[en] Objective: To determine the clinical characteristics of patients with colorectal cancer, the relation of diagnostic tests after the first symptoms and the different intervals of time from the beginning of the symptoms up to the treatment. Material and Methods: A prospective follow-up study. Incidental cases diagnosed in the sanitary area of A Coruña (period:2006-2013;n=1891; Security=95%, Precision= ±2'26%). Descriptive and multivariate analysis to identify variables associated to the different intervals of diagnostic and therapeutic delay. Authorized by the CEIC Galicia (code 2004/159 and 2009/110). ftesults: The median age is 71 years old and 60'3% are males. 63'1% of them are located in the colon and a 36'9% in the rectum. The most frequent location is the sigmoid colon (50'3%). The most frequent histological type is the adenocarcinoma (92'2%). The most frequent first symptoms are different according to the location of the tumour. In colon cancer we have more frequently abdominal pain (48'8%), rectal bleeding (43'9%) and asthenia (41'6%). In the rectum cancer: rectal bleeding (81'5%), asthenia (31'9%), weight loss (31'3%) and new appearance of diarrhea (27'7%). The perception of considering their uneasiness as something serious, consulting with somebody or going to the doctor (73'3% of them go first to their family doctor), depends on what symptoms the patient has. Al! the Intervals of time that were measured present smaller delays for colon cancer than for cancer in the rectum. The Patient's Interval (first symptoms-first medical consultation) is 71'0 ±112'1 days with a median of 30 days for colorectal caneer. Those with colon cancer had shorter delay when presenting with vomits (OR=0'604;p=0'038), abdominal distention (OR=0'611;p=0'010) or when they considered at the beginning that their symptoms were serious (OR=O'518;p<0'001). The loss of appetite would increase this delay (OR=1'628;p=0'008). In rectum cancer abdominal pain deereases delay (OR=O'591;p=0'022) and rectal pain increases it (OR=O'591;p=0'022). The Health System Interval (first medical consultation to diagnosis) is 63'8 ± 73'2 days with a median of 33 days. The delay in colorectal cancer decreases by going to the emergency department (OR=0'324;p<0'001), to the specialist (OR=0'611;p=0'044) or by the decision of the family doctor to use the fast track (OR=0'749;p=0'OO9). The first symptoms-diognosis /ntervo/ is of a median of 82 days and a media of 124'5 ± 124'2 days. A larger delay is predicted for colon cancer when the patient has changes in the stools (OR=2'050;p=0'007) and for rectum cancer when rectal pain is suffered during bowel movements (OR=2'369;p=0'005). The interval is shortened in colon cancer when presenting with vomits (OR=0'532;p=0'013), abdominal distention (OR=O'562;p=0'002), thinking the symptoms were something serious (OR=0'603;p=0'003) and going to the emergency department (OR=0'350;p<O'001). In the rectum, the delay is shortened when presenting abdominal distention I (OR=0'359;p<0'OOl). The surgica/ /nterva/ (diagnosis-primary surgery) (colon:30'3 ± 40' 4 days vs. 71'0 ± 62'8:rectum) decreases for colon cancer with the presence of abdominal pain (OR=0'437;p<0'OOl), vomits (OR=O'448;p=0'047), abdominal distention (OR=0'355;p=0'042) and asthenia (OR=0'445;p<0'001) or being at stage II-IV. Stage 111 increases the surgical delay for rectum cancer (OR=1'785;p=0'030) and decreases it with age (OR=0'982;p=0'042) and abdominal pain (OR=O'564;p=0'028). Conclusions: Clinical manifestations are associated with the location of the tumour and in turn, it modifies significantly the attitude and patient's delay. The decision of the family practitioner as for the tests required and the ways of referral modify the Health system's delay. The fast-track's start-up has shortened this delay. After the diagnosis the surgical delay is modified by the stage of the tumour and clinical manifestations. Throughout the studied period after the setting up of the fast-track these intervals were significantly reduced: symptoms-diagnosis Interval, first medical contact-diagnosis Interval and the symptoms-treatment Interval.

