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COLORECTAL CANCER


Raising Awareness
The importance of taking a family history.
  • Family history taking is a neglected part of the assessment of patients in primary care.
  • Patients often have little understanding of possible inherited predisposition in relation to cancer.

    Prevention
    Cigarette smoking and dietary factors have been linked with colorectal cancer
  • Provide dietary information and encourage eating plenty of vegetables and fruit.
  • Encourage patients to stop smoking.

    Screening
    General Screening - no screening programme for general population

    Risk Directed Screening
  • Positive family History - First degree relative with colorectal cancer <45 years and members of families with multiple cancers
  • Genetic syndromes
  • Chronic Inflammatory Bowel Disease
  • Pre-existing Colorectal Adenoma or Carcinoma

    Diagnosis & Referral
  • Symptoms and warning signs that warrant Investigation
  • Rectal bleeding in patients aged 45 or over
  • A palpable rectal lesion on PR
  • Altered bowel habit lasting 6 weeks or more
  • Blood seen on bowel wall or on glove after PR (haemorroids only bleed on defecation)
  • Tenesmus
  • Passage of mucous PR
  • Abdominal pain associated with any of the above

    Physical Examination
  • Abdominal and digital rectal examination (10% of rectal cancers are palpable)

    In case of suspected colorectal cancer the large bowel should be completely examined by either - colonoscopy or flexible sigmoidoscopy plus double contrast Barium Enema

    Appropriate investigations pending hospital appointment
  • A FBC - unrecognised anaemia may delay surgery
  • FOB testing doesn't contribute to management of symptomatic patients

    Follow up
    Whether the General Practitioner is directly involved with the clinical follow up or not he/she should ensure:
  • All patients are seen within 3 months of surgery to assess late complications.
  • Colonoscopy within 1 year to confirm clear colon.
  • USS of liver 1 year after surgery in any patient considered a candidate for hepatic resection if metastases were detected.
  • All patients who have had a Total Mesorectal Excision are followed up for purpose of auditing surgeons performance of technique.
  • Follow up of those patients who request it for psychological reassurance.
  • Younger patients and those with a history of multiple colonic lesions have regular colonoscopy at 3-5 year intervals.