The Incidence and Outcome of Rectal Bleeding in General Practice

The objective of the studies reported in this paper was to determinethe incidence as well as the final diagnostic outcome of rectalbleeding presenting in general practice. Because of the widevariety observed in incidence rates among 83 general practitioners(GPs) in the first study (A) an additional study (B) was undertaken.In study B with 10 GPs special efforts were made to maximizethe catchment rate. The mean ‘consultation incidence rate’was 7 per 1000 people per year. A follow-up period of at least1 year was applied to establish the final diagnostic conclusion.Occurrence of colorectal cancer was found in 3% of patientswith rectal bleeding. This may represent an overestimation ofthe prior probability since there was a selection in favourof patients with clinically relevant rectal bleeding. In about90% of patients rectal bleeding was related to minor ailmentsor self-limiting disorders. Further study on predictive valuesof (combinations of) other signs and symptoms is necessary todevelop clinical recommendations.     

Colorectal cancer and polyps in patients aged 40 years and over who consult a GP with rectal bleeding

BACKGROUND: Rectal bleeding is common in the community and in general practice,but few studies have examined the causes of rectal bleedingin patients presenting to general practitioners. OBJECTIVE: To determine the frequency of neoplastic conditions in patientswith rectal bleeding presenting in general practice and to explainthe associations between presenting symptoms and final diagnoses. METHODS: We conducted two studies, the first in 1989, the second in 1991,in which we invited Danish general practitioners to register3–4 patients aged 40 and over presenting with rectal bleeding. RESULTS: In Study 1 among 208 patients aged 40 and over and presentingwith a first episode of rectal bleeding, colorectal cancer andpolyps were present in 15.4 and 7.7%, respectively. In Study2 among 209 patients aged 40 and over and presenting with overtrectal bleeding, 156 reported a first bleeding episode or achange in their usual bleeding pattern, and in this group colorectalcancer and polyps were diagnosed in 14.1 and 11.5%, respectively.In the group with unchanged bleeding the cancer polyp prevalencewas 6.7% (P < 0.05). The patients in both studies were followedthrough a yearly letter to the GP for at least 32 and 22 months,respectively. CONCLUSIONS: A joint analysis of the two study populations showed that onlyage and change in bowel habit contributed to differentiatingthe cancer from the non-cancer patients. Keywords. Colorectal cancer, polyps, rectal bleeding.     

Bowels: Beliefs and Behaviour

A postal questionnaire about knowledge, beliefs, and experiencesof bowel function was returned by 171 patients aged 55 yearsand over from a group general practice in London. Of the respondents,10% reported no predictable frequency of movement, a higherproportion being women than men; 79% believed that a daily movementis important and 90% that ‘regularity’ is necessaryfor good health; 14% were dissatisfied with their bowel habitsand 16% regularly self-treated; 95% gave reasonable definitionsof ‘regular’ and ‘diarrhoea’; a tenthwere unsure about the definition of ‘constipation’.Although 76% believed there were bowel symptoms which requireimmediate medical attention, 98% would in the first instancetreat themselves for constipation, 90% for diarrhoea, and 25%for rectal bleeding. To reduce delay in the diagnosis of colorectal cancer, it issuggested that consultations for disturbance of bowel functionbe encouraged among the middle-aged and the elderly. Doctorsshould examine such patients with the diagnosis of malignancyin mind.     

Brief Report: Exploration of Colorectal Cancer Risk Perceptions Among Latinos

To explore colorectal cancer risk perceptions among Latinos. Focus groups discussions among Spanish-speaking Latinos conducted between February and July 2007 with 37 men and women who were age-eligible for colorectal cancer screening. Predominant themes of perceived colorectal cancer risk included: general cancer risks, risks related to nutrition and the digestive tract, and risks related to sexual practices. Participants frequently referred to the role of diet in keeping the colon “clean,” suggesting that retained feces increase colorectal cancer risk. Among both men and women, rectal sex was commonly associated with increased colorectal cancer risk. Some Latinos may hold misperceptions about colorectal cancer risks, including an association between rectal sex and colon cancer, that may impact their screening behaviors. Clinicians and public health officials should consider these potential risk misperceptions and explore for other risk misperceptions when counseling and educating patients about colorectal cancer screening.     

