Bowel cancer diagnosis delayed by other illness

The researchers from the University of Exeter analysed clinical data from over 4,500 patients across the UK who were later diagnosed with bowel cancer. In a study published in the British Journal of Cancer, they looked at whether pre-existing illness affected the time it took them to get a cancer diagnosis, making it one of the first studies to investigate this.

They found that if you have a single serious illness or mental health issue unrelated to cancer, such as depression or heart disease, your bowel cancer is diagnosed on average 10 days later than usual, a 13% increase from the usual time taken for a diagnosis. This could go up to over one month when patients had multiple illnesses. These illnesses may take up a lot of time in visits to the GP and leave not enough time available to investigate symptoms or signs linked to cancer.

A bowel cancer sign or symptom which can be explained by a pre-existing condition, such as stomach pains, delayed cancer diagnosis by 9 days on average, a 12% increase from the usual time taken for a diagnosis. These cancer signs and symptom can be explained by the additional illness that the patient has so doctors are ‘led astray’, making it more difficult to arrive at a cancer diagnosis.
They also found that if you have Inflammatory Bowel Disease (IBD), it can delay a bowel cancer diagnosis by 26 days.

Professor Jose Valderas, one of the lead researchers from the University of Exeter Medical School, said: “When you’re trying to diagnose cancer, other illnesses can be a distraction either because they also require attention or because they can mask what would otherwise be flagged as a possible sign of cancer.

“It’s vital that doctors realise that existing illnesses make a diagnosis of cancer more difficult and stay alert to recognize signs and symptoms of cancer as such. It’s also important that patients flag symptoms with their doctor as early as possible, whether it’s unexplained weight loss or changes to your bowel habits.”

Professor Willie Hamilton, one of the lead researchers from the University of Exeter, said: “A ten day delay may not sound much but it may be the difference between a well-planned admission and an emergency admission with a complication. This really matters - as the complications may kill.”

The study, ‘Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records’ is published in the British Journal of Cancer. Authors are Luke TA Mounce, Sarah Price, Jose M Valderas, and Willie Hamilton.

Commenting on the study, Deborah Alsina MBE, Chief Executive of Bowel Cancer UK, said: “As symptoms of bowel cancer can relate to later stage of disease it is important that delays in diagnosis are minimised. While the delays highlighted in this study are relatively small, if they add onto delays in patients presenting to their GP with symptoms, or in a diagnostic appointment, they become more serious. Currently around 20% of people are diagnosed with bowel cancer as an emergency when outcomes are generally poorer and almost 50% in later stages of the disease when it is harder to treat.
“This interesting study highlights another aspect of the complexity of diagnosing bowel cancer as the majority of patients have multiple conditions. Therefore finding quicker, more effective ways to identify and diagnose these patients is crucial to help GPs and other clinicians identify or rule out bowel cancer quickly to give people the very best opportunity for successful treatment. Bowel cancer is after all, treatable and curable especially if diagnosed early.”

Anna’s story:

Without even going on holiday, Anna Gilmore contracted a rare tropical disease that led to Irritable Bowel Syndrome, and significantly delayed her diagnosis of bowel cancer. The mother-of-two, 38, believes eating unwashed fruit led to her having giardiasis, an illness caused by a tiny parasite. Symptoms include diarrhoea, stomach cramps, nausea and bloating, and can last up to four years.

In bowel cancer, early diagnosis significantly improves chances of survival and a positive outcome. Fortunately for Anna, her sister worked at a specialist bowel hospital and insisted she saw a specialist. In Anna’s case, the picture was further clouded by a family history of Crohn’s disease. Anna, from Surrey, had significantly adjusted her diet and was eating a “beige buffet” to avoid an ever-growing list of foods that irritated her stomach. It was months before Anna’s conditioned worsened to the point where she was experiencing significant pain and “appeared six months pregnant”. After a GP told her it was still the aftermath of the giardiasis, Anna contacted the bowel specialist again. She immediately ordered a colonoscopy and Anna was diagnosed with bowel cancer three months ago.
“It was a total shock to everyone,” she said. “I had been worried I had Crohn’s disease – cancer didn’t come into it. The diagnosis of bowel cancer is never easy in someone young, but for me the giardiasis and IBS really complicated the picture.

“I was just lucky that my sister insisted I go to a specialist. I was on Bupa so I could self-refer. If I’d still been reliant on a GP, I don’t think I’d have been diagnosed now and I’d be in a whole world of pain.”
Anna’s prognosis is promising. The tumour was removed, but irregularities were found in her blood vessels in new measures that are now explored, so Anna is mid way through six months of chemotherapy. She is focussing on spending time with her husband and her boys, aged six and four, and she is hopeful that she will beat bowel cancer.

She said: “Although I was unlucky to get giardiasis and bowel cancer at the same time, I’m really lucky that the cancer was diagnosed in time. Research like this is really important – it’s really sensitive and embarrassing talking to the GP about poo, and we tend to accept what they say and not want to go back. Clinicians need to be on alert for bowel cancer even where there’s another explanation.”