Skip to main content


Log in

Can Early Diagnosis of Symptomatic Colorectal Cancer Improve the Prognosis?

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript


Patients with colorectal cancer continue to present with relatively advanced tumors. Delay in diagnosis is often believed to have been a contributing factor, and the validity of this hypothesis has seldom been questioned. The aim of this study was to establish whether a delay in diagnosis is related to long-term survival and if the most frequent symptoms were related to the stage or time at which the carcinoma was diagnosed. Data from 660 patients surgically treated for uncomplicated colorectal carcinoma in our institution between 1985 and 2000 were analyzed retrospectively. Age, sex, initial symptoms, duration of symptoms, neoplasm location, curative surgery, TNM stage, and survival time were the variables recorded. Patients were classified into two groups according to symptom duration: < 3 months versus ≥ 3 months. Comparative statistical analysis was performed for the two groups as well as the initial symptom, TNM stage, and survival time. Also, the initial symptoms most frequently reported were compared with the TNM stage. The two groups were found to be equal with regard to distribution of age, gender, location of the neoplasm, type of surgery performed, and TNM stage. We found that symptom duration was shortened in the presence of abdominal pain (p = 0.002) [odds ratio (OR) 0.53; 95% confidence interval (CI) 0.35–0.80] and was delayed in the presence of an anemic syndrome (p = 0.006) (OR 2.4; 95% CI 1.27–4.56). Also, the stage of the neoplasm was related to rectal bleeding (p < 0.001) and abdominal pain (p = 0.008). The log-rank test indicated that duration of symptoms was not related to long-term survival (p = 0.90). We concluded that the duration of colorectal cancer symptoms is not related to the stage or prognosis of tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.
Fig. 2.

Similar content being viewed by others


  1. MC Aldridge RKS Phillips R Hittinger et al. (1986) ArticleTitleInfluence of tumor site on presentation, management and subsequent outcome in large bowel cancer Br. J. Surg. 73 663–670 Occurrence Handle1:STN:280:BimB1MjktVE%3D Occurrence Handle3742184

    CAS  PubMed  Google Scholar 

  2. M Khubchandani (1985) ArticleTitleRelationship of symptom duration and survival in patients with carcinoma of the colon and rectum Dis. Colon Rectum 28 585–587 Occurrence Handle1:STN:280:BiqB2MnotlY%3D Occurrence Handle4017822

    CAS  PubMed  Google Scholar 

  3. A Maguire M Porta N Malats et al. (1994) ArticleTitleCancer survival and the duration of symptoms: an analysis of possible forms of the risk function ISDS II Project Investigators. Eur. J. Cancer 30A 785–792 Occurrence Handle1:STN:280:ByqD3c%2FpsFQ%3D

    CAS  Google Scholar 

  4. L Polissar D Sim A Francis (1981) ArticleTitleSurvival of colorectal cancer patients in relation to duration of symptoms and other prognostic factors Dis. Colon Rectum 24 364–369 Occurrence Handle1:STN:280:Bi6B28%2FhvVI%3D Occurrence Handle7261819

    CAS  PubMed  Google Scholar 

  5. HE Mulcahy DP O’Donoghue (1997) ArticleTitleDuration of colorectal cancer symptoms and survival: the effects of confounding clinical and pathological variables Eur. J. Cancer 33 1461–1467 Occurrence Handle10.1016/S0959-8049(97)00089-0 Occurrence Handle1:STN:280:ByiH2sbgt10%3D Occurrence Handle9337690

    Article  CAS  PubMed  Google Scholar 

  6. L Roncoroni N Pietra V Violi et al. (1999) ArticleTitleDelay in the diagnosis and outcome of colorectal cancer: a prospective study Eur. J. Surg. Oncol. 25 173–178 Occurrence Handle10.1053/ejso.1998.0622 Occurrence Handle1:STN:280:DyaK1M3jt1yhuw%3D%3D Occurrence Handle10218461

    Article  CAS  PubMed  Google Scholar 

  7. SJ Winawer AG Zauber MJ O’Brien et al. (1993) ArticleTitleRandomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps: the National Polyp Study Workgroup N. Engl. J. Med. 328 901–906 Occurrence Handle10.1056/NEJM199304013281301 Occurrence Handle1:STN:280:ByyC1cfptFE%3D Occurrence Handle8446136

