Management of Colorectal cancer
Symptoms
• Blood in the stools
• Mucus discharge
• Recent change in bowel habits (constipation more common than
diarrhoea)
• Alternating constipation with spurious diarrhoea
• Bowel leakage when flatus passed
• Unsatisfactory defecation (the mass is interpreted as faeces)
• Abdominal pain (colicky) or discomfort (if obstructing)
• Rectal discomfort
• Symptoms of anaemia
Investigations
• Faecal occult blood (FOBT)
• Colonoscopy
• Sigmoidoscopy, esp. fl exible sigmoidoscopy
• Barium enema (accurate as a double contrast study) if colonoscopy
unavailable
If FOBT is positive—investigate by colonoscopy or fl exible sigmoidoscopy.
Screening (based on family history: Table 25)2-yrly FOBT and 5-yearly
colonoscopy is recommended for those > 50 yrs and colonoscopy yearly or
2-yearly from 25 yrs for those at high risk (or even earlier every 12 months
from 10–15 years if strong history of familial polyposis) and, in addition,
fl exible sigmoidoscopy and rectal biopsy for those with ulcerative colitis.
Has a good prognosis if diagnosed early.
Management Early surgical excision is the treatment, with the method
depending on the site and extent of the carcinoma.
Symptoms
• Blood in the stools
• Mucus discharge
• Recent change in bowel habits (constipation more common than
diarrhoea)
• Alternating constipation with spurious diarrhoea
• Bowel leakage when flatus passed
• Unsatisfactory defecation (the mass is interpreted as faeces)
• Abdominal pain (colicky) or discomfort (if obstructing)
• Rectal discomfort
• Symptoms of anaemia
Investigations
• Faecal occult blood (FOBT)
• Colonoscopy
• Sigmoidoscopy, esp. fl exible sigmoidoscopy
• Barium enema (accurate as a double contrast study) if colonoscopy
unavailable
If FOBT is positive—investigate by colonoscopy or fl exible sigmoidoscopy.
Screening (based on family history: Table 25)2-yrly FOBT and 5-yearly
colonoscopy is recommended for those > 50 yrs and colonoscopy yearly or
2-yearly from 25 yrs for those at high risk (or even earlier every 12 months
from 10–15 years if strong history of familial polyposis) and, in addition,
fl exible sigmoidoscopy and rectal biopsy for those with ulcerative colitis.
Has a good prognosis if diagnosed early.
Management Early surgical excision is the treatment, with the method
depending on the site and extent of the carcinoma.