组织芯片技术检测Ang-2、caspase-3和CD147在结直肠癌中的应用价值

目的探讨组织芯片技术检测Ang-2、caspase-3和CD147蛋白表达及在结直肠癌中的应用效果。方法选择2012年7月-2016年12月本院确诊为结直肠癌的患者420例作为研究对象,并以同期确诊为结直肠良性疾病的70例患者作为结直肠疾病组,并取70例正常肠道组织标本作为对照组,均采用免疫组化法和蛋白芯片法检测肿瘤标志物Ang-2、caspase-3和CD147蛋白表达,随访患者临床预后,采用Logistic回归分析探讨结直肠癌预后的风险因素。结果结直肠癌组Ang-2、caspae-3、CD147蛋白阳性表达均明显高于结直肠疾病和正常肠组织患者,各组蛋白芯片和免疫组化法检测Ang-2、caspae-3、CD147蛋白表达结果无差异,蛋白芯片技术在结直肠癌组患者中敏感度、特异度、阳性预测值、阴性预测值均为95%,在结直肠疾病组和对照组患者中敏感度、特异度、阳性预测值、阴性预测值均较高,TNMⅢ期、低分化肿瘤、caspae-3阳性是结直肠癌患者预后不良的独立风险因素。结论组织芯片技术检测Ang-2、caspase-3和CD147蛋白表达有助于诊断和评价结直肠癌的病情及预后。     

Management of colorectal cancer in three south Thames District Health Authorities

This study describes the management of colorectal cancer, diagnosed in 1988, of residents in three South Thames Districts.Of the 328 cases identified as having being diagnosed in 1988, case notes were retrieved on 263 (80%) including 62 registered by death certificate only. There were 159 cases (61%) of colon cancer and 104 cases (39%) of rectal cancer. Of these, 172 cases (68%) were admitted electively and 90 (32%) as emergencies. Patients subsequently diagnosed with colon cancer had a relative risk of being admitted through emergency (relative to rectal cancer patients) of 1.39 (95% C.I.: 1.16, 1.67). Elective admissions varied significantly by district of residence (P < 0.0001) ranging from 36–65% for colon cancers and from 63–92% for rectal cancers across the three districts. Dukes' stage was recorded in only 143 (54%) sets of case notes, with significant variation by district of residence in the proportion of elective patients for whom a Dukes' stage was indicated (P < 0.01).Two-hundred and thirty-six (90%) cases received treatment. Of the treated cases, 233 patients received surgery with 29 cases of colon cancer (18%) and 32 cases of rectal cancer (31%) receiving adjuvant therapy. The proportions of anterior resection, AP resection and colostomies given, varied by district. Patients presenting for elective surgery were more likely to be treated by a consultant than patients presenting on emergency: the relative risks were 2.58 (95% C.I.: 1.74, 3.82) for colon cancer patients and 4.93 (95% C.I.: 2.20, 11.06) for rectal cancer patients. In 44 (26%) colon cancer cases and 21 (22%) rectal cancer cases it was explicitly stated that the tumour had not been fully resected.For colon tumours the five year relative survival rates were 35% (95% C.I.: 21%, 50%), 52% (95% C.I.: 34%, 70%), and 14% (95% C.I.: −2%, 30%) in districts A, B and C respectively. The corresponding figures for rectal tumours were 45% (95% C.I.: 27%, 64%), 62% (95% C.I.: 41%, 83%) and 24% (95% C.I.: −1%, 50%).There were wide variations in the representation, management of and survival from colorectal cancers across the three districts. Differences were significant at the level of district of residence, mode of presentation and surgical grade. More assiduous recording of Dukes' stage is imperative if consensus is to be achieved on effective management. Further work is also warranted on district differences in diagnostic and referral protocols.     

