Colorectal cancer is the third leading cause of cancer and the second leading cause of all cancer-related deaths in the United States. Each year approximately 145,000 new cases of colorectal cancer are diagnosed in the United States (105,000 new cases of colon cancer and 40,000 new cases of rectal cancer). The lifetime chances of developing colorectal cancer is approximately 5%. Combined, these two types of cancer cause 56,000 deaths per year. The frequency of colon cancer is essentially the same among men and women. Signs and symptoms associated with colorectal cancer include:
Rectal bleeding (overt or occult)
Change in bowel habits
Mucus per rectum
If detected early, colon and rectal cancer are curable by surgery. Long-term survival correlates with the stage at diagnosis of the disease in colorectal cancer. Progress has been made in understanding the basis for predisposition and progression of colorectal cancer. Risk factors for colorectal cancer include:
Diet rich in fat and cholesterol
Inflammatory bowel disease (ulcerative colitis)
Alcohol ingestion in rectal cancer
Genetic predisposition (hereditary polyposis and nonpolyposis syndromes)
Hereditary nonpolyposis colorectal cancer (HNPCC) is the most common known hereditary cause of colon cancer. HNPCC is hereditary and involves a mutation in one of five different genes and is also known as Lynch Syndrome. About 1% to 5% of colon cancers are attributed to HNPCC. A patient with HNPCC has up to 80% chance of developing colon cancer during their lifetime. The mean age for someone with HNPCC developing colorectal cancer is 44 years. Cancers tend to be on the right (ascending) colon, are poorly differentiated and mucus producing. Genetic testing and screening in these individuals with HNPCC for colon cancer should be started as early as 20-22 years of age.
The vast majority of colorectal cancers are adenocarcinomas which arise from a preexisting adenomatous polyp(s) that develop in the normal colon mucosa. The progression sequence from adenoma to carcinoma is a well characterized clinical and histopathological series of events. Convincing evidence of increased early detection resulting in a reduced colorectal cancer mortality supports the use of specific screening guidelines which include:
Fecal occult blood test
Carcinoembryonic antigen (CEA)
Digital rectal examination
Failure to adhere to the acceptable screening guidelines can result in a significant delay in the diagnosis of colon and rectal cancer, depriving a patient of a meaningful chance of cure and a better quality of life.
The overall 5 year survival rate from colon cancer is approximately 60%. the 5 year survival rate is different for each stage of the disease at the time of diagnosis. Several classifications are utilized to stage colon cancer. The Dukes and TNM System are the most widely used.
Dukes (modified) Classification
Stage A: Carcinoma confined to the wall of the bowel
Stage B: Carcinoma spread by direct continuity to perirectal or pericolonic
tissue; no lymph node metastasis
Stage C: Metastasis present in regional lymph nodes
Stage D: Omental implant; peritoneal seeding; metastasis beyond the
confines of surgical resection
Tumor-Node-Metastasis (TNM) System
TNM 0: Tis, N0, M0
TNM I: T1, N0, M0 & T2, N0, M0
TNM II: T3, N0, M0 & T4, N0, M0
TNM III: Any T, N1, M0 & Any T, N2, M0
TNM IV: Any T, Any N, M1
For Dukes stage A tumors involving only the mucosa, the 5 year survival rate exceeds 90%; For Dukes stage B colon cancers, the 5 year survival rate is greater than 70% and can get to be better than 80% if the tumor does not penetrate the muscularis mucosa; For Dukes stage C with lymph nodes involvement, the 5 year survival rate is usually less than 60%; and for metastatic colon cancer, the 5 year survival rate is about 5%.
If you (or a loved one) are suffering from complications due to a failure to timely diagnose, delayed diagnosis or misdiagnosis of colon or rectal cancer, or the recommended screening guidelines were not followed, let Dr. Borten and the Boston area medical malpractice attorneys at Gorovitz & Borten evaluate your case. We can help you assert your rights and get the compensation you deserve.
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