Oncology Experts Discuss Inadequate Screening Procedures For Patient With Advanced Colon Cancer

Case Overview

This case involves a female patient who had been treating with a family physician regularly for more than a decade, and had also consulted with a colo-rectal surgeon multiple times for what she was told were hemorrhoids. On one occasion, the colorectal surgeon performed banding procedures in the area of what was discovered soon after to be a large, necrotic tumor. He banded the area several times, but never identified the tumor as such. Some time after this, a colonoscopy was performed by another colorectal surgeon who discovered the presence of a large necrotic mass. A CT scan of the abdomen revealed irregular wall thickening involving proximal rectum with posterior rectal wall mass, as well as other signs that represented regional metastasis. At this time, rectal carcinoma was diagnosed and subsequently treated with chemo-radiotherapy to reduce the size of the tumor before surgery could be undertaken. It was alleged that earlier colonoscopies should have been performed to detect the tumor, and that the patient suffered a worse outcome as a result of this failure to diagnose.

Questions to the Oncology expert and their responses

Could the patient have had a better outcome if colonoscopies were performed sooner or if the care was rendered differently?

If asymptomatic she should have had either colonoscopies starting at age 50 and every 10 years or proctosigmoidoscopies every 5 yrs. In either scenario it would seem as if there was a failure to diagnose in a timely manner. Survival is clearly related to stage as diagnosis and thus earlier diagnosis would more likely than not have been associated with an improved survival. The delay in diagnosis here definitely had a negative impact on this patient's outcome.

Is it possible that the trauma and banding in the area of the tumor serve to increase the risk of the metastasis of the tumor?

I am unaware if the trauma and bleeding associated with 'banding' can increase risk of metastasis, as it is certainly not an area where we have clinical research data.

About the expert

This triple board certified Medical Oncologist has been practicing for over 30 years. After graduating magna cum laude from Case Western Reserve University, this expert received his medical degree from the State University of New York/Downstate Medical Center. He went on to complete a residency in medicine and fellowship in hematology/medical oncology at Duke University Medical Center. Since then he has held clinical and teaching positions at leading cancer centers, including Memorial Sloan-Kettering Cancer Center, Mount Sinai School of Medicine and Montefiore Einstein Center for Cancer Care. This expert has published over 20 peer-reviewed articles and has also authored several book chapters in oncology textbooks. He is a member of several professional organizations including the American Society of Clinical Oncology and American Society of Hematology. A former Director of both Solid Tumor Service and Head and Neck Oncology at Mount Sinai School of Medicine, he currently serves as an Associate Professor of Clinical Medicine at a major medical university where he is also the Clinical Director of Medical Oncology Service.

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Specialties:

Oncology