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Bleeding-related symptoms in colorectal cancer

A nationwide study reported in December's issue of Alimentary Pharmacology & Therapeutics investigates bleeding-related symptoms in patients with colorectal cancer.

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Little is known about the major presenting features of patients with colorectal cancer in a population-based setting, especially regarding bleeding-related symptoms.

Professor Bjornsson and colleagues from Iceland determined the proportion of colorectal cancer patients presenting with bleeding-related symptoms, to compare bleeders and nonbleeders and to explore the role of anticoagulants in bleeders.

The research team performed a nationwide, population-based, retrospective study, investigating all patients diagnosed with CRC in Iceland from 2008 to 2011.

Bleeding-related symptoms were defined as overt bleeding, iron deficiency anemia or a positive fecal occult blood test.

Obstructive symptoms were defined as a confirmed diagnosis of ileus or dilated intestines on imaging.

74% of patients had bleeding-related symptoms
Alimentary Pharmacology & Therapeutics

The team reported that data were available for 95% of patients.

In all, the researchers observed that 74% of patients had bleeding-related symptoms.

Of these 348 patients, 61% had overt bleeding.

Bleeders were less likely than nonbleeders to have metastases at diagnosis, at 19% vs. 34%.

The team observed that overt bleeders were less likely than nonbleeders to have obstructive symptoms, 2% vs. 16% respectively.

The team found that occult bleeders were more likely to have proximal cancer than both overt and nonbleeders.

However, they were less likely than nonbleeders to have metastases.

The research team noted that bleeders were more likely to use warfarin than nonbleeders, and the use of low-dose aspirin was the same.

Professor Bjornsson's team concludes, "The majority of patients with colorectal cancer present with bleeding-related symptoms."

"Bleeders with colorectal cancer present earlier than nonbleeders."

"Warfarin use may induce bleeding in some patients, resulting in an earlier diagnosis."

Aliment Pharmacol Ther 2013: 39(1): 7784
05 December 2013

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