Bleeding-related symptoms in colorectal cancer: a 4-year nationwide population-based study.

• Published in: Alimentary Pharmacology & Therapeutics
• Main Authors: Hreinsson, J P, Jonasson, J G, Bjornsson, E S
• Other Authors: 1Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital, Reykjavik, Iceland.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2014
• Subjects: Ristilkrabbamein; Járnskortur; Colorectal Neoplasms/epidemiology*; Colorectal Neoplasms/diagnosis; Gastrointestinal Hemorrhage/diagnosis; Intestinal Obstruction; Anemia; Iron-Deficiency/diagnosis; Warfarin/adverse effects; Occult Blood; Iceland; Retrospective Studies; Aged; 80 and over; Iron-Deficiency/epidemiology*; Anticoagulants/adverse effects; Aspirin/adverse effects; Female; Gastrointestinal Hemorrhage/epidemiology; Gastrointestinal Hemorrhage/etiology; Hemorrhage/diagnosis; Hemorrhage/epidemiology*; Hemorrhage/etiology; Humans; Iceland/epidemiology; Male; Middle Aged
• Online Access: http://hdl.handle.net/2336/326093; https://doi.org/10.1111/apt.12519

To access publisher's full text version of this article click on the hyperlink at the bottom of the page Little is known about the major presenting features of patients with colorectal cancer (CRC) in a population-based setting, especially regarding bleeding-related symptoms. To determine the proportion of CRC patients presenting with bleeding-related symptoms, to compare bleeders and nonbleeders and to explore the role of anticoagulants in bleeders. This was a nationwide, population-based, retrospective study, investigating all patients diagnosed with CRC in Iceland from 2008 to 2011. Bleeding-related symptoms were defined as overt bleeding, iron deficiency anaemia or a positive faecal occult blood test. Obstructive symptoms were defined as a confirmed diagnosis of ileus or dilated intestines on imaging. Data were available for 472/496 (95%) patients, males 51%, mean age 69 (±13) years. In all, 348 (74%) patients had bleeding-related symptoms; of these 348 patients, 61% had overt bleeding. Bleeders were less likely than nonbleeders to have metastases at diagnosis, 19% vs. 34% (P < 0.001). Overt bleeders were less likely than nonbleeders to have obstructive symptoms, 2% vs. 16% respectively (P < 0.0001). Occult bleeders were more likely to have proximal cancer (69%) than both overt (17%) and nonbleeders (44%) (P < 0.0001); however, they were less likely than nonbleeders to have metastases (22% vs. 35%, P < 0.05). Bleeders were more likely to use warfarin than nonbleeders (9% vs. 3%, P < 0.05); the use of low-dose aspirin was the same (24%). The majority of patients with CRC present with bleeding-related symptoms. Bleeders with CRC present earlier than nonbleeders. Warfarin use may induce bleeding in some patients, resulting in an earlier diagnosis. Landspitali National University Hospital of Iceland Research Fund.