Background: Most patients with colorectal cancer (CRC) develop clinical signs and symptoms which are not specific for CRC, and usually at a late stage of the disease, resulting in a considerable delay of the diagnosis. In our study we examined patients with bowel symptoms which were at increased risk for developing CRC, because of their family history.
Methods: Over the last 6 years, colonoscopy was performed in 203 patients with colorectal symptoms, who had at least one Ist degree relative with CRC, at the Colorectal Surgery Unit of St George's Hospital. Five hundred ninety two individuals without CRC family history and with either rectal bleeding (n = 479), or with change of bowel habits (n = 113) were used as control group.
Results: In the group of patients with family history of CRC 81 colonic lesions were found in 53 patients (53/203, 26%). Patients with family history of CRC were grouped in three categories according to their main symptom. In the subgroup of patients with bleeding (n = 129) there were found 46 colonic lesions in 33 patients. In the subgroup of patients with change of bowel habits (n = 45) we were able to detect 39 colonic lesions. In the group of patients with abdominal pain (n = 29) 4 patients had a metaplastic polyp and one patient had a neoplastic polyp. With regard to the number of 1st degree relatives with CRC, we found that 16/172 (9%) patients with one such relative and 4/31 (13%) of the patients with two relatives were diagnosed with neoplastic polyps.
Conclusions: Total colonoscopy (TC) is an excellent diagnostic procedure for the examination of symptomatic patients with positive family history of colorectal cancer. TC has a diagnostic role detecting the cause of symptoms or excluding the presence of malignancy. Simultaneous resection of the neoplastic and metaplastic polyps, provides an additional, secondary prevention of CRC.