The usual and trouble-free process in diagnosing gastrointestinal malignancy is that after the onset of clinical symptoms and referral to the health care system, the doctor suspects the patient and performs diagnostic procedures, the most important of which is gastrointestinal endoscopy (4, 10). This test will confirm the tumor and the pathological examination of the biopsy will confirm it. If the above process goes easily, the patient is referred for surgical treatment as soon as possible. But in fact, many problems arise in this simple process. Factors that can lead to delays in surgical treatment include: late symptoms of the disease, delay in the initial visit of the patient, lack of necessary attention of physicians in the initial treatment of patients, inappropriate diagnostic-therapeutic measures, inappropriate endoscopy and or without biopsy, long pathological examination of biopsies, financial problems for hospitalization and surgery, long surgical appointments, long preoperative examinations, the attitude of some people and even doctors that surgery is useless in these patients (11). The result of the above problems is that a significant number of patients are diagnosed at a more advanced stage, which has consequences such as inability to cure the patient, shortening of patient survival, negative socio-economic effects in society and public distrust of the health that system seeks treatment (12). To determine the importance of each of the above problems, without a comprehensive review, it is not possible to determine the priority and the necessary budget for possible solutions. Doing this study will indicate which of the problems is a priority and which is the best way to solve this problem. The results of the above study indicate a delay of one year in the surgical treatment of patients with gastrointestinal cancers (including esophageal, gastric and colorectal cancers), which could indicate a national problem in the diagnosis and treatment of this group of diseases. Examination of the experiences of other countries also shows a delay in the diagnosis of these diseases (13). In a study in United Kingdom, 27 patients with esophageal cancer and 80 patients with gastric cancer, found that the interval between the onset of symptoms and diagnosis was 17 weeks (1 to 168 weeks) and the stage of diagnosis in patients with esophageal cancer. It has a significant relationship with delay in diagnosis (14, 15).
According to the work done in this hospital, one of the important factors in delaying the treatment of patients, especially cancer patients and gastrointestinal cancer, can be the lack of fast and timely hospitalization and operating room, after which the patient must be wait a while for the surgery. From the beginning of symptoms to the start of treatment and transfer of the patient to specialists, this should be done by a general practitioner or in the emergency room. Assigning part of continuing education programs for physicians, especially general practitioners, to gastrointestinal cancers to focus on symptoms and clinical suspicion, indications for diagnostic or referrals, types of diagnostic tests, and the value of each are priority strategies. Development of endoscopic standards and monitoring of endoscopic procedures performed in the country are other solutions. The next step is to educate the public about the symptoms of these diseases; and work that can be offered as a suggestion in this field, in prioritizing surgeries related to malignancies referred to medical centers, as well as establishing a systemic management of the initial diagnosis and finally treatment leading to surgery in patients with malignancies in each classification is.
5.2. Limitation of Study:
One of them is that collection of some data based on patient statements. Although many cases have been collected using written documents and paraclinical results and patient records, there are still cases such as the distance from the onset of symptoms to the visit to the doctor or the distance from the visit to the general practitioner to the specialist visit. For per case we just collected their information only by asking the patient. Therefore, for future more detailed and extensive studies, it is recommended that relevant information be collected from the physicians of the patients under study to increase the validity of the study.
Another limitation of the study was that the patients were hospitalized in the surgical ward, so patients with advanced or metastatic cancers who were not candidates for surgery were not included in the study and were referred directly for chemoradiotherapy. Therefore, the rate of non-surgical cancers in the community is probably higher than the rate obtained in this study. To solve the above problems, it is necessary to conduct a wide-ranging study that examines patients in the early stages of the process, and also considers patients from different social backgrounds. It is also necessary to gather the necessary information from more human resources, such as doctors.