Turunen M J, Peltokallio P
Ann Chir Gynaecol. 1982;71(5):277-82.
The causes of long delay by the doctor (Dd) in the diagnosis of colorectal cancer are discussed. The median delay in this whole prospective material (100 patients) was 9.8 months (Dd 5.4 months and patient's delay (Pd) 4.4 months) compared to 18.1 months (Dd 14.7 months and Pd 3.4 months) in the 30 patients severely delayed (Dd more than 6 months). A false negative barium enema (16 patients) and acceptance of the patient's symptoms without resort to investigation were the main causes of severe delay. The most common error of diagnosis were haemorrhoids and anaemia. Tumours in the right hemicolon were the most difficult one to diagnose representing 53% of those severely delayed. The false negative barium enemas were mainly attributed to small sized early stage cancers of which 69% were located in right hemicolon, indicating also the diagnostic difficulties in this part of the colon. The age distribution among those severely delayed showed slight predominance of patients younger than 50 years, resulting from lack of cancer-conscious attitude of the doctors examining younger patients. Males outnumbered females among those severely delayed. This study emphasizes that a more cancer-conscious doctor with a more critical attitude to barium enema examination and willing to use colorectal endoscopy in the diagnosis of colorectal diseases provides the key to a shorter delay and thus maybe to improved survival
本文探讨了医生（Dd）在结直肠癌诊断中长时间延误的原因。在这组全部的前瞻性研究对象（100例患者）中，诊断的中位延误时间为9.8个月（医生延误5.4个月，患者延误4.4个月），而在30例严重延误（医生延误超过6个月）的患者中，这一数字为18.1个月（医生延误14.7个月，患者延误3.4个月）。钡剂灌肠检查假阴性（16例患者）以及在未进行检查的情况下接受患者症状是导致严重延误的主要原因。最常见的诊断错误是痔疮和贫血。右半结肠癌是最难诊断的，在严重延误的病例中占53%。钡剂灌肠检查假阴性主要归因于早期小尺寸癌症，其中69%位于右半结肠，这也表明了该部分结肠的诊断困难。严重延误患者的年龄分布显示，50岁以下患者略占多数，这是由于检查年轻患者的医生缺乏癌症意识。在严重延误的患者中，男性多于女性。本研究强调，一名对癌症更具意识、对钡剂灌肠检查持更批判性态度并愿意在结直肠疾病诊断中使用结直肠内镜检查的医生，是缩短延误时间从而可能提高生存率的关键。
