Advertisement

Young patients with benign anal diseases and rectal bleeding: should a colonoscopy be performed?

  • Belisa G. Muller
  • Paulo C. Contu
  • Cláudio Tarta
  • Anderson R. Lazzaron
  • Tiago L. Ghezzi
  • Daniel C. DaminEmail author
Original Article

Abstract

Background and aim

There is no consensus whether a colonoscopy should be recommended for patients under 50 years of age who present with both anal bleeding and benign anal diseases. The aim of this study is to evaluate the effectiveness of colonoscopy to detect neoplastic lesions in this specific group of patients.

Methods

A prospective study analyzing the results of colonoscopies performed in patients younger than 50 years of age who reported a rectal bleeding and also had a diagnosis of benign anal disease at first clinical visit.

Results

One hundred and eighty-seven consecutive patients were prospectively included in this study. In 35 patients (18.7%), adenomatous polyps were diagnosed. Thirty-seven percent of those lesions (13 cases) were further classified as either advanced adenomas or serrated adenomas. The prevalence of adenomas was 14.6% among patients under the age of 40 and 20% among those between 40 and 50 years of age. Thirty-one percent of the adenomas (11 cases) were located in the right colon, without any other concomitant lesion in the distal colon. In addition, an unsuspected case of sigmoid carcinoma was diagnosed.

Conclusion

The performance of colonoscopy in young patients with benign anal diseases and hematochezia resulted in a high rate of detection of neoplastic lesions. The method might be considered as a valid strategy of investigation in this frequent clinical situation.

Keywords

Colorectal cancer Colonoscopy Young patients Gastrointestinal bleeding Colorectal neoplasms 

