title: Colorectal Cancer Initial Diagnosis: Screening Colonoscopy, Diagnostic Colonoscopy, or Emergent Surgery, and Tumor Stage and Size at Initial Presentation.
abstract: BACKGROUND
  Rates of colorectal cancer screening are improving but remain suboptimal. Limited information is available regarding how patients are diagnosed with colorectal cancer (for example, asymptomatic screened patients or diagnostic workup because of the presence of symptoms). The purpose of this investigation was to determine how patients were diagnosed with colorectal cancer (screening colonoscopy, diagnostic colonoscopy, or emergent surgery) and tumor stage and size at diagnosis.
  
  
  METHODS
  Adults evaluated between 2011 and 2014 with a diagnosis of colorectal cancer were identified. Clinical notes, endoscopy reports, surgical reports, radiology reports, and pathology reports were reviewed. Sex, race, ethnicity, age at the time of initial diagnosis, method of diagnosis, presenting symptom(s), and primary tumor size and stage at diagnosis were recorded. Colorectal cancer screening history was also recorded.
  
  
  RESULTS
  The study population was 54% male (265 of 492) with a mean age of 58.9 years (range, 25-93 years). Initial tissue diagnosis was established at the time of screening colonoscopy in 10.7%, diagnostic colonoscopy in 79.2%, and during emergent surgery in 7.1%. Cancers diagnosed at the time of screening colonoscopy were more likely to be stage 1 than cancers diagnosed at the time of diagnostic colonoscopy or emergent surgery (38.5%, 7.2%, and 0%, respectively). Median tumor size was 3.0 cm for the screening colonoscopy group, 4.6 cm for the diagnostic colonoscopy group, and 5.0 cm for the emergent surgery group. At least 31% of patients diagnosed at the time of screening colonoscopy, 19% of patients diagnosed at the time of diagnostic colonoscopy, and 26% of patients diagnosed at the time of emergent surgery had never undergone a screening colonoscopy.
  
  
  CONCLUSIONS
  Nearly 90% of colorectal cancer patients were diagnosed after development of symptoms and had more advanced disease than asymptomatic screening patients. Colorectal cancer outcomes will be improved by improving rates of colorectal cancer screening.
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA. Electronic address: courtney.moreno@emoryhealthcare.org.
authors.forename: Courtney C
authors.initials: CC
authors.lastname: Moreno
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: Pardeep K
authors.initials: PK
authors.lastname: Mittal
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
authors.affiliation: Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors.forename: Robin
authors.initials: R
authors.lastname: Rutherford
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Cardona
authors.affiliation: Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Natalyn N
authors.initials: NN
authors.lastname: Hawk
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: W Thomas
authors.initials: WT
authors.lastname: Dixon
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: Hiroumi D
authors.initials: HD
authors.lastname: Kitajima
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA; Department of Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA.
authors.forename: Jian
authors.initials: J
authors.lastname: Kang
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: William C
authors.initials: WC
authors.lastname: Small
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: John
authors.initials: J
authors.lastname: Oshinski
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: John R
authors.initials: JR
authors.lastname: Votaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013505:Digestive System Surgical Procedures; D055088:Early Detection of Cancer; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D047368:Tumor Burden
keywords: Cancer detection; Colorectal cancer; Diagnostic colonoscopy; Screening colonoscopy; Screening compliance