Volume 6, Number 2;  July 6, 2006

Patient: 60 year old incarcerated African-American male, presenting with maroon-colored stool and history of hemorrhoids.  Patient appeared thin, wasting.  Rectal exam was negative for blood.  H&H were 12.8 and 39.1, WBC 4.6, platelets 327.  Due to probability of no follow-up once returned to jail, team proceeded with endoscopy (neg.),  followed by colonoscopy.  Colonoscopy revealed a 15cm mass in upper rectum, ultimately identified as moderately differentiated adenocarcimona.

Session Handout:

Ransohoff DF. Sandler RS. Clinical practice. Screening for colorectal cancer. New England Journal of Medicine. 346(1):40-4, 2002 Jan 3. UI: 11778002

Readings:

[Article available 1 yr post-publication]

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Unique Identifier [PMID]: 15932566

Authors: Beale AL. Penney MD. Allison MC.

Institution: Royal Gwent Hospital, Newport, South Wales, UK.

Title: The prevalence of iron deficiency among patients presenting with colorectal cancer.

Source: Colorectal Disease. 7(4):398-402, 2005 Jul.

Abstract: OBJECTIVES: To examine prospectively the prevalence of iron deficiency among new patients presenting with colorectal cancer and to compare transferrin saturation and serum ferritin as markers of iron deficiency in this group of patients. PATIENTS AND METHODS: Data were gathered on all patients presenting with a new diagnosis of colorectal cancer over a 12-month period. Iron status was estimated and, when possible, confirmed by measurement of serum ferritin concentration and transferrin saturation. Iron status was further examined in relation to tumour site and Dukes' stage. RESULTS: During the study 157 patients presented with a new colorectal cancer. Of these, 130 could be evaluated and 78[60%] had evidence of iron deficiency. Transferrin saturation was below the reference range in 55 patients, but serum ferritin was below in only 18 patients. Among the 49 patients with right-sided cancers, 39[80%] were iron deficient. Iron deficiency was significantly more likely in patients with right sided cancers compared with those with cancers at or distal to the splenic flexure (chi2 = 13, P < 0.001). CONCLUSION: The majority of patients with a new diagnosis of colorectal cancer are iron deficient at presentation. In such patients transferrin saturation measurement is a more sensitive marker of iron deficiency than serum ferritin. The potential role of measuring serum transferrin saturation as an adjunct to faecal occult blood screening should be explored further.

Publication Type: Journal Article.

  Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 9719230

Record Owner NLM

Authors: Sadahiro S. Suzuki T. Tokunaga N. Mukai M. Tajima T. Makuuchi H. Saito T.

Institution: Department of Surgery, Tokai University School of Medicine, Bohseidai, Isehara, Japan.

Title: Anemia in patients with colorectal cancer.

Source: Journal of Gastroenterology. 33(4):488-94, 1998 Aug.

Abstract: Although anemia is one of the signs of colorectal cancer, the relationships between histological findings and hematological findings other than hemoglobin level have not been adequately investigated. We investigated the relationship between hematological findings, serum iron, and histological findings in 358 patients (207 men and 157 women) with colorectal cancer. Their mean (+/-SD) ages were 64.3 +/- 12.4 and 63.8 +/- 13.3 years. A hemoglobin level of less than 10 g/dl was the criterion for anemia, and 20.8% of the men and 25.8% of the women met this criterion. Univariate analysis showed that carcinoma of the cecum, ascending colon, and transverse colon; large-size carcinoma, invasion beyond the proper muscle layer; positive lymph node metastasis: and clinical stage (Dukes' B, C, and D) were factors associated with high incidence of anemia. Histological type did not affect the hematological findings. Multivariate analysis showed that age, tumor site, and tumor size were significant factors related to anemia. Depth of invasion, the presence or absence of lymph node metastasis, and Dukes' classification were not significant factors. In the presence of these factors, mean corpuscular volume and mean corpuscular hemoglobin concentration values were low, and red blood cells were microcytic and hypochromic. The incidence of a low serum iron level was about twice the frequency of a hemoglobin level of less than 10 g/dl. The results of the multivariate analysis showed that none of the factors were significantly related to iron deficiency.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth