Crohn's Disease Could Delay Bowel Cancer Diagnosis

Abdominal pain, frequent and recurring diarrhea, blood in the stool, and problematic bowel movements are all common symptoms for those suffering from Crohn’s disease. Unfortunately, they are also identical symptoms with those of bowel cancer, which can be one of the hardest cancers to diagnose in its earliest stages.

Researchers at the University of Exeter recently studied the relationship between bowel cancer diagnoses and other pre-existing conditions, hypothesizing that the diagnosis for bowel cancer was being delayed by an increased focus on existing conditions. In the case of Crohn’s disease, the symptoms are so identical that a general practitioner might identify early signs of cancer with common symptoms of Crohn’s disease.

The research suggests that any condition—not only gastrointestinal illnesses—could contribute to a delayed bowel cancer diagnosis. The Exeter study found that the time spent with a general practitioner is usually focused on the most immediate condition, with little time and attention given to the investigation of ulterior conditions such as bowel cancer. Since the symptoms can be mild relative to other aggressive cancers, bowel cancer often goes undiagnosed in its early stages.

Any diagnosis is subject to the ability of the patient to communicate arising symptoms, and the level of attention that the general practitioner pays to said symptoms. Even with the proper testing, which itself takes a certain amount of time, an official diagnosis could be delayed for a variety of reasons. As conditions progress, this can lead to more severe complications with each passing day.

Delays in Diagnosing Bowel Cancer

The Exeter study found that any serious preexisting condition, either mental or physical, leads to an average of a ten-day delay in the diagnosis of bowel cancer. This ten day delay is a 13% increase over the standard time that it takes to diagnose. The study also found that the more serious illnesses that a person has, the longer the diagnosis will take, up to more than one month in cases of multiple severe illnesses.

Stomach pains, an early sign of bowel cancer, can be attributed to almost any serious preexisting condition. If the stomach pains can be explained by the immediate illness, a bowel cancer diagnosis could be delayed on average about nine days. This nine day delay is a 12% increase over the standard diagnosis timeframe, which could prove the difference between a relatively simple treatment, and a complication.

Doctors that are ‘led astray’ by symptoms in both the preexisting condition and bowel cancer are not necessarily at fault for not catching the cancer. It is incredibly difficult to arrive at a cancer diagnosis when the present symptoms mask the signs and symptoms of cancer. If a patient is suffering from coronary heart disease, a general practitioner will naturally ascribe any discomfort, fatigue, or reduced appetite to the immediate condition.

These other serious illnesses serve as a distraction for any cancer diagnosis, and unfortunately, where there is one serious illness, there are usually others to follow. It is important for both patients and doctors to be aware of any new developments as conditions progression, especially unexplained weight loss or rectal bleeding.

Professor Jose Valderas, a lead researcher at the University of Exeter Medical School, cautions both doctors and patients by saying that it is “vital that doctors realize that existing illnesses make a diagnosis of cancer more difficult and stay alert to recognize signs and symptoms of cancer as such.” He also urges patients to “flag symptoms with their doctors as early as possible,” though it should be noted that paranoia or consistently reporting imagined symptoms might have the opposite effect.

Stages and Progression of Bowel Cancer

Another lead researcher on the Exeter study, Professor Willie Hamilton, 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.”

This principle could easily be extended further. Individuals previously diagnosed with Irritable Bowel Syndrome were found in the Exeter study to have delayed diagnoses up to 26 days—nearly a month in which cancer was missed and allowed to progress.

According to the American Cancer Society, bowel cancer has a remarkably high five-year survivability rate in its early stages. Beyond five years, a survivor has little to no risk of remission, and for patients diagnosed in Stage I the chances of surviving beyond five years is approximately 92%.

That being said, bowel cancer is the number two leading cause of cancer related deaths in men, and number three in women. This is due in part to the fact that only approximately 4 out of 10 cancers are found in stage I. Bowel cancer can only be caught by screening; there are no symptoms in the earliest stages.

Cancers found in Stage II and Stage III can have varying survivability rates depending on the severity and location of the tumor, and can range from as low as 50% to as high as 84% survivability. A cancer that has reached nearby structures in the body is going to have a lower chance of survivability than one that has not grown very far into the wall of the intestine. It is also in these later stages, when cancer becomes obstructive or aggressive, that symptoms begin to occur.

In order for a cancer to be classified as Stage IV, it must have metastasized to a distant organ. By the time that this occurs, the survivability rate drops to about 11%.

The Importance of a Quick Diagnosis

Deborah Alsina MBE, Chief Executive of Bowel Cancer UK, commented on the study, saying: “Currently around 20% of people are diagnosed with bowel cancer as an emergency when outcomes are generally poorer and almost 50% in the later stages of the disease where it is harder to treat.”

She goes on to note that “…the majority of patients have multiple conditions. Therefore, finding quicker, more effective ways to identify and diagnose these patients is crucial to help GP’s and other clinicians identify or rule out bowel cancer quickly to give people the best opportunity for treatment.”

Armed with this knowledge, anyone who has a gastrointestinal disease would benefit greatly from screenings and other tests to make sure that bowel cancer is not present. Any delay could have significantly more repercussions on likelihood of survival. Though bowel cancer is relatively slow in its progression, each passing day of a Stage III cancer increases the likelihood that it will metastasize.

Unfortunately, it is not reasonable enough to deny the possibilities of having cancer because there are no symptoms present. Waiting for symptoms can lead to increased dangers and complications, and the Exeter study shows that this is especially true for cases in which symptoms are identical to those of GI tract diseases. This is the time when patients should be extra cautious.

The Exeter study also underlines another virtue when it comes to the health of the individual. In general, caring for oneself and maintaining one’s health should be a proactive exercise, not a reactive one.