New cases of colon and rectal cancer are diagnosed every year in England; patient prognosis improves when the cancer is detected early and treatment is administered, reducing early mortality rates. In the UK alone, GlobalData epidemiologists forecast there will be just over 120,000 diagnosed prevalent cases of colorectal cancer in men and women aged 18 years and above by the end of 2023; that number is forecast to increase to almost 137,000 in 2031.
Symptomatic colon or rectal cancer patients will typically present with discomfort in the abdomen, unexplained anaemia, weight loss and fatigue before a diagnosis is made. The two most characteristic symptoms of colon or rectal cancer are a change in bowel habits (CIBH) and rectal bleeding.
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Both cancers have a long lag period between the discovery of a polyp and its development into a cancerous tumour. By the time patients are symptomatic, it is typically indicative of late-stage cancer; however, the predictive powers of CIBH and rectal bleeding on advanced-stage disease at initial diagnosis of either cancer has not been extensively researched.
A study by Zakkak, Lyratzopoulos and Barclay looked to fill this gap in the research. They quantified the association between individuals presenting with rectal bleeding or CIBH and a diagnosis of either of the cancers in the 12 months following, and also the association between patients with either cancer diagnosis and the presentation with either of the two studied symptoms in the 12 months preceding their diagnosis.
The study showed a higher risk in men and older individuals
The research, published in Cancer Epidemiology in November 2023, examined patient data from 30 to 99-year-olds in England who presented to primary care with a complaint of either one of the studied symptoms between 2007 and 2017 and measured the number of individuals who received a diagnosis of either colon or rectal cancer in the 12 months following the initial reporting of symptoms. The stage of cancer at diagnosis was also measured in patients with either a colon or rectal cancer diagnosis from 2012 to 2018 in a nested cohort.
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The findings showed that for both CIBH and rectal bleeding presentation, colon or rectal cancer risk was higher in men and older individuals. Across all age groups, the risk of developing cancer was slightly higher in men who presented with CIBH rather than rectal bleeding in the 12 months preceding their diagnosis; however, the opposite was true in women. The risk of developing colon cancer in patients at 80 years of age who initially presented with rectal bleeding was 3.6% in men and 2.5% in women; in rectal cancer, the risk was 3.3% in men and 1.5% in women. A slightly higher risk of 4.3% for developing colon cancer was found for men presenting with rectal bleeding and a reduced risk of 2.1% in women; in rectal cancer, the risk was 3.5% in men and 0.96% in women.
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By GlobalDataNeed for bowel health awareness and monitoring
Among patients with a colon cancer diagnosis, 10.9% had presented with rectal bleeding and 6.8% with CIBH 12 months preceding the diagnosis. In rectal cancer patients, 33.3% had presented with rectal bleeding and 14.9% with CIBH. Younger age was associated with a higher risk of advanced-stage colon cancer at initial diagnosis in men, and rectal cancer in both men and women. CIBH was more common in advanced-stage cancer patients compared to rectal bleeding across all age groups. The demographic most at risk of advanced-stage colon or rectal cancer was men aged around 80 years of age presenting with CIBH.
The findings from this study indicate that rectal bleeding and CIBH are predictive of cancer, especially in older patients. However, the association between the index symptoms and the stage of cancer at diagnosis is not strong enough to produce any conclusive statements. Concern over awareness of bowel health and monitoring should continue, along with the pursuit of new ways of strengthening health promotion to reduce colon and rectal cancer mortality and morbidity.
