Rectal bleeding after pelvic radiotherapy is often attributed to radiation proctitis and patients do not routinely undergo flexible endoscopy.
Dr Andreyev and colleagues from England assessed the significance of bleeding after radiotherapy.
The investigative team maintained a prospective register of all such patients referred to their endoscopy unit.
The team reported that 139 men with a median age of 70 years, and 32 women with a median age of 61 years were referred with rectal bleeding with a median duration of 2 years after pelvic radiotherapy.
The researchers found that primary tumour sites were urological in 139 patients, gastrointestinal in 7 and gynaecological 25.
|73 % with advanced polyps or cancer required only flexible sigmoidoscopy to make the diagnosis|
|Alimentary Pharmacology & Therapeutics|
90 patients had bleeding alone whilst 81 had other symptoms.
In addition, the investigators observed that 141 patients had typical radiation proctitis and in 65 this was the sole diagnosis.
The team also noted that 8 patients had cancer, 9 had high-risk adenomas, and 6 had 3 or more small adenomas and that 95 other diagnoses were made.
The research team noted that 73 % of patients with advanced polyps or cancer required only flexible sigmoidoscopy to make the diagnosis, while 27 % of diagnoses were made only after colonoscopy.
Of the patients with diagnoses made after colonoscopy, 47 % had no other symptoms apart from rectal bleeding.
Dr Andreyev’s team concluded, “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.”