You may have read our recent post regarding colon cancer rates among “young” (ahem) folks – people under 45. While some organizations recommend the first screening colonoscopy at 50, the American Cancer Society has recommended screening begin at 45. So, a patient has a negative screen; what happens next? Well, commonly providers do not recommend a second screening for ten more years. The thinking is that colon cancer is slow growing and that timeframe balances the risks and benefits of the colonoscopy. After all, the screening is intended to catch cancer before it becomes symptomatic. How, then, can malpractice lead to late stage colon cancer?

First, by way of background, colon cancer (also called colorectal cancer) develops mostly from polyps, which are abnormalities that develop in the lining of the colon. The different types of polyps are adenomatous polyps, hyperplastic or inflammatory polyps, and serrated polyps (either sessile serrated or traditional serrated). Certain characteristics of the polyps indicate to clinicians an increased likelihood of cancer. For example, Hyperplastic and serrated polyps carry a higher risk of developing into cancer. Similarly, larger polyps (greater than 1cm) are more likely to be cancerous.

Malpractice can occur in a number of way. A doctor may miss a polyp or polyps altogether and they are allowed to grow unchecked. A doctor may see the polyp, but only remove part of it. Alternatively, he or she may miss the significance of changes to the mass, especially if it has evolved over time. Even so, the doctor should remove the polyp, aiming to remove all of the possibly abnormal tissue. Sometimes your doctor may recommend a much longer follow-up than is actually warranted for the abnormality. Once tissues are removed, they are sent to a pathologist, who looks for abnormalities under magnification. Malpractice may occur where a pathologist misidentifies advancing cancer for more benign conditions.

The real injury happens when enough time is allowed to lapse between the error and the time it is caught so treatment may begin. Sometimes a precancerous mass (T0) or early stage mass (T 1 or T2) have been given enough time to grow through the different layers of the colon and enter the patient’s blood stream. Given the opportunity, the cancer may metastasize and reappear in the lungs, liver, or bones, for example. And, at that point, treatment options get limited.