Primary-to-secondary care referral experience of suspected colorectal malignancy in young adults

Abstract

INTRODUCTION Colorectal cancer in patients younger than 50 years of age is increasing steadily in the UK with limited guidelines available indicating need for secondary care referral. The aims of this study were to report the cancer incidence in those aged under 50 years referred to secondary care with suspected colorectal malignancy and also to analyse the quality of those referrals. METHODS A total of 197 primary care referrals made between 2008 and 2014 to a UK district general hospital for suspected colorectal malignancy were analysed. All confirmed cancers were further evaluated regarding presenting symptoms, tumour characteristics and clinical outcomes. Each referral was given a referral performance score (out of 9) dependant on relevant information documented. RESULTS The overall malignancy rate was 9.1% (11 male and 7 female patients). The median age in this cohort was 41.5 years (interquartile range [IQR]: 37-49 years). Abdominal pain was the only presenting symptom to differ significantly when comparing malignant with non-malignant patients (44.4% vs 21.8% respectively, p=0.042). The median time period between referral date and colorectal specialist consultation was 11 days (IQR: 7-13 days) and the median referral performance score was 5 (range: 3-9). CONCLUSIONS Malignancy is prevalent in patients under 50 years of age who are referred to secondary care for suspected colorectal cancer. Those referred with abdominal pain in the presence of other high risk lower gastrointestinal symptoms are at significant risk of having a malignancy. Major deficiencies are apparent in urgent primary care referrals, highlighting the need for further national guidance to aid early diagnosis of colorectal cancer in the young.

Systematic review with meta‐analysis of over 90 000 patients. Does fast‐track review diagnose colorectal cancer earlier?

“…Of these, 1655 were excluded because they were not conducted in the UK or were not in accordance with NICE guidance. The full texts of the remaining 95 records were reviewed, of which 49 were included in the review . Of the 49 included publications, one reported two datasets from different centres .…”

Possible Value of Faecal Immunochemical Test (FIT) When Added in Symptomatic Patients Referred for Colonoscopy: A Systematic Review

“…We included 35 studies 26 prospective and 9 retrospective studies with a total of 4,833,056 symptomatic patients [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 53 , 54 , 55 , 56 , 58 , 59 ]. In addition, we included nine prospective studies with a positive FIT in symptomatic patients, with a total of 5296 patients [ 24 , 34 , 47 , 51 , 52 , 53 , 54 , 55 , 56 ].…”

“… 8 weeks - consecutive outpatients with symptoms considered suspicious for the presence of a colon disease to rule out the presence of CRC. - Colonoscopy or barium enema - Trained GP’s - Exclusion: previous diagnoses of colorectal disorders or a recent large bowel examination Curless 1994 [ 33 ] Retrospective 123 +125 control <70 year 150 + 148 control <70 year Hospitals of Gateshead and Newcastle Health Districts, UK 1 year - histological diagnosis of colorectal adenocarcinoma - Within 2 weeks interview - Exclusions: previous diagnosis of colorectal adenoma or carcinoma, known colitis, non-whites, and those dying before interview - Controls: matched with sex and age Jensen 1993 [ 34 ] Prospective 194 Varberg Hospital, Sweden - - symptoms indicating colorectal disease, referred by GP for double-contrast barium enema (DCE) - fecal occult blood test and rectosigmoidoscopy before the DCE Patel 2016 [ 35 ] Retrospective 197 West Suffolk Hospital, Suffolk, UK 6 years - primary care referrals for suspected colorectal malignancy - <50 years Cheong 2000 [ 36 ] Prospective 375 Hospital University Kebangsaan Malaysia, Kuala Lumpur 1 year - All patients undergoing colonoscopy Hippisley-Cox 2012 [ 37 ] Cohort study using data from 375 UK QResearch ® general practices for development and 189 for validation. 4.1 mil...…”

Young-Onset Colon Cancer: A Case Report

“…CRC is often asymptomatic but may present with red-flag symptoms such as unexplained anemia, and rectal bleeding. Young-onset CRC patients predominantly present with hematochezia, change in bowel habits, abdominal pain, anemia, and weight loss [1,[17][18][19][20][21][22][23][24]. Precursor adenomatous lesions are less likely to have associated young-onset CRCs [24].…”

“…Young-onset CRC patients predominantly present with hematochezia, change in bowel habits, abdominal pain, anemia, and weight loss [1,[17][18][19][20][21][22][23][24]. Precursor adenomatous lesions are less likely to have associated young-onset CRCs [24]. They generally occur distal to the splenic flexure or the rectum [25,26].…”