Objective: To explore the spectrum of typical symptoms associated with colorectal cancer (CRC) and their influence in timely diagnosis.
Methods: A total of 400 cases were randomly collected from 1798 CRC patients treated at our hospital from January 2000 to December 2010. A retrospective chart review was undertaken for all identified cases. Besides demographics and tumor features, TNM stage was obtained from medical records and pathological forms. Other relevant data were as follows: (1) initial symptom complex, (2) presenting symptom or symptom complex, (3) patient duration: period from initial symptoms to consulting a doctor, (4) hospitalization duration: period from initial seeing a doctor to a confirmed CRC case, (5) diagnostic duration: patient duration plus hospitalization duration, (6) rate of misdiagnosis: CRC subjects being diagnosed and treated as other diseases for at least 30 days was identified as misdiagnosis. χ(2) tests were used to compare the differences of rates of kinds of symptoms and early diagnosis.
Results: Among 400 study subjects, the frequencies of initial symptoms in a decreasing order were change in bowl habits (170, 42.5%), abdominal pain and/or discomfort (157, 39.3%), rectal bleeding (147, 36.8%) and anorectal stimulating symptoms (69, 17.3%). And 176 cases (44.0%) presented multiple symptoms. Short-term health care seeking (≤ 15 d) after initial symptoms was 40.7% (159/391) within all cases, but only 25.3% (42/166) cases with symptoms of change in bowel habits saw a doctor. The rate was significantly lower than that of other cases (117/225, 52.0%, P = 0.000) without this symptom. An onset of symptom complex did not lead to short-term health seeking compare to individual symptoms. Above 50% cases were already in late stage (TNM stage later than IIb) as any of the above initial symptoms appeared. No differences of pathology and differentiate of tumors were found among cases with different initial symptoms (P > 0.05). Further analyzed the consulting symptoms: rectal bleeding 179 frequency (44.8%), abdominal pain or discomfort 159 frequency (39.8%), change in bowl habits 155 frequency (38.8%), and Anal rectum stimulating symptoms 69 frequency (17.3%). 50.8% (203 cases) consulted a doctor with multiple symptoms. 59.9% (236/394) cases were of short term hospitalization duration (≤ 15 d). However, only 52.5% (83/158) in cases whose consulting symptoms included abdominal pain or discomfort, lower than that in other cases without these symptoms (64.8%, 153/236) (P < 0.05). High rate of misdiagnosis (50.0%, 10/20) was found in Melena consulter than others (26.8%, 101/377, P < 0.05).
Conclusions: Change in bowel habits, rectal bleeding and abdominal pain are the most common symptoms in CRC. And consulting and initial symptoms are similar. Diagnostic and hospitalization delays are seen in half of CRC cases.