A 68-year-old man, with a past history of cardiac disease, diabetes, hypertension, an MI six years prior, and prostate cancer two years prior (with radical prostatectomy, radiation and chemotherapy) saw his PCP of 20 years for a routine check-up. His physician noted that the patient “was fairly up-to-date, screening wise, but should have a colonoscopy sometime.” He had never had one, and the PCP intended to discuss this with him when he saw him for a more complete exam. Six months later, the patient returned to the PCP for a full physical, however, a discussion of a screening colonoscopy did not occur and no occult blood testing was done.
A year later, the patient presented to the emergency department complaining of epigastric pain for the prior three days. He was discharged, but returned the next morning with the same complaint. An abdominal and gall bladder ultrasound revealed a large gallstone. A GI cocktail was given and the patient’s symptoms resolved and he was discharged home.
Four days later the patient followed up with his PCP, again complaining of epigastric pain and reporting a 25-pound weight loss. No change in bowel habits or blood in his stool were noted. The PCP diagnosed the patient with peptic ulcer disease and prescribed Nexium. A month later, an upper GI was negative for an ulcer or mass.
After another six months, the patient called his PCP with complaints of crampy abdominal pain and bloody stools. The PCP referred the patient to the emergency department to rule out a GI bleed. In the emergency department, the patient reported lower abdominal symptoms for the past three weeks with the first incidence of bright red blood nine days prior. A colonoscopy was done and found to be positive for colon cancer. Subsequent testing revealed metastasis to the liver. The patient died three years later from his disease.