Surgeon Uncovers Missed Diagnosis of Sigmoid Colon Cancer

This case involves a seventy-three-year-old female patient with a history of smoking, diabetes, and hypertension. The patient was seen by her primary care physician several times for rectal exams and testing for blood in the stool. On all occasions, there was no blood found in the stool. At some point, the patient underwent a preoperative exam by a surgeon who was unrelated to the case and noted blood in the patient’s stool. This surgeon suggested that the patient follow up with her primary care physician postoperatively. A few months went by before the patient followed up with her PCP. It was noted that the patient had a previously guaiac-positive stool. A subsequent CT and colonoscopy diagnosed sigmoid colon cancer in this patient. Additional testing revealed metastasis to the lungs and liver. Appropriate systemic chemotherapy was initiated, but the patient expired a few months after the diagnosis of colon cancer was made.

Question(s) For Expert Witness

1. Could the delayed diagnosis of colon cancer have played a role in the patient’s death?

Expert Witness Response E-006210

The goal of colorectal cancer screening is to decrease mortality through early diagnosis and treatment of precancerous lesions and early curable lesions. Guidelines for appropriate colorectal cancer screening include tests that detect adenomatous polyps and cancer every 5 or 10 years depending on the type of procedure or imaging study used. Annual guiaic-based fecal occult blood tests with high sensitivity for cancer, fecal immunochemical tests, and stool DNA tests are also recommended. Individuals with increased risk for developing colorectal cancer should start at an earlier age and be more frequent with their screening visits. Moreover, those with genetic risks or hereditary familial syndromes should undergo added surveillance protocols.