Colon cancer is the fourth most diagnosed cancer and the fourth leading cause of cancer death in the US. The risk of colon cancer increases with age and family history. Diagnosis of colon cancer is usually by colonoscopy, and screening is recommended for adults 50 years of age and older.
There are approximately 140,000 new cases of colon and rectal cancer each year in this country. It is estimated that colon cancer will cause 53,200 deaths in 2020. Sure, studies like this are a little dry and hard to get your mind around. But if you think about those statistics for just a second, it is incredible.
Things are improving but just not quickly enough. There has been an almost 30% drop in the colorectal cancer mortality rate over the past couple of decades. This is in large part from doctors and patients doing a better job with increased colonoscopy screening.
“Colon cancer is the 5th most commonly misdiagnosed disease.”
That does not mean that every colon cancer case where symptoms and problems consistent with colon cancer are missed by a doctor is a medical malpractice lawsuit in the making.
But it does underscore that too many colon cancer deaths every year are the result of mistakes that doctors make in interpreting a patient’s symptoms and in the negligent treatment of cancer after it is diagnosed. If you believe you may have a claim because a doctor failed to properly diagnose colon cancer, call 800-553-8082, or get a free online consultation.
- What is Colon Cancer?
- How Does Colon Cancer Progress?
- How Should Doctors Diagnose Colon Cancer?
- What Symptoms Should Doctors Recognize as Potential Colon Cancer?
- How Is Colon Cancer Misdiagnosed?
- Is Misdiagnosis Always Medical Malpractice?
- Colon Cancer Verdicts and Settlements
- Contact Us
- More Information
Colon cancer is the result of the uncontrolled growth of cells of the colon. The colon is another word for the lower intestine. 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 the third most commonly diagnosed cancer in the country. It is also 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 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.
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 and 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.
The early detection and diagnosis of colon cancer are essential in halting the progression of this 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 a curable stage.
Colonoscopy and sigmoidoscopy are endoscopic examinations of the large colon and the distal part of the small bowel that check for abnormal areas, lesions, polyps and/or tumors. They also allow 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.
Symptoms of colon cancer include a change in one's bowel habits (diarrhea, constipation, change in consistency) that lasts 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.
Doctors need to refer the patient to an oncologist (cancer doctor) 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 for colon cancer. A colonoscopy should be performed by a specially trained doctor who looks with a lighted tube through the rectum and colon.
It has been well known since 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, screening colonoscopies, and sigmoidoscopies with a 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.
Misdiagnosis of colorectal cancer, which includes under-diagnosis and over-diagnosis, happens because of the physician, the patient, or the diagnostic tests (laboratory and histopathology).
Early stages of colorectal cancer may not present with overt symptoms and, as a result, some cases are misdiagnosed. Often, the symptoms are reasonably missed. In these cases, the symptoms exhibited only fit the colon cancer symptoms mosaic with the benefit of hindsight. But there are also many instances where colon cancer is missed because of medical malpractice.
Though colonoscopies are the "gold standard" for colon cancer screening, they have an estimated "miss rate" of 22-27%. Incomplete bowel cleans out and inspection times can affect detection rates. Further, some lesions are difficult to visualize with colonoscopy and can go undetected.
Due to the embarrassing symptoms, some women and men will not seek medical advice or will try to self-diagnose. In other cases, doctors may not ask the patient about their symptoms. Physicians may also not order correct laboratory or histopathology tests to determine the presence of colon cancer or may not order a colonoscopy.
Errors may also occur with equipment, mislabeling of slides, or misinterpretation of laboratory results or histopathology slides. In one study, it was reported that 1.4% of histopathological slides are not accurately read. Furthermore, appropriate follow up on abnormal laboratory results are not re-evaluated.
It should be noted that not every case involving a delayed diagnosis is malpractice. To have a case, you must also be able to prove that the outcome would have been different if the negligence had not occurred. The answer to this question depends on the stage of cancer, the kind of cancer, how early it could have been discovered, and the probable success of treatment.
It is imperative that patients with concerns seek medical advice and openly discuss symptoms they may have. Second opinions should be sought if there is uncertainty in the diagnosis, as early detection provides the best chances for a positive outcome.
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.
- 2019, New York: $4,500,000 Settlement A urologist sends a patient to a radiologist for abdominal CT scans. The radiologist properly identified what appeared to be colon cancer on the images, but he did not call the patient or urologist to notify them directly. Instead, the radiologist listed the finding on the second page of their report and faxed it to the urologist. The urologist received the report but never bothered to look at the second page. As a result of this communication failure, the diagnosis of the patient’s colon cancer was delayed for 19 months, at which point it was less treatable. He sues both the radiologist and the urologist and each of them settle with the plaintiff.
