Colorectal cancer is one of the most common malignant tumours in western countries. It is the second leading cause of cancer death in the United States [1]. In Britain, colorectal cancer causes 20000 deaths annually [2]. In Finland, colorectal cancer was in fifth place in men and in third place in women among all cancers in the 1980s [3]. The number of colorectal cancers will increase in the future. It is predicted that in Finland the number of new colorectal cancers will almost double by the first decade after 2000 [3].

Cancer of the colon and rectum is especially a disease of older people, as incidence doubles with every decade of age over 40 years [2]. Necropsy studies show that the prevalence of colorectal cancer in asymptomatic patients is 1.6% in 50-60 year olds and 3% in those over 75 [4]. An improvement has been found in the 5-year relative survival rates in all age groups for both colonic and rectal cancers [5].

Delay in the diagnosis of colorectal cancer is still a problem although improvement has been taking place during recent decades. A reduction in the delay before treatment has been reported from 7 months in 1950 to 2 months in 1970 [6]. The time from the first symptom to the first medical consultation has been reported to be 113.4 days (16.2 weeks) for rectal cancer and 88.9 days (12.7 weeks) for colonic cancer [7]. The time from first examination to treatment was 154.0 days (22.0 weeks) for rectal cancer and 135.1 days (19.3 weeks) for colonic cancer [7]. The delay may be a particular problem for those patients in whom emergency surgery becomes necessary (obstruction or perforation). Emergency surgery is associated with higher hospital fatality than elective surgery. Early diagnosis may place more patients in the elective group. As a whole, the present delay in diagnosing colorectal cancer is a considerable one and needs attention.

This retrospective study was planned to find out how the diagnosis and related factors differ in elderly patients compared with younger ones.

Patients

The medical histories of 178 consecutive colorectal cancer patients were examined retrospectively from hospital records. The patients were admitted to and treated in Turku University Hospital and Turku City Hospital during the years 1989 and 1990. The group consisted of 79 men and 99 women. The average age at the time of diagnosis was 71.0 (SD [+ or -] 12.6, range 27-97) years in the whole group, 69.1 (SD [+ or -] 12.3, range 32-97) years in men and 72.6 (SD [+ or -] 12.7, range 27-93) years in women.

Methods

The patients’ medical histories were studied by the same physician (M.K.) and the information collected in a planned form. The main symptom at the time of diagnosis was recorded (blood in stools, diarrhoea, constipation, obstruction, stomach pain, loss of weight, general weakness, other symptom). The time between onset of symptoms and the first medical consultation, and the time between the first medical consultation and diagnosis were recorded. The haemoglobin value was obtained from all records. Rectal examination was recorded as follows: (1) normal, (2) palpable tumour, and (3) information lacking. Special interest was focused on the methods of diagnosis (barium enema, rectoscopy, sigmoidoscopy, colonoscopy, operation, autopsy) and also on the possibility that some diagnostic method missed a tumour. These variables were compared between three age groups (under 65 years old, 65-80 years old and over 80 years old) and between sexes.

The differences between means were compared by Student’s t test. The Mann-Whitney U test was used for data with nonparametric distribution. Comparisons between groups were made using Pearson’s [[chi].sup.2] test.

Results

The main symptom: Seven different main symptoms were identified in this group of colorectal cancer patients. Table I shows the main symptoms which did not differ between the three age groups.

[TABULAR DATA OMITTED]

The time from the first symptom to the first medical consultation: This could be identified in 101 patients and was 82.8 days in the whole group, 77.8 days in men and 86.6 days in women. Table II shows the mean time in three age groups in men and women; men under 65 years old and women over 80 years had a longer interval between first symptom and first medical examination than the other groups.

Table II. Time from the first symptom to the first medical consultation in three age groups in men and women

Days
Age group
(years)       Mean          [+ or -] SD     n
Men
<65           112.7(a)       95.0           18
65-80          38.1(b)       54.7           16
>80            78.8          62.6            9
All            77.8          81.2           43
Women
<65            77.9          94.5           11
65-80          75.2          53.9           28
>80           108.3         114.0           19
All            86.6          85.3           58
(a) p = 0.0081 as compared with men aged 65 80 years.
(b) p = 0.034 as compared with women aged 65-80
years.