TY  - INPR
N2  - 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.
ID  - discovery10065198
UR  - https://doi.org/10.1038/s41416-018-0335-z
SN  - 1532-1827
JF  - British Journal of Cancer
A1  - Cross, AJ
A1  - Wooldrage, K
A1  - Robbins, EC
A1  - Pack, K
A1  - Brown, JP
A1  - Hamilton, W
A1  - Thompson, MR
A1  - Flashman, KG
A1  - Halligan, S
A1  - Thomas-Gibson, S
A1  - Vance, M
A1  - Saunders, BP
A1  - Atkin, W
TI  - Whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study
AV  - public
Y1  - 2019///
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ER  -