Colorectal Carcinoma

BMJ Learning modules
Colorectal Cancer
Lower GI Cancer

Doctors.net module
Diagnosing Colorectal Cancer  http://www.doctors.net.uk/ecme/wfrmNewIntro.aspx?moduleid=1334
Rectal Bleeding

A note on iron deficiency anaemia4-6% of cases are caused by coeliac disease
The British Society of Gastroenterologists recommends coeliac disease screening is performed in all cases of IDA. This is done either by testing for anti-endomysial antibodies (EMA) or tissue transglutaminase (tTG) antibodies.

CancerThe stats aren't good for cancer. 26% of colorectal cancers are not diagnosed until they present as an emergency.
28% present with metastatic disease
1 in 20 people develop colorectal cancer
Peak incidence is in the 7th decade
Increasing incidence

Risk Factors
    Meat consumption and a diet high in animal fat
    Obesity (association stronger in men than women)
    Lack of physical exercise
    Smoking or alcohol
    Type 2 diabetes mellitus or acromegaly
    Renal transplantation
    Previous abdominal radiation


Beneficial Factors
 A diet rich in fruit and vegetables
    Increased fibre
    Treatment with aspirin
    Treatment with non-steroidal anti-inflammatory drugs

2 week wait:
- > 40yrs with PR bleeding + looser stools for more than six weeks
- >60 years with PR bleeding for >6 weeks
- >60 years with looser or more frequent stools without bleeding
- RIF or palpable rectal mass.
- Men with unexplained iron deficiency anaemia (Hb <110)
- Non-menstruating women with an Hb <100
- Carcinoembryonic antigen (CEA) is a useful tumour marker in those patients with a raised CEA preoperatively and whose value drops post-resection.

Bleeding in General
Lower GI bleeding is defined as bleeding distal to the ligament of Treitz
The BLEED Criteria is useful