Whole colon investigation versus flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study

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Title: Whole colon investigation versus flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study
Authors: Cross, A
Wooldrage, K
Robbins, E
Pack, K
Brown, JP
Hamilton, W
Thompson, MR
Flashman, KG
Halligan, S
Thomas-Gibson, S
Vance, M
Saunders, BP
Atkin, W
Item Type: Journal Article
Abstract: Background Patients with suspected colorectal cancer (CRC) usually undergo colonoscopy. Flexible sigmoidoscopy (FS) may be preferred if proximal cancer risk is low. We investigated which patients could undergo FS alone. Methods Cohort study of 7375 patients (≥55 years) referred with suspected CRC to 21 English hospitals (2004–2007), followed using hospital records and cancer registries. We calculated yields and number of needed whole-colon examinations (NNE) to diagnose one cancer by symptoms/signs and subsite. We considered narrow (haemoglobin <11 g/dL men; <10 g/dL women) and broad (<13 g/dL men; <12 g/dL women) anaemia definitions and iron-deficiency anaemia (IDA). Results One hundred and twenty-seven proximal and 429 distal CRCs were diagnosed. A broad anaemia definition identified 80% of proximal cancers; a narrow definition with IDA identified 39%. In patients with broad definition anaemia and/or abdominal mass, proximal cancer yield and NNE were 4.8% (97/2022) and 21. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency (41% of cohort), proximal cancer yield and NNE were 0.4% (13/3031) and 234. Conclusion Most proximal cancers are accompanied by broad definition anaemia. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency, proximal cancer is rare and FS should suffice.
Issue Date: 22-Jan-2019
Date of Acceptance: 24-Oct-2018
URI: http://hdl.handle.net/10044/1/65582
DOI: https://doi.org/10.1038/s41416-018-0335-z
ISSN: 0007-0920
Publisher: Cancer Research UK
Start Page: 154
End Page: 164
Journal / Book Title: British Journal of Cancer
Volume: 120
Copyright Statement: © 2018 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
Sponsor/Funder: Cancer Research UK
Department of Health
Funder's Grant Number: 25004
02/02/01
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
COMPUTED TOMOGRAPHIC COLONOGRAPHY
BOWEL PREPARATION
BARIUM ENEMA
COLONOSCOPY
REFERRALS
DIAGNOSIS
DISEASE
SIGGAR
YIELD
1112 Oncology and Carcinogenesis
Oncology & Carcinogenesis
Publication Status: Published
Online Publication Date: 2018-12-19
Appears in Collections:Division of Surgery
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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