Contemporary Investigation and Management: Colorectal Cancer

In part two of?the?Contemporary Investigation and Management: Colorectal Cancer series ? Colorectal Surgeon, Jonathan Wilson,?looks at a common cause of rectal bleeding, and how not all rectal bleeding signals cancer?

?As I have previously suggested, less than 1 in 10 of urgent colorectal GP referrals result in the diagnosis of cancer. Benign conditions, such as haemorrhoids (piles), diverticular disease, irritable bowel syndrome and inflammatory bowel disease are much more frequently attributed to rectal bleeding or change in bowel habit after appropriate investigation.

Case presentation 1:

A 41 year old solicitor presented to his GP with rectal bleeding. He had noticed fresh blood on the toilet paper intermittently for several years, although this had increased lately after an episode of constipation and straining on the toilet. He also reported noticing ?lumps? prolapsing from the anus after opening his bowels, which disappeared spontaneously afterwards. There was no other change in bowel habit, weight loss or abdominal pain, and he was otherwise fit and well. Although, his grandfather had cancer of the colon diagnosed at the age of 72.

His GP referred him onto the local colorectal surgeon who explored the history of the complaint, and then performed a surprisingly easy and pain-free examination of the abdomen and anus in the out-patient department. He was told that there were some medium sized haemorrhoids that were almost certainly the cause of the bleeding, but for complete reassurance, a second visit to the hospital endoscopy department was arranged the following week at the patients convenience for a ?flexible sigmoidoscopy?.

For this procedure, he attended the Endoscopy Unit for less than two hours, and had a rectal enema on arrival (a small volume of liquid laxative inserted easily via the anus, which results in a bowel movement to clear the lower colon). Immediately after this his surgeon passed a small flexible telescope via the anus around the lower colon, which took less than 15 minutes.

As previously suggested, the surgeon confirmed that there was nothing else to see other than haemorrhoids, and recommended some treatment, there and then, known as ?rubber band ligation?. In this technique, minute rubber bands are applied just above the main haemorrhoids (often 2-3 in number), which reduce the blood flow into the piles, thereby causing them to shrink over a period of time (up to several months after). They also hitch the prolapsing tissue back up into the anus ? like a face-lift. The technique is usually painless, due the lack of nerve endings in this area of anatomy.

The patient was back at work later that day, with a six week follow-up appointment arranged.

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Source: http://blog.thewellingtonhospital.com/2012/02/contemporary-investigation-and-management-colorectal-cancer-2/

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