超声微探头在大肠癌术前分期中的价值

目的 探讨超声微探头(UMP)在大肠癌术前分期中的应用价值.方法 应用UMP(Olympus UM-2R,12MHz)术前检测61例大肠癌患者,根据UMP下胃肠壁结构层次和邻近器官浸润情况判断肿瘤侵犯的深度进行T分期.所有病例术后均行病理检查,并与UMP分期进行比较.结果 UMP对大肠癌侵犯管壁深度(T分期)诊断的总准确率为86.9%(53/61),早期癌诊断准确率高达100.0%(3/3).UMP分期与TNM分期进行一致性检验,Kappa=0.790,具有较高的一致性.结论 UMP能够比较准确地判断大肠癌浸润深度,对大肠癌术前T分期诊断有一定的临床应用价值,可以为大肠癌患者选择合适的治疗方法提供依据.     

直肠息肉摘除对直肠癌预防的前瞻性评价

目的 评估直肠镜在人群中筛检效果,验证直肠息肉摘除能否阻断直肠癌的自然史,降低直肠癌的发病率及死亡率。方法 １９７７￣１９８０年间在海宁次对３０岁以上２３余万人群进行１５ｃｍ肠镜筛检,对检出的４０７６例肠息肉进行镜下摘除后定期肠镜随访。结果 肠息肉患者经２０年定期肠镜随访,共计肠镜随访到并摘除肠腺瘤９５２例次,非腺瘤性息肉４１７例次,另外还随检出肠癌２７例。直肠镜筛检验出的直肠癌的生存率显著高于非     

上海市区居民1973-2005年结直肠癌发病趋势分析

目的 了解1973-2005年上海市区居民结直肠癌发病率的时间变化趋势.方法 结直肠癌发病资料来自上海市肿瘤发病登记处,共采集32 962例结肠癌患者资料和24 662例直肠癌患者资料.根据人口普查资料中性别、年龄构成估算各年人口数,利用世界标准人口,采用直接法计算标化发病率.标化发病率年度变化百分比(APC)估算采用对数线性回归法,并用病例数进行加权.结果 1973-2005年男女性结直肠癌发病率均呈上升趋势,结肠癌的标化发病率分别从6.09/10万和5.70/10万上升至14.70/10万和14.35/10万,APC分别为3.03%(t=14.77,P<0.01)和3.21%(t=22.15,P<0.01).男女性直肠癌标化发病率分别从7.68/10万和6.51/10万上升至11.45/10万和8.28/10万,APC分别为1.34%(t=7.28,P<0.01)和0.93%(t=7.34,P<0.01).女性结直肠癌的APC在85岁～组达到最高,分别为5.86%和2.79%;而男性在80岁～组APC最高,分别为4.64%和2.38%.男女性45岁及以上各年龄组结肠癌的APC大于直肠癌.33年间,男女性结直肠癌的平均发病年龄由57～60岁推迟到66～70岁.结肠癌发病年龄较直肠癌略晚[2003-2005年,男性结肠癌平均发病年龄为(68.61±12.17)岁,男性直肠癌为(66.81±12.62)岁,t=4.90,P<0.01;女性结肠癌为(69.20±12.13)岁,女性直肠癌为(67.75±12.54)岁,t=3.81,P<0.01].结论 上海市区男女性结直肠癌的标化发病率在33年里稳步上升,其中结肠癌上升趋势更加明显,有必要进一步探讨导致这种变化的原因.     

Unexplained inversion of the incidence ratio of colon and rectal cancer among men in East Germany. A time trend analysis including 147,790 cases

Introduction The incidence rate ratio of colon to rectal cancer is usually about 2:1. It has been observed for a while that the incidence of colon cancer among men (as opposed to women) in the Former German Democratic Republic (GDR) is lower than the rate of rectal cancer. Detailed analyses of this phenomenon have not been done so far. The aim was to give insights in this observation by detailed incidence and mortality analyses and to explore the worldwide ratio of colon and rectal cancers based on population-based cancer registry data. Methods We analyzed age-standardized incidence and mortality data of colorectal cancers in East Germany (1961–1989 and 1996–2002; mortality 1980–2002), West Germany, Saarland (1970–2002) and all over the world (1978–82 up to 1993–97). Results With the incidence increase of colorectal cancers in the GDR, the ratio of colon to rectal cancer incidence became larger and surpassed the reference value (ratio = 1) during the time of the reunification. Also the mortality data revealed a similar pattern. Estimated annual percentage increases of colon subsite incidences tended to be higher within the distal colon as compared to the proximal colon Conclusions Our analyses of international cancer registries over a period of 20 years show that the colon–rectum cancer ratio is positively associated with the overall incidence of colorectal cancer with a stronger association among women than men. Non-causal factors such as underdetection or registration artefacts are unlikely to explain the unusual colon/rectal rate ratio among men. A gradual decrease of the job-related physical activity among men may have contributed to the findings.     

