PWE-068 Common malignancies can be missed during investigation for iron deficiency anaemia

Abstract

Introduction Between 2000 and 2002, 639 consecutive patients referred to the Iron Deficiency Anaemia (IDA) pathway were prospectively collated on a database. We present a case series of potentially missed malignancies. Methods 639 patients presenting to the IDA pathway were prospectively entered onto a database. Initial assessment included OGD and colonic imaging. A 5-year review of outcomes was undertaken using patient medical records and hospital histopathology databases to identify important missed diagnoses. Results 126 (20%) patients were initially found to have a GI luminal tumour; 55 (9%) of these being malignant. These comprised 48 colorectal and seven upper GI malignancies. 12 non-GI, or GI non-luminal malignancies were found. Complete medical records were available for 595 (93%) of patients. Of the 584 patients in whom a malignancy was not initially found, 15 (3%) were subsequently found to found to have one. Six were colorectal, meaning 11% of the total 54 colorectal cancers presenting initially had been missed. The most common cause was a falsely negative barium enema. Three were upper GI, meaning a surprisingly high 30% of the total of 10 upper GI malignancies presenting had been missed. The most common cause was falsely reassuring OGD biopsy histology. Five non-luminal or non-GI tumours were subsequently found meaning 29% of the total 17 had been initially missed. When the malignancy was found on initial presentation 43% of the patients survived for 5 years after diagnosis, whereas none of the patients whose diagnosis was delayed survived 5 years, with a median survival of 10.5 months from diagnosis. Conclusion This is an effective pathway with a very high yield of tumours: 161 (25%), of which 131 were luminal GI tumours and 30 were non-luminal or non-GI tumours. However the pathway still misses significant numbers of malignancies, with barium enemas more prone than colonoscopy to missing tumours, and upper GI, non-luminal and non-GI tumours being more difficult to find. Missed malignancies had poor survival outcomes. For these reasons a high index of suspicion for malignancy in patients with IDA should be maintained.