Colonoscopy in symptomatic patients with positive family history of colorectal cancer

Background: Most patients with colorectal cancer (CRC) develop clinical sig ns 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 ris k for developing CRC, because of their family history Methods: Over the las t 6 years, colonoscopy was performed in 203 patients with colorectal sympto ms, who had at least one I st degree relative with CRC, at the Colorectal S urgery Unit of St George's Hospital. Five hundred ninety, two individuals w ithout 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 grou ped 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 p atients. 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 abdom inal pain (n=29) 4 patients had a metaplastic polyp and one patient had a n eoplastic polyp. With regard to the number of Ist 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. C onclusions: Total colonoscopy (TC) is an excellent diagnostic procedure for the examination of symptomatic patients with positive family history of co lorectal cancer. TC has a diagnostic role detecting the cause of symptoms o r excluding the presence of malignancy. Simultaneous resection of the neopl astic and metaplastic polyps, provides an additional secondary prevention o f CRC.