56 year old female underwent multiple colonoscopies beginning 8/29/05.
8/29/05 diagnostic colonoscopy found a sessile polyp at 8-10 cm, partial removal, pathology confirmed Tubulovillous Adenoma. Recommended 3 month follow-up.
11/21/05 Repeat colonoscopy, removed more but not the entire sessile polyp at 10 cm. Pathology confirmed Tubulovillous Adenoma. Recommended 3 year follow-up.
11/24/08 Repeat colonoscopy. Patient now complaining of painless rectal bleeding and change in bowel habits. Finds fungating tumor with the sessile polyp extending from 8 centimeter to 12 centimeters, removed 40 percent, pathology confirmed Tubulovillous Adenoma. Dr. moved office and unable to find to obtain immediate results.
2/9/09 Finds surgeon, he does a sigmoidoscopy in an effort to biopsy, cauterize and remove the rectal tumor. Pathology confirmed Tubulovillous Adenoma. Recommends 6 month follow-up.
Unable to locate surgeon, schedules follow-up with new surgeon.
6/25/09 laparoscopic and sigmoidoscopy and resection of the tumor, removes about 17 centimeters of tumor including a 6 x3 x 2 centimeter tumor labels stage T2 N1 MX with 3 of 10 positive lymph nodes, it is identified pathologically as invasive carcinoma. All margins are free.
Underwent 25 weeks of chemotherapy, 25 radiation treatments, and they now recommend additional chemo.

Issue: Was there a deviation for the standard of care resulting in a 6 month or a 3 ½ year delay in diagnoses of colon cancer and if so the impact on the pt?

EXPERT RESPONSES

In 2005 sessile polyp needed to be removed either through the scope or by resection. Up to 30% of lesions will transform to malignancy. Three year follow up negligent also and 2008 cancer was there and they failed to completely remove recurrent lesion. Dr JF – Gastroenterologist

I think the gaps in her care were significant deviations. She should have had an operation after the 3 month follow up failed to remove all of the tumor. Dr DD – Gen Surgeon

Most likely the answer is yes, impt delay. In terms of definitive management I’d defer to a colorectal surgeon’s opinion. Dr PK – GI Oncologist.

Deviation would require a GI surgeon to opine, but likely would find merit. Causation there but a T2N1 stage IIIa has a fairly high survival rate with state of the art management, which is sounds like she got. Dr RB – Oncologist