Risk of colorectal cancer in general practice patients presenting with rectal bleeding, change in bowel habit or anaemia

Introduction: Some studies have suggested that colorectal cancer at a younger age had distinct biological characteristics: different clinical presentations, more advanced stage at time of diagnosis and poorly differentiated carcinoma. The aim of the study is to analyze clinical and histopathological differences between younger (≤40 years of age) and older (>40 years of age) colorectal cancer patients.Methods: A cross-sectional analysis was conducted amongst the colorectal cancer patients who visited Bir Hospital between July 2015 and April 2017. All colonoscopically diagnosed and histopathologically proven cases of colon cancer were included. Chi-square test and independent t – test was performed to analyze the difference between clinical presentations and histopathological findings among two groups of patients and p value of <0.05 was considered as significant.Results: Thirty younger patients and thirty older patients were enrolled without any differences in gender proportion. There were no statistical differences between clinical presentation and histological grade and type in younger and older patients. The younger patients had more complaints of altered bowel habit (p <0.001) while older patients mostly presented with per rectal bleeding (p< 0.008).Conclusions: In this study, colorectal cancer at younger ages showed similar characteristics to those of older patients except altered bowel habit was more common in younger patients while per rectal bleeding was more common in older patients. Although colorectal cancer incidence increases with age, younger patients with altered bowel habits, weight loss, anemia and anorexia should also be given due medical attention and undergo evaluation promptly. Keywords: carcinoma; colon; per rectal bleeding; younger group. [PubMed]

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Predictive value of signs and symptoms for colorectal cancer in patients with rectal bleeding in general practice

Family Practice ◽

10.1093/fampra/12.3.279 ◽

1995 ◽

Vol 12 (3) ◽

pp. 279-286 ◽

Cited By ~ 68

Author(s):

Gerda H Fijten ◽

Richard Starmans ◽

Jean WM Muris ◽

Hubert JA Schouten ◽

Geert H Blijham ◽

...

Keyword(s):

Colorectal Cancer ◽

General Practice ◽

Rectal Bleeding ◽

Predictive Value ◽

Signs And Symptoms

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EP.TU.333FIT stratification in the COVID era - Is it safe for rectal bleeding?

British Journal of Surgery ◽

10.1093/bjs/znab311.043 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Jaspreet Seehra ◽

James Bailey ◽

Caroline Chapman ◽

Joanne Morling ◽

David Humes ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Rectal Bleeding ◽

Digital Rectal Examination ◽

Final Analysis ◽

Bowel Habit ◽

Hospital System ◽

Testing Protocol ◽

Low Threshold ◽

Electronic Hospital

Abstract Aims Faecal Immunochemical Tests (FIT) are increasingly used for stratification of colorectal cancer risk in symptomatic patients. FIT is not currently recommended for use in patients with rectal bleeding, but recent studies have reported its safe use. We report our experiences of FIT in patients presenting with rectal bleeding during the COVID-19 pandemic. Methods Patients referred to NUH NHS Trust with rectal bleeding from 15/04/20-15/08/20 were invited to complete a postal-based FIT (OC-Sensor). Demographics, symptoms, investigations and results were recorded. Outcomes were retrospectively reviewed using an electronic hospital system. Result 344 patients were invited to participate, with 301 (87.5%) returning FITs in accordance with testing protocol. 36 patients declined to be seen, 4 were considered not fit for investigation, and 4 had incomplete records. 257 patients were included in the final analysis with 10 CRC detected (3.9%). Rectal bleeding (257, 100%) was the most common presenting symptom followed by change in bowel habit (133, 51.8%). 10 CRC were diagnosed (3.9%). 2 CRC were detected with FIT <4 µg Hb / g faeces (2/137, 1.5%) and 8 were detected >100 µg Hb / g faeces (8/45, 17.8%). FIT result was significantly associated with CRC diagnosis (p < 0.0001). 4 with CRC had anaemia (4/53, 7.5%), 1 had thrombocytosis (1/12, 8.3%). Conclusions FIT missed 20% of CRC in this patient group with the application of a very low threshold (<4 µg Hb / g faeces). Both cancers missed by FIT were detectable on digital rectal examination, emphasising the importance of this examination in primary care.

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Sa1649 - The Diagnostic Value of a Change in Bowel Habit for Colorectal Cancer

Gastroenterology ◽

10.1016/s0016-5085(18)31473-2 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-341-S-342

Author(s):

Minea S. McCulloch ◽

Imran Aziz ◽

Annikka V. Polster ◽

Andreas-Bernd Pischel ◽

Henrik Stålsmeden ◽

...