1.5T磁共振成像在直肠癌诊断及术前TN分期中的应用效果

目的：分析研究1.5T磁共振成像在直肠癌诊断及术前TN分期中的应用效果及其价值。方法：选取2017年9月～2019年11月本院收治的56例直肠癌患者作为观察对象,56例患者均进行1.5T磁共振成像并诊断,将所有患者的术后病理检查结果作为金标准,观察1.5T磁共振成像的应用效果及其价值。结果：使用1.5T磁共振成像对患者T分期总准确率为92.86%(52/56),T1、T2、T3、T4敏感性分别为81.82%;68.75%;94.44%。对患者N分期N0、N1、N2的诊断总准确度为94.64%,特异度为93.33%;敏感性为92.31%。结论：为诊断直肠癌的患者应用1.5T磁共振成像其诊断效果显著,对于患者TN分期的灵敏度、特异性以及阴性阳性预测值相对较高,使得诊断结果较为准确。     

Clinical features of colorectal cancer before emergency presentation: a population-based case-control study

OBJECTIVE: To identify the clinical features of colorectal cancer presenting as a surgical emergency. DESIGN: Population-based case-control study. SETTING: All general practices in Exeter Primary Care Trust, Devon, UK. Participants. 349 patients with colorectal cancer, 62 of these having an emergency presentation. Five randomly selected controls matched by age, sex and general practice for each case. DATA: The entire primary care record, from 24 months to 30 days before diagnosis, was coded using the International Classification of Primary Care-2. MAIN OUTCOME MEASURES: Symptom reporting by patients with emergency presentation of colorectal cancer compared with matched controls and non-emergency presentations. RESULTS: Eight features of colorectal cancer were associated with the 62 emergency presentations of colorectal cancer. 39 (63%) of patients had reported at least one symptom to their doctors a minimum of 30 days before the diagnosis. In multivariable analysis, three features remained independently associated with cancer: abdominal pain, odds ratio 6.2 (95% CI 2.8-14), P<0.001; loss of weight 3.4 (1.3-8.5), P=0.01; and diarrhoea 3.4 (1.2-5.7), P=0.02. When emergency presentations were compared with elective cases, abdominal pain was more common [interaction odds ratio 2.3 (1.6-3.3); P=0.047] and rectal bleeding less common [0.30 (0.08, 1.0); P=0.040]. CONCLUSION: The majority of patients destined to have an emergency presentation of colorectal cancer have reported symptoms of their cancer to their doctor well before the emergency. Some emergency presentations should therefore be preventable.     

Breast self-examination practices and attitudes among breast cancer, benign breast disease and general practice patients

Beliefs, attitudes, intentions, perceived barriers, benefitsand past experience of breast self-examination (BSE) and perceivedsusceptibility to breast cancer were explored among female samplesof breast cancer patients (n = 117), benign breast disease patients(n = 208) and general practice controls (n = 329). Benign diseasepatients reported the highest level of monthly BSE in the yearpreceding the survey (49%), followed by cancer patients (34%)and controls (32%). Family history of breast cancer was associatedwith prior BSE practice only in the breast cancer sample. Amongbenigns and controls, who were asked to rate their perceivedrisk of developing breast cancer, no association was found betweenthis subjective measure of susceptibility and BSE practice.Multiple regression models were constructed to explain pastBSE practice (32% explained variance) and intention to performBSE in future (54% explained variance). Among those not practisingBSE, a model to predict BSE intention explained 57% of the variancefor intention to do BSE. The model also identified attitudeto BSE, emotional incentives to do BSE, personal disorganizationand having had benign or malignant breast disease, as predictorsof BSE intention (P < 0.05). It is concluded that some ofthe traditional content of health education programs, such asthe efficacy of BSE in detecting early breast cancer and thehigh incidence of the disease, may have little motivationalpower. It may be more effective to highlight the positive reassuranceBSE can provide and to develop new ways to help women get organizedto do regular BSE.     

