Screening for Colorectal Cancer?
Screening for Colorectal Cancer?
The question relates to patients with hemorrhoids who choose not to have them treated and present the dilemma of how and when to screen for colon cancer in the presence of guaiac-positive stools. Screening of stool for occult blood is not useful. Is it not best to screen such patients with full colonoscopy at the standard recommended intervals once confirming hemorrhoids as a source of the bleeding, as opposed to flexible sigmoidoscopy?
John A. Mosby, MD
The question of how to select patients for colonoscopy is an important one. Colonoscopy is currently the best tool with which to evaluate the colon for neoplastic disease. All patients with guaiac-positive stools should be evaluated with colonoscopy. Colonoscopy in this setting is not a screening procedure but a diagnostic procedure. Patients with guaiac-positive stools or gross blood in their stools are exhibiting symptoms possibly due to neoplasm. It is often tempting to ascribe small amounts of blood to anorectal disease; this is a dangerous error. In our 4-surgeon colon and rectal practice we perform about 200 resections for colon and rectal cancer each year. At least once a month we operate on a patient who has a history of passing small amounts of blood for some time that was ascribed to anorectal disease and was not investigated early on.
Screening colonoscopy is done for patients who have no symptoms of possible colonic neoplasm. Guidelines for screening colonoscopy have been published by the American Cancer Societyand the American Society of Colon and Rectal Surgeons.
The question relates to patients with hemorrhoids who choose not to have them treated and present the dilemma of how and when to screen for colon cancer in the presence of guaiac-positive stools. Screening of stool for occult blood is not useful. Is it not best to screen such patients with full colonoscopy at the standard recommended intervals once confirming hemorrhoids as a source of the bleeding, as opposed to flexible sigmoidoscopy?
John A. Mosby, MD
The question of how to select patients for colonoscopy is an important one. Colonoscopy is currently the best tool with which to evaluate the colon for neoplastic disease. All patients with guaiac-positive stools should be evaluated with colonoscopy. Colonoscopy in this setting is not a screening procedure but a diagnostic procedure. Patients with guaiac-positive stools or gross blood in their stools are exhibiting symptoms possibly due to neoplasm. It is often tempting to ascribe small amounts of blood to anorectal disease; this is a dangerous error. In our 4-surgeon colon and rectal practice we perform about 200 resections for colon and rectal cancer each year. At least once a month we operate on a patient who has a history of passing small amounts of blood for some time that was ascribed to anorectal disease and was not investigated early on.
Screening colonoscopy is done for patients who have no symptoms of possible colonic neoplasm. Guidelines for screening colonoscopy have been published by the American Cancer Societyand the American Society of Colon and Rectal Surgeons.