title: Is whole colonic imaging necessary for symptoms of change in bowel habit and/or rectal bleeding?
abstract: OBJECTIVE
  Following the introduction of a 2-week-wait (2ww) cancer pathway, many units are triaging patients with change in bowel habit (CIBH) and/or rectal bleeding (RB) straight to colonoscopy. Evidence suggests that right-sided colonic cancer does not present with these symptoms, hence imaging the left colon only is satisfactory. If this were substantiated, patients could be offered a flexible sigmoidoscopy (FS) alone. This study aimed to review presenting symptoms of patients diagnosed with a right-sided colonic malignancy and assess whether their tumours would be missed based on this practice.
  
  
  METHODS
  This is a retrospective analysis of patients who underwent curative resection for a proximal colonic malignancy over a 4-year period. Two-week-wait referral proforma and case notes were analysed for mode of presentation.
  
  
  RESULTS
  Of 206 elective right hemicolectomies performed, 20/206 (9.7%) patients presented in the absence of either iron deficiency anaemia or palpable abdominal mass. Twelve patients had polyposis identified in the left colon and eight patients had no left-sided colonic pathology. One patient had a strong family history of colon cancer (two first-degree relatives) in the group absent of left-sided pathology.
  
  
  CONCLUSIONS
  Twelve patients who had left-sided polyposis and one patient with a strong family history would have undergone whole colonic imaging based on current colorectal cancer management guidelines. The remaining seven patients with right-sided cancer would have been missed if FS were the only investigation used. Patients presenting on the 2ww with symptoms of a CIBH and/or RB can be adequately investigated with a FS with a 3% chance of missing a proximal cancer.
authors.affiliation: Department of Colorectal Surgery, Heart of England NHS Foundation Trust, Birmingham, UK. saritbadiani@doctors.org.uk
authors.forename: S
authors.initials: S
authors.lastname: Badiani
authors.forename: A
authors.initials: A
authors.lastname: Desai
authors.forename: M A S
authors.initials: MA
authors.lastname: Chapman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003113:Colonoscopy; D003672:Defecation; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012007:Rectum; D012017:Referral and Consultation; D012189:Retrospective Studies; D012812:Sigmoidoscopy; D006113:United Kingdom; D014850:Waiting Lists