    Article  CAS  PubMed  Google Scholar 

  8. FT McDermott ESR Hughes E Pihl et al. (1981) ArticleTitlePrognosis in relation to symptom duration in colon cancer Br. J. Surg. 68 846–849 Occurrence Handle1:STN:280:Bi2D1M3lvFQ%3D Occurrence Handle7317765

    CAS  PubMed  Google Scholar 

  9. CJ Young JL Sweeney A Hunter (2000) ArticleTitleImplications of delayed diagnosis in colorectal cancer Aust. N. Z. Surg. 70 635–638 Occurrence Handle10.1046/j.1440-1622.2000.01916.x Occurrence Handle1:STN:280:DC%2BD3cvmt1Shug%3D%3D

    Article  CAS  Google Scholar 

  10. L Pahlman B Glimelius P Enblad (1985) ArticleTitleClinical characteristics and their relation to surgical curability in adenocarcinoma of the rectum and rectosigmoid Acta Chir. Scand. 151 685–693 Occurrence Handle1:STN:280:BimC2Mvmt1Y%3D Occurrence Handle4096173

    CAS  PubMed  Google Scholar 

  11. H Graffner S Olsson (1986) ArticleTitlePatient’s and doctor’s delay in carcinoma of the colon and rectum J. Surg. Oncol. 31 188–190 Occurrence Handle1:STN:280:BimB2Mrlslw%3D Occurrence Handle3724171

    CAS  PubMed  Google Scholar 

  12. D Goodman TT Irvin (1993) ArticleTitleDelay in the diagnosis and prognosis of carcinoma of the right colon Br. J. Surg. 80 1327–1329 Occurrence Handle1:STN:280:ByuD287ks10%3D Occurrence Handle8242314

    CAS  PubMed  Google Scholar 

  13. SR Majumdar RH Fletcher AT Evans (1999) ArticleTitleHow does colorectal cancer present? Symptoms, duration, and clues to location Am. J. Gastroenterol. 94 3039–3045 Occurrence Handle10.1016/S0002-9270(99)00510-9 Occurrence Handle1:STN:280:DyaK1MvkvFWktA%3D%3D Occurrence Handle10520866

    Article  CAS  PubMed  Google Scholar 

  14. FL Green DL Page ID Fleming et al. (2002) NoChapterTitle AJCC (American Joint Committee on Cancer) Cancer Staging Manual EditionNumber6th edition Springer-Verlag New York

    Google Scholar 

  15. G Arbman E Nilsson V Storgren-Fordell et al. (1996) ArticleTitleA short diagnostic delay is more important for rectal cancer than for colonic cancer Eur. J. Surg. 162 899–904 Occurrence Handle1:STN:280:ByiC3MrlvFQ%3D Occurrence Handle8956960

    CAS  PubMed  Google Scholar 

  16. H Shida K Ban M Matsumoto et al. (1996) ArticleTitleAsymptomatic colorectal cancer detected by screening Dis. Colon Rectum 39 1130–115 Occurrence Handle1:STN:280:BymH38fkt1I%3D Occurrence Handle8831529

    CAS  PubMed  Google Scholar 

  17. S Carter M Winslet (1988) ArticleTitleDelay in the presentation of colorectal carcinoma: a review of causation Int. J. Colorectal Dis. 13 27–31 Occurrence Handle10.1007/s003840050127

    Article  Google Scholar 

  18. M Pescatori G Maria B Beltrani et al. (1982) ArticleTitleSite, emergency, and duration of symptoms in the prognosis of colorectal cancer Dis. Colon Rectum 25 33–40 Occurrence Handle1:STN:280:Bi2C3MnlsFI%3D Occurrence Handle7056139

    CAS  PubMed  Google Scholar 

  19. E Robinson J Hohilever J Zidan et al. (1986) ArticleTitleColorectal cancer: incidence, delay in diagnosis and stage of disease Eur. J. Cancer Clin. Oncol. 22 157–161 Occurrence Handle10.1016/0277-5379(86)90025-8 Occurrence Handle1:STN:280:BimC1M3lvFw%3D Occurrence Handle3699078