STIMULATION OF CHEMICALLY INDUCED RECTAL CARCINOGENESIS BY CHRONIC ETHANOL INGESTION

The effect of chronic ethanol administration on 1. 2-dimethylhydrazine-inducedrectal carcinogenesis was investigated in 32 paired male Sprague-Dawleyrats fed a nutritionally-adequate liquid diet containing 36%of the total calories as either ethanol or isocaloric carbohydrates.Chronic ethanol ingestion increased the total number of rectaltumors significantly (17 vs 6; P<0.02), whereas no cocarcinogeniceffect of ethanol was observed in other parts of the intestine.Alcohol did not influence tumor size or histopathology. A 47%increase in the activity of mucosal alcohol dehydrogenase inthe distal colorectal region was found between chronically-ethanol-fedrats and pair-fed controls (0.241± 0.019 vs 0.164±0 020 µmol/mg of protein/hr; P<0.01). This could inpart explain the cocarcinogenic effect of alcohol in this tissue.Faecal bile acids, however, do not play a role as promotorsof rectal carcinogenesis under the present experimental conditions.The results give experimental support to the epidemiologic findingsof an increased incidence of rectal cancer in the alcoholic.     

Self-reported information on the diagnosis of colorectal cancer was reliable but not necessarily valid

OBJECTIVE: Self-report is commonly used in epidemiologic studies; however, few data exist on the reliability and validity of this method for eliciting information related to the diagnosis of colorectal cancer. We examined the test-retest reliability and validity of colorectal cancer patients reporting on the process of their diagnosis. STUDY DESIGN AND SETTING: One hundred and sixteen participants completed two telephone interviews, 1 month apart, and 95 general practitioners (GPs) completed a written questionnaire, to elicit information relating to key elements of the process of diagnosis of colorectal cancer. RESULTS: Acute symptoms such as rectal bleeding had higher reliability and validity than more general symptoms. Colonoscopy was the most accurately recalled diagnostic test. Recall of diagnosis date, and date of colonoscopy, had high test-retest reliability. There were considerable differences between dates of diagnostic tests given by participants and GPs, but there was no evidence of a bias in a particular direction. Accuracy of recall did not diminish as time from diagnosis increased. CONCLUSION: This study confirms that self-reported symptoms, tests, and dates in the colorectal cancer diagnostic pathway are generally reliable; however, the validity of reported symptoms and tests can be moderate to poor.     

PET-CT对肺癌纵隔淋巴结转移的诊断效能及相关影响因素的研究

目的 探究正电子发射计算机断层显像（PET-CT）对肺癌纵隔淋巴结转移的诊断效能,分析影响诊断效能的相关因素以及肺癌淋巴结转移的影响因素,为临床提供理论参考。方法 选取我院2019年1月—2020年12月收治的经手术病理证实的181例肺癌（476枚淋巴结）患者临床资料进行分析,均行PET-CT进行诊断,分析诊断的效能（灵敏度、特异性、准确性以及阳性/阴性预测值）;分析影响PET-CT诊断效能的因素,以及肺癌患者发生纵隔淋巴结转移的相关危险因素。结果 PET-CT诊断肺癌淋巴结转移的灵敏度65.75%（96/146）,特异性89.39%（295/330）,准确率82.14%（391/476）,阳性预测值73.28%（96/131）,阴性预测值85.51%（295/345）,同手术病理结果相比,差异无统计学意义（P > 0.05）。真阳性淋巴结与假阳性淋巴结的短径、SUVmax值相比较,差异均无统计学意义（P > 0.05）;真阳性淋巴结与假阳性淋巴结的密度相比,差异有统计学意义（P < 0.05）。经Logistic回模型分析分析显示,肿瘤的病理类型为腺癌、中央型肺癌、低分化程度是肺癌患者发生纵隔淋巴结转移的危险因素（P < 0.05）。结论 PET-CT诊断肺癌纵隔淋巴结转移有较高的灵敏度、特异性、准确性;诊断的灵敏度受淋巴结的短径与SUVmax值影响,诊断的特异性受淋巴结的密度影响。纵隔淋巴结转移主要与病理类型、病灶部位、分化程度有关。     

The Phadiatop In Vitro Test for Allergy in General Practice: Is it Useful?