Notes

References

  1. 1.
    Davis DM, Marcet JE, Frattini JC, Prather AD, Mateka JJ, Nfonsam VN (2011) Is it time to lower the recommended screening age for colorectal cancer? J Am Coll Surg 213(3):352–361.  https://doi.org/10.1016/j.jamcollsurg CrossRefPubMedGoogle Scholar
  2. 2.
    Chen KC, Chung CS, Hsu WF, Huang TY, Lin CK, Lee TH, Weng MT, Chiu CM, Chang LC, Chiu HM (2018) Identification of risk factors for neoplastic colonic polyps in young adults with bloody stool in comparison with those without symptom. J Gastroenterol Hepatol 33(7):1335–1340.  https://doi.org/10.1111/jgh.14070 CrossRefPubMedGoogle Scholar
  3. 3.
    Center MM, Jemal A, Smith RA, Ward E (2009) Worldwide variations in colorectal cancer. CA Cancer J Clin 59(6):366–378.  https://doi.org/10.3322/caac CrossRefPubMedGoogle Scholar
  4. 4.
    Bailey CE, Hu CY, You YN, Bednarski BK, Rodriguez-Bigas MA, Skibber JM et al (2015) Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg 150(1):17–22.  https://doi.org/10.1001/jamasurg.2014.1756 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66:7–30.  https://doi.org/10.3322/caac.21332 CrossRefPubMedGoogle Scholar
  6. 6.
    Wang W, Chen W, Lin J, Shen Q, Zhou X, Lin C (2019) Incidence and characteristics of young-onset colorectal cancer in the United States: an analysis of SEER data collected from 1988 to 2013. Clin Res Hepatol Gastroenterol 43:208–215.  https://doi.org/10.1016/j.clinre.2018.09.003 CrossRefPubMedGoogle Scholar
  7. 7.
    INCA-Instituto Nacional do Câncer-Estimativa 2018-Síntese de Resultados e Comentários [Internet]. [cited 2019 Aug 26]. Available from: http://www1.inca.gov.br/estimativa/2018/sintese-de-resultados-comentarios.asp
  8. 8.
    Silva ACB, Vicentini MFB, Mendoza EZ, Fujiki FK, da Fonseca LG et al (2019) Young-age onset colorectal cancer in Brazil: analysis of incidence, clinical features, and outcomes in a tertiary cancer center. Curr Probl Cancer:S0147–0272(18)30204–6.  https://doi.org/10.1016/j.currproblcancer.2019.01.009
  9. 9.
    Guillem JG, Forde KA, Treat MR, Neugut AI, Bodian CA (1987) The impact of colonoscopy on early detection of colonic neoplasms in patients with rectal bleeding. Ann Surg 206:606–611.  https://doi.org/10.1097/00000658-198711000-00009 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wong RF, Khosla R, Moore JH, Kuwada SK (2004) Consider colonoscopy for young patients with hematochezia. J Fam Pract 53:879–884PubMedGoogle Scholar
  11. 11.
    Khalid AB, Majid S, Salih M, Hashmat F, Jafri W (2011) Is full colonoscopic examination necessary in young patients with fresh bleeding per rectum? Endoscopy. 43(8):692–696.  https://doi.org/10.1055/s-0030-1256356 CrossRefPubMedGoogle Scholar
  12. 12.
    Carlo P, Paolo RF, Carmelo B, Salvatore I, Giuseppe A, Giacomo B, Antonio R (2006) Colonoscopic evaluation of hematochezia in low and average risk patients for colorectal cancer: a prospective study. World J Gastroenterol 12:7304–7308.  https://doi.org/10.3748/wjg.v12.i45.7304 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ramakrishnan K, Scheid DC (2003) Predictors of incomplete flexible sigmoidoscopy. J Am Board Fam Pract 16:478–484.  https://doi.org/10.3122/jabfm.16.6.478 CrossRefPubMedGoogle Scholar
  14. 14.
    Pabby A, Suneja A, Heerden T, Farraye F (2005) Flexible sigmoidoscopy for colorectal cancer screening in the elderly. Dig Dis Sci 50:2147–2152.  https://doi.org/10.1007/s10620-005-3022-x CrossRefPubMedGoogle Scholar
  15. 15.
    Weissfeld JL, Schoen RE, Pinsky PF et al (2005) Flexible sigmoidoscopy in the PLCO cancer screening trial: results from the baseline screening examination of a randomized trial. J Natl Cancer Inst 97:989–997.  https://doi.org/10.1093/jnci/dji175 CrossRefPubMedGoogle Scholar
  16. 16.
    Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, La Monte SJ et al (2018 Jul) Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin 68:250–281.  https://doi.org/10.3322/caac.21457 CrossRefPubMedGoogle Scholar
  17. 17.
    Siegel RL, Miller KD, Jemal A (2017) (2017), Cancer statistics, 2017. CA Cancer J Clin 67:7–30.  https://doi.org/10.3322/caac.21387 CrossRefGoogle Scholar
  18. 18.
    Cress RD, Morris C, Ellison GL, Goodman MT (2006) Secular changes in colorectal cancer incidence by subsite, stage at diagnosis, and race/ethnicity, 1992-2001. Cancer. 107(5 suppl):1142–1152.  https://doi.org/10.1002/cncr.22011 CrossRefPubMedGoogle Scholar
  19. 19.
    Yeo H, Betel D, Abelson JS, Zheng XE, Yantiss R, Shah MA (2017) Early-onset colorectal cancer is distinct from traditional colorectal cancer. Clin Colorectal Cancer 16(4):293–299.  https://doi.org/10.1016/j.clcc.2017.06.002 CrossRefPubMedGoogle Scholar
  20. 20.
    O’Connel JB, Maggard MA, Livingston EH, Yo CK (2004) Colorectal cancer in the young. Am J Surg 187:343–348.  https://doi.org/10.1016/j.amjsurg.2003.12.020 CrossRefGoogle Scholar
  21. 21.
    Willauer AN, Liu Y, Pereira AAL, Lam M, Morris JS, Raghav KPS et al (2019) Clinical and molecular characterization of early-onset colorectal cancer. Cancer.  https://doi.org/10.1002/cncr.31994 CrossRefGoogle Scholar
  22. 22.
    Siegel RL, Fedewa SA, Anderson WF, Miller KD, Ma J, Rosenberg PS et al (2017) Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst 109(8).  https://doi.org/10.1093/jnci/djw322
  23. 23.
    Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN et al (2010) Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116:544–573.  https://doi.org/10.1002/cncr.24760 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Khodadoostan M, Shavakhi A, Padidarnia R, Shavakhi A, Ahmadian M (2018) Full colonoscopy in patients under 50 years old with lower gastrointestinal bleeding. J Res Med Sci 23:45.  https://doi.org/10.4103/jrms.JRMS_531_17 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Koh FH, Seah A, Chan D, Ng J, Tan KK (2018) Is colonoscopy indicated in young patients with hematochezia. Gastrointest Tumors 4:90–95.  https://doi.org/10.1159/000481686 CrossRefPubMedGoogle Scholar
  26. 26.
    Koning MV, Loffeld RJ (2010 Jul 7) A survey of abnormalities in the colon and rectum in patients with haemorrhoids. BMC Gastroenterol 10:74.  https://doi.org/10.1186/1471-230X-10-74 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Khan R, Hyman D (2010) Hematochezia in the young patient: a review of health-seeking behavior, physician attitudes, and controversies in management. Dig Dis Sci 55:233–239.  https://doi.org/10.1007/s10620-009-0750-3 CrossRefPubMedGoogle Scholar
  28. 28.
    Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE et al (2006) Quality indicators for colonoscopy. Am J Gastroenterol 101:873–885.  https://doi.org/10.1111/j.1572-0241.2006.00673.x CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Belisa G. Muller
    • 1
    • 2
  • Paulo C. Contu
    • 1
  • Cláudio Tarta
    • 1
  • Anderson R. Lazzaron
    • 1
    • 2
  • Tiago L. Ghezzi
    • 1
  • Daniel C. Damin
    • 1
    • 2
    Email author
  1. 1.Division of Coloproctology, Hospital de Clinicas de Porto Alegre, and Department of SurgeryFederal University of Rio Grande do SulPorto AlegreBrazil
  2. 2.Postgraduate Program in Surgical SciencesFederal University of Rio Grande do SulPorto AlegreBrazil

Personalised recommendations