Concerns regarding colorectal cancer remain a topical issue, primarily because of its common nature with over 30, 000 new cases being diagnosed on an annual basis in the UK alone.
It is the third most common cancer in the UK. In addition, there has been increased exposure to the disease, since the government introduced the national screening programme, in an effort to reduce the significant implications associated with the diagnosis of advanced disease.
So what are the risk factors ?
Age. Colorectal cancer is a disease that primarily affects people over the age of 50. It can however occur at a younger age, but is less common. Despite this in a symptomatic individual (see below) irrespective of age, but especially over the age of 35, there is a low threshold to investigate.
Family history of colorectal cancer (CRC) or high risk colon polyps.
Patients with a family history of either of the above have an increased risk of developing the disease and thus require further investigation. The presence of a first degree relative who has developed CRC under the age of 60 (in particular under the age of 45) or alternatively has a family history of multiple cancers should be referred for early colonoscopy and genetic surveillance.
Previous surgery for colorectal cancer
Will require long term surveillance.
Chronic inflammatory conditions of the colon
Ulcerative Colitis and Crohns disease increase the risk of developing colorectal cancer.
Diabetes & Obesity
Patients with diabetes or who are obese have an increased risk of colorectal cancer.
Diet
There is a weak association between eating large amounts of red meat and colorectal cancer.
Smoking and Alcohol
Excessive consumption of either is associated with an increased risk of colorectal cancer.
What measures are undertaken in the clinical setting?
New onset symptoms are actively pursued during consultation, in all age groups, primarily to exclude alternative diagnoses. It is important to maintain a high index of clinical suspicion, with increasing age.
High risk symptoms
• Rectal bleeding with altered bowel habit (loose stools for more than 6 weeks)
• Rectal bleeding in the absence of anal canal symptoms eg itching
• Increased frequency of bowel movements for more than 6 weeks
• Palpable abdominal mass or rectal mass
• Iron deficiency anaemia
Low risk symptoms
• Transient change in bowel habit, less than 6 weeks (e.g constipation)
• Persisting abdominal discomfort, (age more than 50, there is a 10% association with intra abdominal malignancy)
• Impaired Glucose tolerance (type II diabetes).
The patient pathway
Having undertaken a concise history and following a thorough examination, a rigid sigmoidoscopy is undertaken in clinic.
Thereafter flexible sigmoidoscopy, colonoscopy or alternatively CT pneumocolon will be undertaken on an elective basis to establish an aetiology for the symptoms described.
If further intervention is indicated, the use of minimally invasive techniques such as keyhole surgery enhances recovery, enabling a more rapid return to normal activity, with minimal lifestyle disruption.
Mr Romi Navaratnam MSc MS FRCS (Lon) FRCS (Gen)
Consultant Colorectal & Laparoscopic Surgeon/Hon. Senior Lecturer in Surgery
Secretary: 020 7078 3832 Fax: 0207 078 3898
Appointments 020 8887 2241 North Middlesex University Hospital
Royal Free & UCL Medical School
Appointments 020 7806 4060 Hospital of St John & St Elizabeth
020 7483 5181 Wellington Hospital (Central)
Correspondence: Hospital of St John & St Elizabeth 60 Grove End Road London NW8 9NH
05 May 2011
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