When a patient has surgery for colon cancer, national guidelines backed by the American Cancer Society and the American Society of Clinical Oncology recommend that a minimum of 12 lymph nodes be examined. Lymph node involvement helps the oncologist determine the stage of cancer, whether the disease has spread and the proper treatment regimen.
But a new study released today in the online issue of the Journal of the National Cancer Institute finds that the majority of hospitals don't examine enough lymph nodes after surgery.
More than 60% of U.S. hospitals failed to comply with the recommendation to get pathology results on at least 12 lymph nodes.
"It's disappointing that despite so much emphasis on this particular issue, so many hospitals still aren't checking enough lymph nodes to ensure they diagnose the accurate stage of cancer," said Dr. Karl Bilimoria, surgery resident and lead author said in a news release. "Knowing the accurate stage of your disease affects your survival and treatment. That's critical.
"Every surgeon has a story about a colon cancer patient where the pathology report showed only a few lymph nodes and no cancer was found," he said. "Then the surgeon asks the pathologist to check six or eight more nodes, and one of those turns out to be positive for cancer. That completely changes the treatment plan."
Some hospitals are better than others at following the guidelines, the study showed. Hospitals designated by the National Cancer Institute as Comprehensive Cancer Centers had a 78% compliance rate; other academic hospitals had a 52% compliance rate; Veterans Administration hospitals had a 53% compliance rate; and community hospitals had almost a 34% compliance rate.
The hospitals that did not comply treat about 65% of colon cancer patients. The recommendation is a guideline, not a law, and surgeons might have good reason for not checking the recommended number of lymph nodes. But patients can ask their surgeon how many lymph nodes were checked. If it's less than 12, they can ask why.
-- Susan Brink
Photo: Colonoscope, used to screen for colon cancer. Credit: Robert Durell / Los Angeles Times