Raising Awareness
The importance of taking a family history.

• Family history taking is a neglected part of the assessment of patients in primary care.
• Patients often have little understanding of possible inherited predisposition in relation to cancer.
  
  Prevention
  Cigarette smoking and dietary factors have been linked with colorectal cancer
• Provide dietary information and encourage eating plenty of vegetables and fruit.
• Encourage patients to stop smoking.
  
  Screening
  General Screening - no screening programme for general population
  
  Risk Directed Screening
• Positive family History - First degree relative with colorectal cancer <45 years and members of families with multiple cancers
• Genetic syndromes
• Chronic Inflammatory Bowel Disease
• Pre-existing Colorectal Adenoma or Carcinoma
  
  Diagnosis & Referral
• Symptoms and warning signs that warrant Investigation
• Rectal bleeding in patients aged 45 or over
• A palpable rectal lesion on PR
• Altered bowel habit lasting 6 weeks or more
• Blood seen on bowel wall or on glove after PR (haemorroids only bleed on defecation)
• Tenesmus
• Passage of mucous PR
• Abdominal pain associated with any of the above
  
  Physical Examination
• Abdominal and digital rectal examination (10% of rectal cancers are palpable)
  
  In case of suspected colorectal cancer the large bowel should be completely examined by either - colonoscopy or flexible sigmoidoscopy plus double contrast Barium Enema
  
  Appropriate investigations pending hospital appointment
• A FBC - unrecognised anaemia may delay surgery
• FOB testing doesn't contribute to management of symptomatic patients
  
  Follow up
  Whether the General Practitioner is directly involved with the clinical follow up or not he/she should ensure:
• All patients are seen within 3 months of surgery to assess late complications.
• Colonoscopy within 1 year to confirm clear colon.
• USS of liver 1 year after surgery in any patient considered a candidate for hepatic resection if metastases were detected.
• All patients who have had a Total Mesorectal Excision are followed up for purpose of auditing surgeons performance of technique.
• Follow up of those patients who request it for psychological reassurance.
• Younger patients and those with a history of multiple colonic lesions have regular colonoscopy at 3-5 year intervals.