Failure To Diagnose Colon Cancer In High Risk Patient

Case Overview

This case takes place in South Dakota and involves a 65-year-old female (adopted / family history unknown who had breast cancer (triple negative, mastectomies and chemo. Three years after being diagnosed with breast cancer, she had mucus and blood in her stools, with intermittent left lower abdominal pain. Her PCP sent her to a colorectal surgeon, who had performed a colonoscopy on the patient 5 years prior to her cancer diagnosis, for a repeat colonoscopy. During this most recent visit, the colorectal surgeon performed an anoscopy and prescribed treatment for hemorrhoids with no further studies. The bleeding improved. A year later, she developed nausea and dizziness. Her PCP palpated an enlarged liver and ordered CT/biopsy of 4 liver tumors. It proved to be metastasis from colon cancer, not breast. CT and colonoscopy showed large descending colon tumor. Her stage 4 colon cancer is now considered terminal.

Questions to the General Surgery expert and their responses

How often do you see patients with complaints of rectal bleeding?

I regularly see patients presenting with rectal bleeding in my day to day practice, this constitutes the bulk of my case load.

What is the standard management of these patients?

The standard of care is to always offer a colonoscopy.

Does a past medical history of breast cancer affect the management of these patients?

That, as well as her past medical history of breast cancer, should have been a red flag.

In regards to her most recent visit with a colorectal surgeon, should a colonoscopy have been performed?

Given the fact that she was adopted it has to be assumed that she fell into a high risk category. Patients with a high risk profile require colonoscopy every five years so this patient was two years overdue for one.

About the expert

This expert is a double board certified Colorectal Surgeon. He received his medical degree from the prestigious Johns Hopkins University and completed a residency and Fellowship training in both General surgery and Colorectal Surgery. He has practiced for over 30 years and is widely respected amongst his peers. He is not only a Fellow of the American College of Surgeons but also a Fellow of the American Society of Colon and Rectal Surgeons, honors bestowed n only the most distinguished surgeons in the field.