[gl] Obxectlvo: Determinar as características clínicas dos pacientes con cancro colorrectal, a relación de probas diagnósticas tralos primeiros síntomas e os diferentes intervalos de tempo desde o inicio ata o trata mento. Material e Métodos: Estudo observacional de seguimiento prospectivo. Inclúense casos incidentes diagnosticados no Área Sanitaria da Coruña (periodo:2006- 2013;0=1891; Seguridade=95%, Precisión=±2,26%). Análise descriptivo e multivariante para identificar variables asociadas aos diferentes intervalos de demora diagnóstica e terapéuti~a. Autorizado polo CEIC Galicia (código 2004/159 e 2009/110). Resultados: A mediana de idade é de 71 anos e o 60,3% son varóns. O 63,1% están localizados no colon e o 36,9% no recto. A localización máis frecuente é o colon sigmoide (50,3%). O tipo histolóxico máis frecuente é o adenocarcinoma (92,2%). Os primeiros síntomas máis frecuentes son diferentes segundo a localización do tumor. No cancro de colon, os máis frecuentes son a dor abdominal (48,8%), a rectorraxia (43,9%) e a astenia (41,6%). No cancro de recto, a rectorraxia (81,5%), astenia (31,9%), perda de peso (31,3%) e diarrea de nova aparición (27,7%). A percepción de considerar o seu malestar como algo serio, consultar con alguén ou acudir ao médico (73,3% ao seu médico de familia) depende dos síntomas que presenta o paciente. Todos os Intervalos de tempo medidos presentan demoras menores para cancro de colon que para cancro de recto. O Intervalo do paciente (primeiros síntomas a primeira consulta médica) é de 71,0 ± 112,1 días cunha mediana de 30 días para cancro colorrectal. Asócianse a unha menor demora no cancro de colon presentar vómitos (OR=0,604;p=0,038), distensión abdominal (OR=0,611;p=0,010) e o considerar ao comezo a seriedade dos síntomas (OR=0,S18;p<0,001). Aumenta a demora a perda de apetito (OR=1,628;p=0,008). No cancro de recto diminúe a demora a dor abdominal (OR=0,591;p=0,022) e aumenta a dor rectal á deposición (OR=0,591;p=0,022). O Intervalo sanitario (primer contacto médico ata o diagnóstico) é de 63,8 ± 73,2 días cunha mediana de 33 días. Diminúe a demora no cancro colorrectal a derivación a urxencias (OR=O,324;p<O,OOl), a especializada (OR=O,611;p=0,044) e a decisión do médico de familia de remitilo vía rápida (OR=0,749;p=0,009). O Intervalo primeiros síntomas-diagnóstica é dunha mediana de 82 días cunha media de 124,5 ± 124,2 días. Predín maior demora para cancro de colon a alternancia nas deposicións (OR=2,050;p=0,007) e para o cancro de recto a dor rectal á deposición (OR=2,369;p=0,005). O intervalo acúrtase no cancro de colon ao presentar vómitos (OR=0,532;p=0,013), distensión abdominal (OR=0,562;p=0,002), pensar que os síntomas eran algo serio (OR=0,603;p=0,OO3) e acudir a urxencias (OR=0,350; p<O,OOl). No recto a demora acúrtase ao presentar distensión abdominal (OR=0,359;p<0,001). O Intervalo cirúrxico (diagnóstico-ciruxía primaria) (colon:30,3 ± 40,4 días vs. 71,0 ± 62,8:recto) dlminúe para o cancro de colon coa presenza de dor abdominal (OR=O,437;p<0,OOl), vómitos (OR=0,448;p=0,047), distensión abdominal (OR=0,355;p=0,042) e astenia (OR=0,445;p<0,001) ou ante un estadio I!-IV. O estadio 111 aumenta a demora cirúrxica para o cancro de recto (OR=1,785;p=0,030) e diminúe coa idade (OR=0,982;p=0,042) e a dor abdominal (OR=0,564;p=0,028). Conclusións: As manifestacións clínicas asócianse á localización e á súa vez modifican significativamente a actitude e demora do paciente. A decisión do médico de atención primaria en canto ás probas solicitadas e vías de derivación modifican a demora do sistema sanitario. A posta en marcha da vía rápida de derivación acurtou a devandita demora. Tras o diagnóstico a demora cirúrxica modifícase polo estadiaxe e manifestacións clínicas. Ao langa do período estudado tras a introdución da vía rápida de derivación reducíronse significativamente os intervalos: síntomas-diagnóstico, primeiro contacto médico-diagnóstico e o Intervalo síntomas-tratamento.