title: Is earlier referral and investigation of bowel cancer patients presenting with rectal bleeding associated with better survival?
abstract: OBJECTIVE
  This study was carried out to determine whether rectal bleeding is related to stage of bowel cancer and whether earlier diagnosis and treatment are associated with improved survival.
  
  
  METHODS
  Eight hundred and forty-five patients were identified in the Wessex Bowel Cancer Audit (1991-1994). Presenting symptoms were identified from case notes. Outcome measures included 5-year survival, Dukes' stage, metastatic disease at surgery and time from onset of symptoms to treatment, in patients presenting with rectal bleeding or other symptoms and signs.
  
  
  RESULTS
  Six hundred and seventy-six (80%) of 845 patient case notes were reviewed. Of these, 408 (60.4%) patients had rectal or sigmoid cancer, and 255 (62.5%) of these 408 patients, who presented with rectal bleeding, had significantly earlier stage disease than those with a change in bowel habit and/or abdominal pain (Dukes' stage A: 23.1%vs 3.6%; Dukes' stage D: 14.5%vs 23.4%; P < 0.001), fewer metastases visible at surgery (14.9%vs 22.6%; P < 0.001) and significantly better 5-year survival (54.8%vs 40.9%; P < 0.001). There was no further significant improvement in 5-year survival in patients treated within 6 months of the onset of symptoms (55.1%vs 53.5%). Hazard ratios showed that 5-year survival was independently associated with age, Dukes' stage and emergency treatment, but not with rectal bleeding, change in bowel habit, abdominal pain or delay in treatment.
  
  
  CONCLUSIONS
  Bowel cancer patients presenting with rectal bleeding had earlier stage disease and significantly better survival than patients presenting with a change in bowel habit or abdominal pain. There was no reduction in 5-year survival in those patients who had a delay in treatment for > 6 months from the onset of symptoms.
authors.affiliation: Department of Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK. judyandmike@live.com
authors.forename: M R
authors.initials: MR
authors.lastname: Thompson
authors.forename: A
authors.initials: A
authors.lastname: Asiimwe
authors.forename: K
authors.initials: K
authors.lastname: Flashman
authors.forename: G
authors.initials: G
authors.lastname: Tsavellas
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology; D003672:Defecation / Q000502:physiology; D057210:Delayed Diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D012007:Rectum; D012189:Retrospective Studies; D012811:Sigmoid Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D016019:Survival Analysis; D013997:Time Factors