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Masson Et Al-2007-Colorectal Disease
Masson Et Al-2007-Colorectal Disease
Article history: Introduction: Faecal immunochemical test (FIT) is advocated in many colorectal cancer-
Received 3 October 2016 screening programs. A positive FIT translates to the need for a colonoscopy. However,
Received in revised form waiting times for diagnostic colonoscopy is long. The aim of our study is to determine the
5 December 2016 correlation of hemoglobin levels in patients with a positive FIT who were subsequently
Accepted 8 December 2016 diagnosed with colorectal cancer, and to compare them with patients with only colonic
Available online 17 January 2017 adenomas and those with normal colonoscopy with the intention of determining if he-
moglobin levels could be used to stratify the urgency of colonoscopy.
Keywords: Methodology: This is a matched caseecontrol study of patients who were FIT positive and
Anaemia subsequently underwent colonoscopy at the National University Hospital, Singapore.
Fecal occult blood test Newly diagnosed colorectal cancers formed the case group. The patients with colorectal
Colorectal cancer cancers were then matched for age, gender and ethnicity at a 1:1 ratio to patients with
Colon cancer colonic adenomas and then those in whom colonoscopy was normal.
Rectal cancer Results: Fifteen patients met the inclusion criteria and formed the case group. The differ-
Colonoscopy ences between the groups were not statistically significant in terms of age, gender and
Endoscopy ethnicity. The median hemoglobin level for the patients in the case group compared to the
control group was (12.4 vs 14.5, p ¼ 0.002) for the group with adenomas and (12.4 vs 14.4,
p ¼ 0.007) for the group with normal colonoscopy.
Conclusion: Colorectal cancer patients presenting with a positive FIT are more likely to be
anemic. A test to identify those patients who have a positive FIT that are anemic could
enable earlier colonoscopic evaluation.
© 2017 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and
Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
* Corresponding author. Division of Colorectal Surgery, Department of Surgery, National University Health System, 1E Kent Ridge Road,
119228 Singapore. Fax: þ65 67778206.
E-mail addresses: jing_yu_ng@nuhs.edu.sg (J.Y. Ng), iantan.jse@gmail.com (I.J.-W. Tan), ker_kan_tan@nuhs.edu.sg (K.-K. Tan).
http://dx.doi.org/10.1016/j.surge.2016.12.001
1479-666X/© 2017 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland.
Published by Elsevier Ltd. All rights reserved.
t h e s u r g e o n 1 6 ( 2 0 1 8 ) 3 6 e3 9 37
Anemia on the other hand, is one of the common signs Following diagnosis, all of them underwent computed
observed in patients with colorectal cancers. Although it does tomographic scans of their Thorax, Abdomen and Pelvis to
not necessarily translate to a more advanced stage on diag- complete the staging. Seven patients (46.7%) were Stage III or
nosis, it is nonetheless an independent predictor of an adverse IV on diagnosis. Table 2 depicts the distribution of cancer
outcome post colonic surgery.6,7 It is however important to stages and the tumour locations in the case group. Eleven
note that a multitude of other causes could also present as patients underwent eventual curative surgery and 2 patients
anemia, many of which are benign in nature.8 had surgery with a palliative intent. They all recovered well
Whilst it is logical that patients with colorectal cancers that with nil significant post-operative complications. One patient
present as a positive FIT should be more anemic on presen- was lost to follow-up post diagnosis of cancer and another had
tation, this relationship has yet to be clearly demonstrated. In extensive metastases on diagnosis, which precluded further
light of this, we undertook this study to determine the corre- surgery.
lation of hemoglobin levels in patients with a positive FIT who When we compared the case group (colorectal cancer pa-
were subsequently diagnosed with colorectal cancer and tients) to the group of patients with colonic adenomas (control
compared them with patients with only colonic adenomas group), the median hemoglobin level was noted to be lower
and those in whom colonoscopy were normal, with the ulti- (12.4 vs 14.5 g/dL). This relationship was again seen when we
mate intention of determining if hemoglobin levels could be compared the case group to the group of patients with normal
used to stratify urgency of colonoscopy. colonoscopy (12.4 vs 14.4 g/DL). Both differences were statis-
tically significant. Table 3 highlights the differences between
the case and control groups.
Methodology
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