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.
Question(s) For Expert Witness
1. How often do you see patients with complaints of rectal bleeding?
2. What is the standard management of these patients?
3. Does a past medical history of breast cancer affect the management of these patients?
4. In regards to her most recent visit with a colorectal surgeon, should a colonoscopy have been performed?
Expert Witness Response E-000211
I regularly see patients presenting with rectal bleeding in my day to day practice, this constitutes the bulk of my case load. The standard of care is to always offer a colonoscopy. This patient's last colonoscopy was seven years prior to her visit to the colorectal surgeon. 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. That, as well as her past medical history of breast cancer, should have been a red flag.
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Michael Morgenstern
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