[Delay in the diagnosis of colon cancer, associated with staging and prognosis. A retrospective study from Landspitalinn University Hospital 1980-1992.].
BACKGROUND
Delay is common in diagnosis of colon cancer, its prognostic effect, however, is debatable. A retrospective study of patients with colon cancer was carried out at Landspitalinn University Hospital, covering a period of 12 years. Symptoms and survival were noted, as well as delay in diagnosis.


METHODS
One hundred seventy eight patients were diagnosed with colon cancer during the 13 year period (1980-1992), 92 males and 86 females, with a median age of 70 years (range 19-96 years). One hundred sixty six patients underwent operations and overall surgical mortality was 7.2%. The patients' symptoms on arrival at the hospital were noted, as well as the length of time from their onset. Also noted was the patients' hemoglobin level. Patients were staged according to Duke's classification, survival calculated, and Cox Multivariate Analysis was carried out. For the benefit of our study the colon was devided into right and left halves at the splenic flexure in order to compare possible differences of the two halves.


RESULTS
Most patients, 168/178, were diagnosed on the bases of their symptoms, most commonly anaemia, bloody stools and abdominal pain. Of the patients 38% suffered delay in diagnosis and treatment of more than three months from the onset of symptoms, a similar rate for patients with right and left tumors. More left tumors than right were diagnosed within one week from the onset of symptoms (right 7%, left 17.5%). The median hemoglobin value was 115g/L (standard deviation 24.5 g/L). One hundred seventy four patients were staged according to Duke, of which 17 were Duke's A, 60 B and 51 Duke's C. Forty six patients had distant metastases at diagnosis, most commonly liver metastases. Five year survival was 43%, appoximately the same for the sexes, 68% for Duke's A and 9% for Duke's "D". No significant difference was found in the staging and survival of patients with left and right colon cancers, hemoglobin concentration less or more than 110 g/L; or of patients whose delay in diagnosis was shorter or longer than three months after the onset of symptoms. Only increased age at the time of diagnosis, and unfavourable Duke's staging, proved to be independent risk factors according to Cox Multivariate Analysis.


CONCLUSIONS
Symptoms, staging and survival of patients with colon cancer at Landspitalinn during the 12 year time period studied, proved to be similar to reports from our neighbouring countries, though in our study more patients were unfavourably Duke's staged (C or "D"). The delay in diagnosis from the onset of symptoms was also similar to that reported by foreign authors. It is clear that a considerable delay is common, however, it does not seem to bring about less favourable staging or worse survival.
Masdottir
S
S
Gudbjartsson
T
T
Jonsson
T
T
Magnusson
J
J