Carcinoma of the colon and rectum. Delay in diagnosis.

During the period 1971-1975 284 patients were treated for adenocarcinoma of the colon or rectum; 52% were aged 70 years or more, and 37% had incurable disease at the time of diagnosis. When staged according to Dukes' classification, tumours of the right colon (coecum and ascending colon) were more advanced than those in other parts of the colon and rectum (p less than 0.05). In retrospect, local symptoms from colon and rectum were present in 95% of the patients, whereas 49% had symptoms and signs possibly indicating malignant disease. Local and/or general symptoms of more than six months' duration were noted for 38%. Only 3 patients were asymptomatic at the time of diagnosis. Evidence of at least one risk factor for colorectal cancer was obtained in 11%. Those admitted as emergencies (34%) showed a significantly higher incidence of incurable disease than those admitted electively (p less than 0.01). In 22% of all patients an abdominal mass could be palpated and in 32% a tumour was found on rectal exploration. X-ray examination of the colon was performed on 218 patients, with apparently normal findings in 30. However, in 18 of the latter 30 new scrutiny aroused suspicion of tumour in the large bowel. Before admission only 45 patients had undergone rectosigmoidoscopy. Doctor's delay exceeded 5 months for 45 patients (16%); these tumours did not differ from those of other patients with respect to Dukes' classification.