Delay in the diagnosis of colorectal cancer

The causes of long delay by the doctor (Dd) in the diagnosis of colorectal cancer are discussed. The median delay in this whole prospective material (100 patients) was 9.8 months (Dd 5.4 months and patient's delay (Pd) 4.4 months) compared to 18.1 months (Dd 14.7 months and Pd 3.4 months) in the 30 patients severely delayed (Dd more than 6 months). A false negative barium enema (16 patients) and acceptance of the patient's symptoms without resort to investigation were the main causes of severe delay. The most common error of diagnosis were haemorrhoids and anaemia. Tumours in the right hemicolon were the most difficult one to diagnose representing 53% of those severely delayed. The false negative barium enemas were mainly attributed to small sized early stage cancers of which 69% were located in right hemicolon, indicating also the diagnostic difficulties in this part of the colon. The age distribution among those severely delayed showed slight predominance of patients younger than 50 years, resulting from lack of cancer-conscious attitude of the doctors examining younger patients. Males outnumbered females among those severely delayed. This study emphasizes that a more cancer-conscious doctor with a more critical attitude to barium enema examination and willing to use colorectal endoscopy in the diagnosis of colorectal diseases provides the key to a shorter delay and thus maybe to improved survival