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You might like to know about. Screening for colorectal cancerThe Two Week RuleBenign anorectal conditionsLaparoscopic colorectal surgery...
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1. What does a GP need to know about colorectal surgery?
Mr Neil J Smith
Consultant General & Colorectal Surgeon
2. You might like to know about… Screening for colorectal cancer
The Two Week Rule
Benign anorectal conditions
Laparoscopic colorectal surgery
...& anything else (time permitting)
3. Colorectal Cancer screening Bowel cancer screening aims to detect bowel cancer at an early stage (in people with no symptoms), when treatment is more likely to be effective
Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16%
The NHS Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 69. ‘Rolled out’ across England since 2006, ‘live’ in Surrey since September 2008.
Faecal Occult Blood test kit (FOBt)
5. What’s the significance of FOBt+? Around 98 in 100 people will receive a normal result and will be returned to routine screening. They will be invited for bowel cancer screening every two years if still within the eligible age range.
Fewer than 20 in 1000 people will receive an abnormal result. They will be referred for further investigation and usually offered a colonoscopy.
Almost 14 in 20 people who have a colonoscopy will have a normal result.
About five in 20 will be found to have a polyp, which if removed may prevent cancer developing.
One in 20 people with a positive FOB test will be found to have cancer when they have a colonoscopy.
6. Two Week Rule Patients must be seen by a specialist within two weeks of (receipt of) the decision to refer
Initiate treatment within 62 days of decision to refer (and within 31 days of the diagnosis being confirmed).
7. Rectal bleeding with ?BH to looser stools (Any Age)
>6/52 ?BH to looser stools and/or increased freq of defaecation (60+)
Palpable abdominal or rectal mass consistent with colorectal tumour (Any Age)
Persistent rectal bleeding without anal symptoms (60+)
Unexplained IDA: Men Hb<11g/dl (Any Age)
Women Hb<10g/dl (postmenopausal)
8. The Two Week Rule <10% of patients referred under TWR have cancer
>50% of new colorectal cancers were referred as TWR
9. Rectal bleeding The history is everything:
Painful or painless?
Associated change in bowel habits?
Associated prolapse/discharge
Anything else?
10. Haemorrhoids
Fissure
Fistula-in-ano
Pruritis ani Benign Anorectal conditions
11. Painless bright red rectal bleeding
Itching / Prolapse (thrombosis)
Differential diagnosis:
fissure (painful)
Perianal haematoma (skin-covered)
Treatment: Injection / Banding / Surgery
(we almost never use OTC preparations) Haemorrhoids
12. Painful bright red rectal bleeding
Typically young women
Differential diagnosis:
Thrombosed haemorrhoid (easy to see)
Perianal haematoma (skin-covered)
Look for sentinel tag (midline, posterior)
Treatment: 8/52 bd topical GTN or Diltiazem
(rarely surgery) Fissure-in-ano
13. Hx of previous perianal sepsis (?I&D)
Purulent offensive discharge, some bleeding
Painful / itching / soreness
External opening will be visible
Treated by EUA +/- lay open / Seton. Fistula
14. Itching / soreness
Exclude associated dermatological condition (lichen planus, dermatitis, etc)
Exclude underlying haemorrhoids / fistula
Avoid perfumed toiletries, ensure good hygeine
Topical steroids may be helpful Pruritis Ani
15. Increasingly common practice
Faster recovery times, smaller wounds
Early discharge from hospital
NB anastomotic leaks may now occur at home! Laparoscopic colorectal surgery
16. Anything else?