title: The significance of rectal bleeding after pelvic radiotherapy.
abstract: BACKGROUND
  Rectal bleeding after pelvic radiotherapy is often attributed to radiation proctitis and patients do not routinely undergo flexible endoscopy.
  
  
  OBJECTIVE
  To assess the significance of bleeding after radiotherapy.
  
  
  METHODS
  We maintained a prospective register of all such patients referred to our endoscopy unit.
  
  
  RESULTS
  One hundred and thirty-nine men (median age 70 years; range 31-82), and 32 women (median age 61 years; range 30-81) were referred with rectal bleeding (median 2 years; range 0-21) after pelvic radiotherapy. Primary tumour sites were urological (n = 139), gastrointestinal (n = 7) and gynaecological (n = 25). Ninety patients had bleeding alone; 81 had other symptoms. One hundred and forty-one had typical radiation proctitis; in 65 this was the sole diagnosis; eight had cancer, nine had high-risk adenomas, and six had three or more small adenomas. Ninety-five other diagnoses were made. Eleven (73%) patients with advanced polyps or cancer required only flexible sigmoidoscopy to make the diagnosis, while four (27%) diagnoses were made only after colonoscopy; 47% of these patients had no other symptoms apart from rectal bleeding.
  
  
  CONCLUSIONS
  After pelvic radiotherapy, clinical symptoms are not reliable in differentiating between radiation proctitis alone or more significant pathology. It is mandatory that all patients with new onset rectal bleeding are investigated with, at least, flexible sigmoidoscopy.
authors.affiliation: Department of Medicine and Therapeutics, Imperial College Faculty of Medicine, Chelsea and Westminster Hospital, London, UK.
authors.forename: H R T
authors.initials: HR
authors.lastname: Williams
authors.forename: P
authors.initials: P
authors.lastname: Vlavianos
authors.forename: P
authors.initials: P
authors.lastname: Blake
authors.forename: D P
authors.initials: DP
authors.lastname: Dearnaley
authors.forename: D
authors.initials: D
authors.lastname: Tait
authors.forename: H J N
authors.initials: HJ
authors.lastname: Andreyev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000532:radiotherapy*; D011349:Proctitis / Q000175:diagnosis / Q000209:etiology*; D011832:Radiation Injuries / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects*; D012002:Rectal Diseases / Q000209:etiology*