- 2018, Ohio: $5,200,000 Verdict A patient went to the doctor’s office complaining of blood in his stool and was examined by the defendant physician's assistant under the supervision of the defendant doctor. Neither the PA nor the doctor elected to perform medical tests that would have ruled out rectal cancer, colon cancer, or polyps as the source of the plaintiff's bleeding. A year later, the plaintiff had a colonoscopy done. The procedure uncovered a tumor in his colon. By then, the cancer was stage IV and had spread to his liver. He died within a year and his family sues, accusing the defendants of breaching the standard of care by failing to order the tests that would have provided earlier detection of his colon cancer. The defendants deny liability, but the jury awards $5.2 million.
- 2018, Pennsylvania: $450,000 Settlement A 52-year-old male patient was under the care of his family doctor. Although the patient had a significant family history of colon cancer and other risk factors, the defendant doctor failed to schedule routine monitoring with colonoscopies and biopsies at the required time intervals. He was eventually diagnosed with advanced-stage colon cancer and died soon after. His estate brings a wrongful death action claiming that the defendant family practice doctor was negligent in not having the patient undergo colonoscopies. The defendant claims that the patient was notified by mailings but did not follow up. Either way, the communication was severely lacking, a common theme in cancer lawsuits. The case eventually settles for $450,000.
- 2017, New York: $4,500,000 Settlement The plaintiff, a 49-year-old male, underwent radiology imaging before a kidney stone procedure. The radiology report that was submitted to the defendant urologist cleared the plaintiff for the kidney stone procedure. On the second page of the report, the radiologist noted that he identified a potentially cancerous mass in the colon. Unfortunately, the urologist never read the second page of the report, so nothing was done. Almost two years pass before the plaintiff’s colon cancer is eventually diagnosed. He sues the urologist and the radiologist for malpractice which resulted in a 19-month delay in diagnosis and treatment of his colon cancer. The case settles for $4.5 million.
- 2017, Ohio: $5,200,000 Verdict A deceased patient, a male in his late 30s, underwent a colonoscopy, during which potentially suspicious tissue was noted. The defendant gastroenterology practice failed to order a biopsy of tissue, resulting in a long delay in the diagnosis of patient’s colon cancer. By the time the cancer was diagnosed, it had already spread, and the patient died shortly afterward. He is survived by a wife and 3 minor children. His estate sues for wrongful death, claiming the defendants breached the standard of care by failing to order biopsies. The case goes to trial and a jury awards $5.2 million.
- 2015, Massachusetts: $3.6 Million Verdict A 45-year-old woman presents to her primary care doctor with abdominal pain after eating and smaller bowel movements. He diagnoses the plaintiff with an ulcer. She returns a month later with complaints of loose bowel movements. In spite of a family history of colon cancer, the doctor simply increases the acid-reducing medication he had prescribed. She returns yet again a month later, this time complaining of constipation. She is sent home again and comes back one more time another month later. Eventually, he refers her to another physician who does the colonoscopy that should have been done months ago. They find Stage IV colon cancer that has metastasized to her ovaries. She dies, and her family files suit. The doctor denies negligence and argues that an earlier diagnosis would not have altered her outcome. The jury disagrees.
- 2014, New Jersey: $1.5 Million Verdict A 54-year-old woman’s family contends in a wrongful death lawsuit that the defendant, a gastroenterologist, negligently failed to visualize the cecum during a colonoscopy that would have detected her cancer.
- 2013, New York: $950,000 Verdict In this wrongful death verdict, an internist misdiagnosed colon cancer for four years as gastritis, leading to stage-IV cancer in a 63-year-old Brooklyn man. The defense made the only argument it could under the circumstances, that an earlier diagnosis would not have averted his death.
- 2012, Maryland: $600,000 Settlement A 63-year-old woman sues a gastroenterologist for failing to diagnose a mass in her colon during a colonoscopy. The woman survives, but sues for the delay in diagnosis and her decreased life expectancy.
- 2012, Pennsylvania: $3 Million Verdict A radiologist fails to note an irregularity on a CT scan which leads to a 22-month delay in treatment and a decreased chance of recovery.
- 2010, Massachusetts: $1.6 Million Settlement The defendants failed to timely diagnose and treat an anastomotic leak which resulted in the decedent's untimely death. The defendants each deny the allegations of negligence.
- 2010, Michigan: $600,000 Settlement A man had an undiagnosed anastomotic leak after colon cancer surgery to remove a mass. The patient's doctor did not recognize and treat the leak, despite multiple office visits.
If you live in the Baltimore-Washington area and believe you or a relative have been a victim of medical negligence in the diagnosis or treatment of colon cancer, call (800) 553-8082 or get a free online medical malpractice consultation.More Information on Cancer Misdiagnosis Claims