    Article  CAS  PubMed  Google Scholar 

  20. KA Kern (1994) ArticleTitleMedicolegal analysis of the delayed diagnosis of cancer in 338 cases in the United States Arch. Surg. 129 397–404 Occurrence Handle1:STN:280:ByuB3cnhvFc%3D Occurrence Handle8154966

    CAS  PubMed  Google Scholar 

  21. P Carraro M Segala BM Cesana et al. (2001) ArticleTitleObstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery Dis. Colon Rectum 44 243–250 Occurrence Handle1:STN:280:DC%2BD3M7ot1Sktg%3D%3D Occurrence Handle11227942

    CAS  PubMed  Google Scholar 

  22. M Kemppainen I Raiha T Rajah et al. (1993) ArticleTitleDelay in diagnosis of colorectal cancer in elderly patients Age Ageing 22 260–264 Occurrence Handle1:STN:280:ByuD38nkvV0%3D Occurrence Handle8213330

    CAS  PubMed  Google Scholar 

  23. HW Holliday JD Hardcastle (1979) ArticleTitleDelay in diagnosis and treatment of symptomatic colorectal cancer Lancet 1 309–311 Occurrence Handle10.1016/S0140-6736(79)90718-9 Occurrence Handle1:STN:280:CSaC3szmvFI%3D Occurrence Handle84959

    Article  CAS  PubMed  Google Scholar 

  24. PH Chapuis OF Dent R Fisher et al. (1985) ArticleTitleA multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer Br. J. Surg. 72 698–702 Occurrence Handle1:STN:280:BimD3c7isVw%3D Occurrence Handle4041728

    CAS  PubMed  Google Scholar 

  25. F McDermott E Hughes E Pihl et al. (1981) ArticleTitleSymptom duration and survival prospects in carcinoma of the rectum Surg. Gynecol. Obstet. 153 321–326 Occurrence Handle1:STN:280:Bi6B2sritlU%3D Occurrence Handle7268605

    CAS  PubMed  Google Scholar 

  26. N Pietra L Sarli BJ Thenasseril et al. (1998) ArticleTitleRisk factors of local recurrence of colorectal cancer: a multivariate study Hepatogastroenterology. 45 1573–1578 Occurrence Handle1:STN:280:DyaK1M%2FltlynsA%3D%3D Occurrence Handle9840107

    CAS  PubMed  Google Scholar 

  27. DP Funch (1985) ArticleTitleDiagnostic delay in symptomatic colorectal cancer Cancer 56 2120–2124 Occurrence Handle1:STN:280:BiqB1c3htFI%3D Occurrence Handle4027939

    CAS  PubMed  Google Scholar 

  28. MA Potter RG Wilson (1999) ArticleTitleDiagnostic delay in colorectal cancer J. R. Coll. Surg. Edinb. 44 313–316 Occurrence Handle1:STN:280:DC%2BD3c%2FhvVKiuw%3D%3D Occurrence Handle10550956

    CAS  PubMed  Google Scholar 

  29. GJ Harris JN Simson (1998) ArticleTitleCauses of late diagnosis in cases of colorectal cancer seen in a district general hospital over a 2-year period Ann. R. Coll. Surg. Engl. 80 246–248 Occurrence Handle1:STN:280:DyaK1cvksVWlsg%3D%3D Occurrence Handle9771221

    CAS  PubMed  Google Scholar 

  30. OF Dent KJ Goulston CC Tennant et al. (1990) ArticleTitleRectal bleeding: patient delay in presentation Dis. Colon Rectum 33 851–857 Occurrence Handle1:STN:280:By6D3crmtlQ%3D Occurrence Handle2209274

    CAS  PubMed  Google Scholar 

  31. PR Kiran RE Glass (2002) ArticleTitleDuration of symptoms and spread of colorectal cancer: a short history does not mean early disease Ann. R. Coll. Surg. Engl. 84 381–385 Occurrence Handle10.1308/003588402760978157 Occurrence Handle1:STN:280:DC%2BD38jitF2juw%3D%3D Occurrence Handle12484575

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Fernando Gonzalez-Hermoso M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gonzalez-Hermoso, F., Perez-Palma, J., Marchena-Gomez, J. et al. Can Early Diagnosis of Symptomatic Colorectal Cancer Improve the Prognosis?. World J. Surg. 28, 716–720 (2004).

Download citation

  • Published:

  • Issue Date:

  • DOI: