Delays in the diagnosis of oesophagogastric cancer: a consecutive case series

Objectives: To examine the time taken to diagnose oesophageal or gastric cancer, identify the source of delay, and assess its clinical importance Design: Study of all new patients presenting to one surgical unit with carcinoma of the oesophagus or stomach. Setting: University department of surgery in a large teaching hospital. Subjects: 115 consecutive patients (70 men, mean age 66 years) with carcinoma of the oesophagus (27) or stomach (88). Main outcome measures: Interval from the onset of symptoms to histological diagnosis, final pathological stage of the tumour, and whether potentially curative resection was possible. Results: The median delay from first symptoms to histological diagnosis was 17 weeks (range 1 to 168 weeks). 25% (29/115) of patients had a delay of over 28 weeks (median 39 weeks). Total delay was made up of the following components: delay in consulting a doctor (29%), delay in referral (23%), delay in being seen at hospital (16%), and delay in establishing the diagnosis at the hospital (32%). No relation was found between delay in diagnosis and tumour stage in patients with gastric cancer, but for oesophageal cancer those with stage I and II disease were diagnosed within 7 weeks compared with 21 weeks (P<0.02) for those with stage III and IV disease. Conclusions: Long delays still occur in the diagnosis of patients with cancer of the stomach or oesophagus. Streamlined referral and investigation pathways are needed if patients with gastric and oesophageal carcinomas are to be diagnosed early in the course of the disease. Key messages Survival of oesophagogastric cancer is most likely if the tumour is caught early The median delay in diagnosis for patients with oesophagogastric cancer was 17 weeks but 25% of patients had delays of more than 28 weeks For patients with oesophageal cancer this delay was associated with tumours of more advanced stage Patient delay in seeking medical help was relatively short; the biggest reductions in delays could be produced by streamlined referral and investigation. Open access endoscopy service reduced delays in diagnosis compared with standard referral