Missed Diagnosis of Advanced Colon Cancer

Case Overview

This case involves a fifty-six-year-old male patient with a family history of colon cancer. The patient presented to his doctor for a routine colonoscopy screening and the procedure revealed a small polyp in the cecum. The remainder of the test was inconclusive due to suboptimal preparation. The physician recommended that the patient get another colonoscopy in three years. Nine months after the initial colonoscopy, however, the patient developed abdominal pain and chronic anemia. He was taken in for an additional scope that found a large mass in the transverse colon. A gastrointestinal biopsy confirmed the mass to be an adenocarcinoma Grade III with one positive node.

Questions to the Gastroenterology expert and their responses

Was the standard of care breached by the treating physician?

If a screening test finds an abnormality, the health care provider must perform additional tests to stage the disease and develop a plan for intervention. In this case, it seems like the patient should have had regular screenings to catch the suspicious lesion before it progressed to a more advanced level. Had his scheduled colonoscopy gone properly, this diagnosis would have (presumably) been made in a more timely fashion, resulting in a better outcome.

Is it fair to assume that a more thorough workup was warranted, given the poor outcome of the colonoscopy and the patient's risk profile?

Additionally, the physician may recommend a colonoscopy. Further, given this patient's family history, it's reasonable for a physician to order more frequent screenings.

About the expert

This extremely qualified, fellowship trained expert has received his medical training at among the top medical institutions in the country. Over his 25+ year medical career, he has acquired high ranking clinical and academic appointments as well as several high profile professional society memberships such as the American College of Gastroenterology, where is is also a fellow.