Keyword(s):

Colorectal Cancer ◽

Diagnostic Value ◽

Bowel Habit

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Prevalence of pelvic floor symptoms in female patients attending the two-week wait clinic with suspected colorectal cancer

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0147 ◽

2016 ◽

Vol 98 (6) ◽

pp. 413-418 ◽

Cited By ~ 1

Author(s):

J Bennett ◽

A Greenwood ◽

P Durdey ◽

D Glancy

Keyword(s):

Colorectal Cancer ◽

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Obstructed Defecation ◽

Bowel Habit ◽

Wexner Score ◽

Exact Test ◽

Female Patients ◽

Presenting Symptoms ◽

Pelvic Floor Symptoms

Introduction The aim of this study was to establish the prevalence of pelvic floor symptoms in women referred to a colorectal two-week wait (2WW) clinic with suspected colorectal cancer. Methods A questionnaire assessing faecal incontinence (FI) (Wexner score) and obstructed defecation syndrome (ODS) (Renzi score) was offered to 98 consecutive female patients attending a colorectal 2WW clinic at a single trust. Results Overall, 56 (57%) of the 98 patients had significant ODS and/or FI (scores >9/20), 33 (34%) had ODS and 40 (41%) had FI. Seventeen patients (17%) had both ODS and FI. Analysis of the 63 patients referred with a change in bowel habit (CIBH) showed 40 (63%) to be Renzi and/or Wexner positive compared with 16 (46%) of the 35 patients who presented without CIBH (p=0.095, Fisher’s exact test). Further analysis showed that 31 (78%) of the 40 patients with FI presented with CIBH compared with 32 (55%) of the 58 without FI (p=0.032). In terms of ODS, 23 (70%) of the 33 patients with ODS presented with CIBH compared with 40 (62%) of the 65 without ODS (p=0.506). Conclusions Over half of the female patients attending our colorectal 2WW clinic had significant pelvic floor dysfunction (FI/ODS), which may account for their symptoms (especially in the CIBH referral category). While it is important for malignancy to be excluded, many patients may benefit from investigation and management of their pelvic floor dysfunction as the cause for their presenting symptoms.

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Differences in diagnostic activity in general practice and findings for individuals invited to the danish screening programme for colorectal cancer: a population-based cohort study

Scandinavian Journal of Primary Health Care ◽

10.1080/02813432.2018.1487378 ◽

2018 ◽

Vol 36 (3) ◽

pp. 281-290

Author(s):

Jakob Søgaard Juul ◽

Berit Andersen ◽

Søren Laurberg ◽

Anders Helles Carlsen ◽

Frede Olesen ◽

...

Keyword(s):

Colorectal Cancer ◽

General Practice ◽

Cohort Study ◽

Screening Programme ◽

Population Based

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The diagnostic value of a change in bowel habit for colorectal cancer within different age groups

United European Gastroenterology Journal ◽

10.1177/2050640619888040 ◽

2019 ◽

Vol 8 (2) ◽

pp. 211-219

Author(s):

Sofia M McCulloch ◽

Imran Aziz ◽

Annikka V Polster ◽

Andreas-Bernd Pischel ◽

Henrik Stålsmeden ◽

...

Keyword(s):

Colorectal Cancer ◽

Fast Track ◽

Diagnostic Yield ◽

Age Groups ◽

Diagnostic Value ◽

Bowel Habit ◽

Cancer Prevalence ◽

Alarm Symptom ◽

Alarm Features ◽

Over 40 Years

Background Change in bowel habit as a sole alarm symptom for colorectal cancer is disputed. Objective We investigated the diagnostic value of change in bowel habit for colorectal cancer, particularly as a single symptom and within different age groups. Methods This retrospective cohort study examined colorectal cancer fast track referrals and outcomes across four Swedish hospitals (April 2016–May 2017). Entry criteria constituted one or more of three alarm features: anaemia, visible rectal bleeding, or change in bowel habit for more than 4 weeks in patients over 40 years of age. Patients were grouped as having only change in bowel habit, change in bowel habit plus anaemia/bleeding or anaemia/bleeding only. Results Of 628 patients, 22% were diagnosed with colorectal cancer. There were no cases of colorectal cancer in the only change in bowel habit group under 55 years, while this was 6% for 55–64 years, 8% for 65–74 years and 14% for 75 years and older. Among subjects under 55 years, 2% with anaemia/bleeding had colorectal cancer, this increased to 34% for 55 years and older ( P < 0.0001). Change in bowel habit plus anaemia/bleeding gave a colorectal cancer prevalence of 16% in under 55 years and increased to 30% for 55 years and older ( P = 0.07). Conclusion Change in bowel habit as the only alarm feature has a low diagnostic yield for colorectal cancer in patients under 55 years.

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A Monitored-Release Study of Methrazone in General Practice

Journal of International Medical Research ◽

10.1177/030006058000800406 ◽

1980 ◽

Vol 8 (4) ◽

pp. 276-282 ◽

Cited By ~ 3

Author(s):

P G Harris

Keyword(s):

General Practice ◽

Skin Rash ◽

Rectal Bleeding ◽

Cardiac Glycosides ◽

Adverse Reactions ◽

Inflammatory Drug ◽

Inflammatory Agent ◽

Release Study ◽

Anti Inflammatory ◽

Severe Leucopenia

Methrazone, a non-steroidal anti-inflammatory drug, was used on a monitored release study in general practice to treat 2,693 patients with rheumatoid or osteoarthritis. In a dose of 200 mg three times daily, it appeared to produce clear benefit in between 50% and 60% of patients. Adverse reactions such as dyspepsia and skin rash led to the drug being withdrawn in 11% of patients. There were three major adverse reactions possibly due to the drug (haematemesis, rectal bleeding and acute purpura), but no cases of severe leucopenia or thrombocytopenia. Methrazone is a useful anti-inflammatory agent. In particular, it is unlikely to cause interactions with other drugs, including cardiac glycosides such as digoxin.

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