Wayne State University, Detroit Medical Center Southfield, MI
Jannel Lee-Allen, MD, MUP1, Daniel Deneve, MD, BSc1, Osose Oboh, MPH2, Maseray S. Kamara, MD1, Bashar Mohamad, MD3; 1Wayne State University, Detroit Medical Center, Detroit, MI; 2MSU College of Human Medicine, Flint, MI; 3WSUPG, Detroit, MI
Introduction: A case series of COVID-19 (C19) delays in diagnosis and treatment of early onset Colorectal cancer (CRC).
Methods: Case 1: A 31-year-old male with controlled Sickle Cell Anemia (no crises in over 10 years) presented to the emergency room (ER) with 6 months of non-focal, abdominal discomfort, 30lb weight loss and CT scan 1 month prior revealing a 5 cm, Ascending Colon lesion [Img. 1]. Chief complaint was an expedited colonoscopy as C19 policies eliminated all outpatient requests. Labs noted worsening microcytic anemia. Outpatient colonoscopy, 4 days later, revealed a circumferential, ulcerated, ascending colon mass, malignant appearing [Img. 2]. CT chest, abdomen and pelvis were negative for metastases. Ascending colon biopsies confirmed invasive, moderately, differentiated adenocarcinoma (IAC), CK 20 and CDX-2 positive. Right hemi-colectomy was completed (tumor size: 8x5x1cm, pathology confirmed IAC with negative lymph nodes, margins, and stains for hereditary syndromes).
Case 2: An 18-year-old male with no past medical history presented to ER with 1 month of anorexia, 15lb weight loss as well as 3 days of generalized abdominal pain. Labs showed microcytic anemia of 4.5 g/dL. Primary team did not request inpatient endoscopies due to mis-perception that C19 policies were still in place. Six weeks later, patient represented with same symptoms. CT scan revealed thickening of right colon with ascites. Colonoscopy showed large, erythematous, ulcerated, circumferential mass in the ascending colon [Img. 3]. Pathology and CT chest are still pending.
*Note: Both patients had no family history of CRC or overt gastrointestinal bleeding.
Discussion: These cases reveal two of many ways that C19 has caused delays in the evaluation of CRC in general and early onset CRC specifically; both direct delays due to restrictions on endoscopies as well as indirect delays due to provider mis-perceptions. Each case had at-least an one month delay in endoscopy from the time of presentation. Thus, future research is needed to determine 1) the average delay to endoscopy compared to pre-C19 era; 2) the most common causes of delay; and 3) the 5-10-year impact of C19 delays on CRC detection, stage, treatment, and mortality.
Image 1. CT with Ascending Colon mass in 31 yo Male.
Image 2. Endoscopic image of Ascending Colon mass in 31 yo Male.
Image 3. Endoscopic image of Ascending Colon mass in 18 yo Male.
Disclosures: Jannel Lee-Allen indicated no relevant financial relationships. Daniel Deneve indicated no relevant financial relationships. Osose Oboh indicated no relevant financial relationships. Maseray Kamara indicated no relevant financial relationships. Bashar Mohamad indicated no relevant financial relationships.