Colorectal cancer: how far the diagnosis is from the first symptoms?

Background: The morbidity and mortality of colorectal cancer (CRC) are unfavorable in Hungary. Not only the poor survival but also the health care expenses of an advanced stage tumor make the importance of early diagnosis.

The aim of our study was to analyze the time periods that elapsed between the patient, primary, secondary and tertiary referral centers.

Method: A questionnaire containing 33 questions related to the symptoms, activity of medical care, and their procedures was used by personal interview with 72 CRC pts (median age 66.4yrs at the time of the diagnosis, M/F ratio 47/25) in Pécs, and Veszprém. All the collected data were analyzed by an independent statistician. Patients were divided into two matched subgroups (N=19 in both groups, A: stage≤pT3NoMo and B> pT3NoMo).

Results: The average time from seeking primary medical care to definitive diagnosis was 3.33±0.4 months. Average time after the first GI symptoms to primary medical care was 2.1±0.16 ms. The presence of alarm symptoms were associated with a shorter first visit period (1.2±0.07 month). The frequency of symptoms (%)/length of symptomatic period before primary medical care (months) were: 1. weight loss (58%)/(2.1 months), 2. haematochesia (56%)/(0.43 months), 3. fatigue (52%)/(2.4 months), 4. diarrhea (47%)/(2.94 months), 5. anemia (49%), 6. abdominal pain (46%)/(1.04 month). More then half of the cases had rectosigmoideal-, 24% showed right side involvement. The most frequent stage was pT3 at the moment of the diagnosis. There was significant difference between group A and B in the symptomatic- definitive diagnosis period, however, no significant difference was found in the periods between the primary-secondary-tertiary referrals.

Conclusion: The ignorance of symptoms by the patients was found to cause the crucial delay of the diagnosis. Thus, either the education of the general population, or screening seem to be the way to shorten this period.