Colon cancer is the result of uncontrolled growth of cells of the colon. It is the third most commonly diagnosed cancer in the country. Colorectal tumors are most commonly in glandular structures in the epithelial tissue that lines the cavities and surfaces of blood vessels. About 5% of us will get colon cancer during our lives. It is more common in men and more common over the age of 50. Approximately 90% of cases are diagnosed in people over 50 years old.
A colon cancer patient's prognosis depends primarily on early diagnosis and treatment. When detected early, colon cancer is very treatable and most amenable to cure. However, if the cancer is detected at an advanced stage and has metastasized outside of the colon, the patient will likely die as a direct result of their colon cancer. Quality medical care is so important.
Colon cancer is distinct from rectal cancer. But epidemiological studies often combine colon and rectal cancer and report rates of colorectal cancer. Colon cancer is associated with a family history of colon or rectal cancer (particularly in people less than 40 years old), obesity, physical inactivity, heavy alcohol consumption, consumption of red or processed meat, and inflammatory bowel disease. Rectal cancer is associated with age and sex without other apparent factors. Adenomatous polyps are the primary precursor of colon cancer and are associated with tobacco smoking.
The risk of colon cancer increases with age and is more likely to occur in those individuals with a family history of colon cancer or adenomatous polyps in a first-degree relative or a personal history of adenomatous colon polyps, ulcerative colitis or breast, ovarian or endometrial cancer. Adenomatous polyps are considered to be precursor lesions, and their removal by endoscopy is thought to decrease the likelihood of death from this disease. Not all colon polyps, however, undergo malignant transformation.How Colon Cancer Progresses
Colon cancer begins in the majority of cases as a benign polyp that arises in the inner lining of the colon. Polyps have no symptoms although they may sometimes bleed. They gradually enlarge over time. Polyps are a concern because they can ultimately become malignant.
The average time from the beginning of a polyp to the time it becomes malignant is about five years. The time from the first sign of malignancy to advanced colon cancer is, on average, about three years. If the process is found at the polyp stage, polyp removal via the colonoscope will do the trick no further intervention is required. If the cancer is discovered at a nascent stage (small and contained within the wall of the bowel), the treatment is surgical resection. This can put the patient into permanent remission.
The presence and spread of cancer to the nearby lymph nodes conveys a much worse prognosis, as this finding markedly increases the chance for the spread of cancer elsewhere. This usually renders the patient incurable. This risk is so significant that such patients, with positive lymph nodes but no obvious or detectable evidence of further spread of cancer, are given adjuvant chemotherapy, in an attempt to stop such microscopic areas of cancer spread from growing.Symptoms
Symptoms of colon cancer include a change in one's bowel habits (diarrhea, constipation, change in consistency) that last longer than four weeks, rectal bleeding or blood in stool, persistent abdominal discomfort (cramps, gas, pain), weakness or fatigue, and unexplained weight loss. In some cases, people with colon cancer experience no symptoms during the early stages of the disease.
Medical malpractice cases often follow when a doctor sees these symptoms and does not make an effort to rule out colon cancer. Doctor need to refer the patient to an oncologist for further testing. Alternatively, a physician must identify colon cancer as a possible explanation for the patient's symptoms and convey the gravity of the potential risk. Usually, a colonoscopy is the best way to look rule out colon cancer. A colonoscopy should be performed by a specially-trained doctor who looks with a lighted tube up the rectum and throughout the colon.
It has been well known from 2005 through the present that patients age 40 or older, with a family history of colon cancer should have colorectal cancer screening, including but not limited to, a DRE, annual fecal occult blood tests, and screening colonoscopies and sigmoidoscopies with a barium enema. In addition, patients who present with early symptoms of colon cancer including, but not limited to continued abdominal pain, bloating, and a change in bowel patterns should undergo diagnostic colorectal cancer testing.
For these reasons, the accepted standard of care from 2005 through the present has required the average qualified internal medicine physician treating a patient age 40 or older with a family history significant for colon cancer to offer, order and or perform colorectal cancer screening, including but not limited to, a DRE, annual fecal occult blood tests and screening colonoscopies and/or sigmoidoscopies with barium enema.
In addition, the accepted standard of care has required the average qualified internal medicine physician treating a patient who also presents with signs and symptoms of colon cancer, including but not limited to continued abdominal pain, bloating, and change in bowel pattern, to recognize and appreciate these signs and symptoms of colon cancer, to perform a DRE, fecal occult blood testing, and to offer, order and/or perform a diagnostic colonoscopy and/or sigmoidoscopy with barium enema.Treatment/Prevention
Early detection and diagnosis of colon cancer is essential in halting the progression of this awful disease. Screening and diagnostic colonoscopies and sigmoidoscopies with barium enema, as well as fecal occult blood tests, and digital rectal examinations (DRE) are instrumental in diagnosing colon cancer at curable stage. Colonoscopy and sigmoidoscopy are endoscopic examinations of the large colon and the distal part of the small bowel to check for abnormal areas, lesions, polyps and/or tumors. This allows for a biopsy if a suspicious lesion is detected. A barium enema is a radiological study used to visualize the large intestine, including the colon and rectum.Colon Cancer Sample Settlements & Verdicts
Below are some examples of jury verdicts and settlements in Maryland and other jurisdictions in colon cancer misdiagnosis cases. These cases can be used to see the type of fact patterns that arise in these cases and can also give you a general understanding of how juries value these cases. You cannot predict the value of your case by taking an average of these verdicts or assuming that your case will have the same result even if the facts seem similar to yours.
