THE UTILITY OF PREOPERATIVE SCREENING COLONOSCOPY IN GYNECOLOGIC ONCOLOGY

The American Cancer Society (ACS) recommends that asymptomatic women, age 50 and over, undergo sigmoidoscopy every 3 to 5 years, after two n egative yearly exams. Epidemiologic evidence suggests that women with gynecologic or breast cancers have an increased risk of developing col on cancer. It is unclear whether the ACS guidelines are applicable for women with a new diagnosis of gynecologic malignancy. This retrospect ive study was undertaken to assess the usefulness of preoperative colo noscopy in our gynecologic oncology patient population. Patients under going evaluation for a major operative procedure for known or suspecte d gynecologic malignancies were referred for colonoscopy at the discre tion of their attending surgeon. Five hundred patients' charts were re viewed to identify 212 patients in whom preoperative colonoscopy was p erformed (the study group). In this group, 17 cases of colonic polyps, 5 cases of synchronous colon cancer, and 2 cases of cancer metastatic to the colon were discovered, representing 11% of the study group. Wh ereas 23% of the patients screened were less than 50 years of age, onl y two cases of polyps occurred in this age group, and no cases of canc er. Patients aged 70 or greater made up 28% of the study group, but ac counted for 41% of the cases of polyps and 40% of the colon cancers. T wenty-nine percent of the study group had adenocarcinoma of the endome trium, representing 7 of 17 cases of polyps, 1 of 5 colon cancers, and 1 of 2 metastatic cancers. Although this retrospective study involved colonoscopy, the locations of the observed lesions were within the th eoretic reach of a flexible sigmoidoscope in 75% of cases. We conclude that in the preoperative workup of gynecologic oncology patients, no colon screening is needed in the asymptomatic patient less than 50 yea rs of age. ACS guidelines are appropriate for patients aged 50-70, but for those 70 or greater we would consider full colonoscopy. (C) 1995 Academic Press, Inc.