Wayne State University, Detroit Medical Center Southfield, MI
Jannel Lee-Allen, MD, MUP1, Osose Oboh, MPH2, Bashar Mohamad, MD3; 1Wayne State University, Detroit Medical Center, Detroit, MI; 2MSU College of Human Medicine, Flint, MI; 3WSUPG, Detroit, MI
Introduction: This is a case of early onset Colorectal cancer (CRC) in which the COVID pandemic caused both diagnosis and treatment delays.
Methods: A 31-year-old male with controlled Sickle Cell Anemia (no crises in over 10 years) presented to Emergency Department with 6 months of non-focal abdominal discomfort, 30lb weight loss and CT one month prior with 5 cm, Ascending Colon lesion [Img. 1]. Chief compliant was an expedited colonoscopy as COVID policies eliminated all outpatient and non-emergent case requests. Labs were notable for hemoglobin 9.6 g/dL (down-trending since 2019, from baseline of 11-13 g/dL) and MCV 59 FL. He denied upper gastrointestinal symptoms, family history of CRC or overt gastrointestinal bleeding. He tested negative for COVID. Outpatient colonoscopy, 4 days later, revealed a circumferential, ulcerated, firm ascending colon mass with malignant appearance [Img. 2]. Same day CT chest, abdomen and pelvis were negative for metastases. Pre-surgical COVID testing returned positive. Surgery was postponed until two negative COVID tests. Ascending colon biopsies confirmed invasive, moderately, differentiated adenocarcinoma, CK 20 and CDX-2 positive. Two weeks later, his COVID criteria was met and right hemi-colectomy was completed (tumor size: 8x5x1cm). Pathology confirmed invasive adenocarcinoma without any lymph nodes and negative margins. Stains were negative for hereditary syndromes. The patient did well after surgery.
Discussion: This patient's immediate early onset CRC outcome was not complicated by COVID delays. Research support delaying surgical intervention in cancer patients whether COVID negative or positive due to high risk for COVID specific mortality . Future research is needed to determine the 5-10-year impact of COVID delays on CRC detection, stage, treatment and mortality. Further, prior studies have shown that colonoscopy delays of greater than 10 months from time of positive FIT led to increased detection of advanced stage CRC compared to colonoscopy within 3-6 months . Thus, in the next 3-6 months Gastroenterologists should prioritize outreach and completion of colonoscopies for patients suspected of malignancy in the pre-COVID era. 1. Kutikov, A et al. A War on Two Fronts: Cancer Care in the Time of COVID-19. Annals of Internal Medicine. Vol. 172,11 (2020): 756-758. 2. Doubeni, CA et al. Timely follow- up of positive cancer screening results: a systematic review and recommendations from the PROSPR Consortium. CA Cancer J Clin. 2018;68(3):199–216.
Image 1. CT with Ascending Colon mass in 31 yo Male.
Image 2. Endoscopic image of Ascending Colon mass in 31 yo Male.
Disclosures: Jannel Lee-Allen indicated no relevant financial relationships. Osose Oboh indicated no relevant financial relationships. Bashar Mohamad indicated no relevant financial relationships.