, resulting in a better outcome. Further, given this patient's family history, it's reasonable for a physician to order more frequent screenings.