This book summarizes current knowledge and outlines directions for the future on how to improve the art of diagnosing colorectal cancer with emphasis on timeliness, one of the most vital issues in cancer management. Using a comprehensive, multi-discliplinary approach, it provides an overview of decisive factors in timely diagnosis of colorectal cancer from symptom scores and symptom awareness to technical aspects. The book starts by discussing early diagnosis from the perspective of patients, including the importance of awareness in the general population as well as psychological aspects. It then goes on to discuss issues of importance to clinicians, such as fast tracking, laboratory testing, improving technical skills and optimizing endoscopy services. In addition, more practical issues such as cost-effectiveness and auditing are also extensively discussed. By focusing on one specific but common form of cancer the content translates well across the scope of other cancer types and can be used by professionals working on different cancer types.This book provides clinicians, clinical researchers and policymakers with a comprehensive overview of the field of timeliness in diagnosing colorectal cancer. By addressing the challenges posed in the management of symptomatic patients it informs and educates the experts and could help improve diagnosis.
General introduction of timely diagnosis of cancer.- Symptom awareness and cancer knowledge in the general population.- Fear of cancer and wishful thinking - psychological aspects of early diagnosis of cancer.- Prevalence of alarm symptoms in the general population (eg rectal bleeding).- The value of symptom scores.- Technical skills in diagnosing colorectal cancer (rectal palpation, rigid rectoscopy).- Fast-track solutions (2 weeks wait in UK, "cancer packages" in Denmark).- Pre-selection for invasive investigations using laboratory tests (f-calprotectin and i-FOBT).- Making use of family history.- Optimizing endoscopy services (managing waiting lists, sigmoidoscopy vs colonoscopy).- Cost-effectiveness of CT colonography vs colonoscopy.- Emergency presentation of colon cancer.- The role of quality registers and audits.- Prognostic impact of timeliness in diagnosing colorectal cancer.- Psychological impact of diagnostic delay on patients and staff.- The role of clinical decision support system.- Risk assessment