Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis

Jellema, Petra; Windt, D.A.W.M. van der; Bruinvels, David J.; Mallen, Christian; Weyenberg, Stijn J.B. Van; Mulder, Chris J.; Vet, Henrica C.W. de

doi:10.1136/bmj.c1269

Cited by 177 publications

(167 citation statements)

References 66 publications

(267 reference statements)

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“…Investigation of high-risk factors by HRFQ has been used in the diagnosis of CRC in clinical processes (24,25), but it is rarely used in CRC mass screening. From previous studies, HRFQ could be one of the primary screening methods for colorectal neoplasm in the population (8); however, fewer data were reported.…”

Section: Discussionmentioning

confidence: 99%

Performance of a Colorectal Cancer Screening Protocol in an Economically and Medically Underserved Population

Cai

Zhang

Zhu

et al. 2011

Cancer Prevention Research

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The performance of combining fecal immunochemical tests (FITs) and a high-risk factor questionnaire (HRFQ) in colorectal cancer (CRC) screening in economically and medically underserved populations is uncertain. This study investigated the performance of a CRC screening protocol of combining FITs and an HRFQ as primary screening methods in a rural Chinese population. A CRC mass screening was conducted using FITs and an HRFQ as the first and colonoscopy as the second stage of screening in Jiashan, [2007][2008][2009]. The target population was 31,963 residents in three communities. The compliance was 84.7% for HRFQ, 76.4% for FITs, and 78.7% for colonoscopy. The detected rates of cancer, adenoma, nonadenomatous polyps, and advanced neoplasm were 2.7%, 14.8%, 5.9%, and 8.9% by FITs, which were higher than those by HRFQ (0.5%, 9.2%, 4.8%, and 3.8%, respectively). There was no significant difference in detected rate for nonadenomatous polyps between FITs and HRFQ. A total of 41.2% adenomas, 53.2% nonadenomatous polyps, and 29.8% advanced neoplasms were detected by HRFQ but missed by FITs. Positive predictive value of the screening protocol of combining FITs and HRFQ for advanced neoplasm was 5.7%, which was higher than FITs alone. Men had a higher prevalence of advanced neoplasm than women. Results indicate that combining FITs and HRFQ as primary screening methods is an efficient CRC screening strategy in economically and medically underserved populations.

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Section: Discussionmentioning

confidence: 99%

Performance of a Colorectal Cancer Screening Protocol in an Economically and Medically Underserved Population

Cai

Zhang

Zhu

et al. 2011

Cancer Prevention Research

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“…Rather, animal morbidity at 7 w.p.i. was attributable primarily to weight loss due to primary tumour burden, a common symptom also observed in CRC patients with later stage disease 19 .…”

Section: Resultsmentioning

confidence: 99%

Lymph node-independent liver metastasis in a model of metastatic colorectal cancer

Enquist¹,

Good²,

Jubb³

et al. 2014

Nat Commun

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Deciphering metastatic routes is critically important as metastasis is a primary cause of cancer mortality. In colorectal cancer (CRC), it is unknown whether liver metastases derive from cancer cells that first colonize intestinal lymph nodes, or whether such metastases can form without prior lymph node involvement. A lack of relevant metastatic CRC models has precluded investigations into metastatic routes. Here we describe a metastatic CRC mouse model and show that liver metastases can manifest without a lymph node metastatic intermediary. Colorectal tumours transplanted onto the colonic mucosa invade and metastasize to specific target organs including the intestinal lymph nodes, liver and lungs. Importantly, this metastatic pattern differs from that observed following caecum implantation, which invariably involves peritoneal carcinomatosis. Anti-angiogenesis inhibits liver metastasis, yet anti-lymphangiogenesis does not impact liver metastasis despite abrogating lymph node metastasis. Our data demonstrate direct hematogenous spread as a dissemination route that contributes to CRC liver malignancy.

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“…Accurate diagnosis, however, is essential in patients with rectal cancer (13). Consequently, physical examination is of paramount importance in every patient, especially when gastrointestinal bleeding is present (14).…”

Section: Discussionmentioning

confidence: 99%

Prospective analysis of clinician accuracy in the diagnosis of benign anorectal pathology: the value of clinical information

Jimeno

Vallverdú

Tubella

et al. 2012

Rev. esp. enferm. dig.

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Aim: the prevalence of anorectal disorders in general population is high. The aim of this study was to analyze the influence of clinical symptoms on diagnostic accuracy for benign anorectal pathology among different specialists and evaluate the relation ship between diagnostic accuracy and years of professional expe rience.Methods: seven typical cases were selected. In a first interview, participants were shown images and asked to make a diagnosis. Afterwards, images with additional information (clinical symptoms) were used. Two groups (group 1 = general surgeons and group 2 = medical specialists who attended emergency department) completed both phases of the study to analyze the influence of clinical symptoms on the final diagnosis.Results: forty four specialists were interviewed. The percentage of participants making a correct diagnosis in groups 1 and 2, respectively, was as follows: case 1 (perianal abscess): 100 vs. 80.6%, (p = 0.157); case 2 (fissure): 92.3 vs. 51.6% (p = 0.015); case 3 (thrombosed hemorrhoid): 92.3 vs. 74.2% (p = 0.321); case 4 (anal condyloma): 100 vs. 87.1% (p = 0.302); case 5 (rectal prolapse): 100 vs. 83.9% (p = 0.301); case 6 (prolapsed hemorrhoid): 92.3 vs. 29% (p = 0.001), and case 7 (fistula): 100 vs. 67.7% (p = 0.021). There were significant differences in the number of correctly diagnosed cases between groups (p < 0.001). Information about clinical symptoms significantly increased overall and specific accuracy. There was no correlation between experience and accuracy.Conclusions: clinical symptoms are important for diagnostic accuracy in anorectal pathology. Training in anorectal pathology in medical specialists is warranted.

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Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis

Cited by 177 publications

References 66 publications

Performance of a Colorectal Cancer Screening Protocol in an Economically and Medically Underserved Population

Performance of a Colorectal Cancer Screening Protocol in an Economically and Medically Underserved Population

Lymph node-independent liver metastasis in a model of metastatic colorectal cancer

Prospective analysis of clinician accuracy in the diagnosis of benign anorectal pathology: the value of clinical information

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