- 2015, Massachusetts: $3,600,000 Verdict. A 45-year-old woman visits the defendant physician on three separate occasions with complains of abdominal pain, smaller and loose bowel movements, and constipation. The plaintiff patient has a history of colon cancer within her family which she relayed to the defendant physician. On the third visit to the defendant, the plaintiff returns again with complaints of constipation and the defendant's notes from that day indicated that her family history was benign for colon cancer. On the fourth visit, the plaintiff again complains of stomach problems and is sent to the gynecologist, who has the patient undergo a colonoscopy. The colonoscopy showed the patient was suffering from Stage IV colon cancer that had manifested in her ovaries. The plaintiff brought suit alleging that the defendant was negligent in failing to note her family history of colon cancer at the onset of her complaints. The defendant denied the allegations and disputed that there was any deviation from acceptable standards of care.
- 2015, New Jersey: $6,000,000 Gross Verdict. A 62-year-old male went to the defendant to have a colonoscopy. During the colonoscopy, the defendant failed to remove one of the polyps that could be clearly seen. As a result, the patient suffered colon cancer that metastasized to his liver which was the cause of his death two years after the colonoscopy. The colonoscopy was recorded, and during the video, a polyp was clearly present in the descending colon, and the defendant had the opportunity to observe and clip the polyp. The plaintiff's expert concluded that at the time it should have been detected and removed there was an approximate 80% chance of survival. The jury found that the defendant was negligent and that the negligence caused 80% of the damages and attributed 20% to the preexisting cancer. They then rendered a gross verdict of $6,000,000.
- 2015, Massachusetts: $2,160,000 Verdict. A 54-year-old woman is under the care of the defendant physician had complaints of abdominal pain, bloating, and change in bowel patterns. The defendant did not recognize these symptoms as possible signs of colon cancer which later was the cause of death of the plaintiff. The plaintiff alleges that the plaintiff suffered a seven-month delay in the diagnosis of the colon cancer due to the defendant's violation of the standard of care. The defendant denied liability and claimed that the care he provided complied with the standard of care applicable to the average qualified internal medicine practitioner. The jury found that the defendant's negligence in his care and treatment of the decedent was a substantial contributing factor in causing her death and awarded $2,160,000 in damages.
- 2015, Massachusetts: $4,500,000 Settlements. A 42-year-old male presented to the defendant physician complaints of a two week period of rectal bleeding in 2008. At this time, the physician diagnosed the plaintiff with hemorrhoids and did not refer the plaintiff for a colonoscopy. In October 2009, the plaintiff again saw the defendant with complaints of rectal bleeding and again diagnosed the bleeding as hemorrhoids. In December 2010, the plaintiff went to a gastroenterologist on his own accord with complaints of rectal bleeding, constipation, and abdominal pain. The gastroenterologist ordered a colonoscopy and diagnosed the plaintiff with stage IV cancer which has metastasized. The plaintiff asserts that the defendant physician failed to timely diagnose the colon cancer which allowed it to go unnoticed and metastasize. The defendant denied any deviation from acceptable standards of care. The parties settled the case for $4,500,000.
- 2014, Maryland, Carroll County: $0 Verdict. An adult male patient's condition was known to increase his risk of developing colon cancer and was put on a plan for surveillance colonoscopies every three to five years. During one of the patient's colonoscopies, he was diagnosed with stage 3C colon cancer which led to his death. Before this colonoscopy, the plaintiff did not have any colonoscopies preformed for the previous four years. The plaintiffs argue that the standard of care requires the defendant perform surveillance colonoscopies each year and that the defendant was negligent in failing to timely diagnose and treat the patient's cancer that caused his death. The jury found the defendants were not negligent and nothing was awarded to the plaintiffs.
- 2014, Massachusetts: $1,000,000 Verdict. An adult female was treated by the defendant physician, who she advised that both her brother and sister had been diagnosed with colon cancer. Over a seven year period, the defendant never screened the plaintiff even after complaints of rectal bleeding. Two years after the initial complaint of rectal bleeding, the plaintiff complained of stomach pain and diarrhea and was ordered a colonoscopy. The plaintiff was diagnosed with Stage 3B colon cancer and underwent removal of a portion of her rectum. She now requires a permanent colostomy bag. The plaintiff alleges that the defendant was negligent in failing to screen the plaintiff and delayed the diagnosis. The defendant denied the allegations and disputed that there was any deviation from acceptable standards of care. The jury awarded the plaintiff $1,000,000 in damages.
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