Dekker F W, Mulder Dzn J D, Kramps J A, Kaptein A A, VandenbrouckeJ P and Dijkman J H. The Phadiatop in vitro test for allergyin general practice: is it useful? Family Practice 1990: 7:144–14.8. A study was performed in order to assess the value of the Phadiatop,a new in vitro allergy test, in general practice. A total of248 patients were screened for bronchial allergy with PRIST,RAST and the Phadiatop. Information about the patient historyand the results of the PRIST, Phadiatop and RAST tests werepresented consecutively to the general practitioner and hisdiagnoses based on and evolving from these were evaluated andcompared with the diagnosis of a specialist. The general practitioner'sdiagnosis based on the resu Its of the Phadiatop was the closestof all the tests to the specialist diagnosis. It is concludedthat Phadiatop is of great use in diagnosing bronchial allergyin general practice.     

Attributable risk for diet, alcohol, and family history in the Melbourne Colorectal Cancer Study.

From the data obtained in a large comprehensive population-based case-control study of colorectal cancer (The Melbourne Colorectal Cancer Study), attributable risk was calculated for a family history of colorectal cancer in near relatives for diet (when > or = 5 of the 11 previously determined dietary risk factors were present) and for beer consumption (for rectal cancer only). The attributable risk was 11% in the presence of a family history of colorectal cancer and 46% in the presence of five or more dietary risk factors. The attributable risk for rectal cancer in the presence of beer consumption was 31% in males and 11% in females. These data are relevant in the consideration of primary prevention of colorectal cancer in Australia, but their general application needs to be approached with caution in view of major differences in the genetic background and the dietary practices in various regions of the world and in view of the uncertainty of what is achievable change, especially for dietary practices.     

研究分析磁共振3.0T高分辨T2WI成像技术在直肠癌术前TN分期中的诊断效果

目的:探究磁共振3.0T高分辨T2WI成像技术在直肠癌术前TN分期中的诊断效果.方法:选取2018年1月~2019年3月本院收治的50例直肠癌患者为研究对象,对其进行磁共振3.0T高分辨T2WI成像技术检查.结果:50例患者中癌症类型分为管状腺癌35例,黏液腺癌3例,高级别绒毛管状腺癌6例,中-低分化腺癌5例,印戒细胞癌1例;病灶形态分为环周浸润22例,环周菜花14例,局部肿块14例;分化程度为高分化6例,中-低分化5例;T分期为T1分期3例,T2分期13例,T3分期19例,T4分期15例;N分期为N0分期7例,N1分期10例,N2分期33例.患者T分期诊断中的灵敏度分别为76.36%、72.52%、96.25%和100.00%,特异度分别为99.99%、95.63%、92.25%和100.00%.N分期灵敏度为86.63%、88.52%和93.25%,特异度为99.63%、94.25%和100.00%.结论:对于直肠癌术前T N分期诊断而言,磁共振3.0T高分辨T2WI成像技术应用具有重要诊断价值,对于患者TN分期诊断和识别具有准确率高、可控性强等优势.     

大肠癌序贯筛检方案在人群中应用的前瞻性评估

目的 建立并验证大肠癌序贯筛检方案在我国人群中应用的效果。方法 以大肠癌高发区嘉善县１９８９年３０岁及以上者作为目标人群,采用随机分组空白对照研究设计,以免疫法粪便潜血试验结合个体危险度隶属度函数（ＡＤ值）为初筛手段,纤维肠为复筛的序贯筛检方案。结果 经筛检后筛检人群与对照人群的大肠癌８年累积发病率分别为３．９５‰（９５％ＣＩ为３．８１～４．１０）和４．０１‰（９５％ＣＩ为３．８６～４．１６）,两