Table 5 Symptom combination at presentation and yield of distal and proximal cancer (N = 7375)

From: Whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study

Symptom/signs combinations

Total patients

Distal cancersa

Proximal cancersa

All sites

n

%

Patients with distal cancer, n

Proportion of distal cancers, %

Diagnostic yield, %

No. needed to examine to diagnose one cancer (95% CI)

Patients with proximal cancer, n

Proportion of proximal cancers, %

Diagnostic yield, %

No. needed to examine to diagnose one cancer (95% CI)

Patients with cancer, n

Proportion with a distal cancer, %

Proportion with a proximal cancer, %

Total

7375

100

429

100.0

5.8

18 (16, 19)

127

100.0

1.7

59 (49, 70)

551

77.9

23.0

Anaemiab and/or abdominal mass

2022

27.4

136

31.7

6.7

15 (13, 18)

97

76.4

4.8

21 (18, 26)

231

58.9

42.0

 Anaemiab, no abdominal mass

1806

24.5

117

27.3

6.5

16 (13, 19)

77

60.6

4.3

24 (19, 30)

192

60.9

40.1

 Abdominal mass, no anaemiab

133

1.8

11

2.6

8.3

13 (7, 24)

10

7.9

7.5

14 (8, 28)

21

52.4

47.6

 Anaemiab and abdominal mass

83

1.1

8

1.9

9.6

11 (6, 24)

10

7.9

12.0

9 (5, 17)

18

44.4

55.6

No anaemiab or abdominal mass

  Total

5353

72.6

293

68.3

5.5

19 (17, 21)

30

23.6

0.6

179 (126, 265)

320

91.6

9.4

  Rectal bleeding

  Total

2195

29.8

221

51.5

10.1

10 (9, 12)

13

10.2

0.6

169 (99, 317)

233

94.8

5.6

  Rectal bleeding alone

571

7.7

43

10.0

7.5

14 (10, 19)

3

2.4

0.5

191 (66, 922)

46

93.5

6.5

  Rectal bleeding and CIBH

1345

18.2

156

36.4

11.6

9 (8, 11)

10

7.9

0.7

135 (74, 281)

165

94.5

6.1

  Rectal bleeding and weight loss or abdominal pain, no CIBH

202

2.7

8

1.9

4.0

26 (14, 58)

0

0.0

0

—

8

100

0.0

  Rectal bleeding and only other symptoms/signsc

77

1.0

14

3.3

18.2

6 (4, 10)

0

0.0

0

—

14

100

0.0

 CIBH, no rectal bleeding

  Total

2866

38.9

68

15.9

2.4

43 (34, 55)

17

13.4

0.6

169 (106, 290)

83

81.9

20.5

  CIBH alone

1464

19.9

31

7.2

2.1

48 (34, 70)

5

3.9

0.3

293 (126, 902)

35

88.6

14.3

   More frequent

836

11.3

15

3.5

1.8

56 (34, 100)

0

0.0

0

—

15

100

0.0

   Less frequent

174

2.4

5

1.2

2.9

35 (16, 107)

2

1.6

1.1

87 (25, 717)

7

71.4

28.6

   Variable

166

2.3

8

1.9

4.8

21 (11, 48)

1

0.8

0.6

166 (31, 6558)

9

88.9

11.1

   Unspecified

288

3.9

3

0.7

1.0

96 (34, 465)

2

1.6

0.7

144 (41, 1188)

4

75.0

50.0

  CIBH and weight loss or abdominal pain

1253

17.0

34

7.9

2.7

37 (27, 54)

10

7.9

0.8

126 (69, 261)

44

77.3

22.7

  CIBH and only other symptoms/signsc

149

2.0

3

0.7

2.0

50 (18, 240)

2

1.6

1.3

75 (21, 614)

4

75.0

50.0

 No rectal bleeding or CIBH

  Abdominal pain or weight loss

241

3.3

2

0.5

0.8

121 (34, 994)

0

0.0

0

—

2

100

0.0

  Only other symptoms/signsc

51

0.7

2

0.5

3.9

26 (8, 209)

0

0.0

0

—

2

100

0.0

Suggested criteria for flexible sigmoidoscopy

 No anaemia or abdominal mass

  Rectal bleeding

2195

29.8

221

51.5

10.1

10 (9, 12)

13

10.2

0.6

169 (99, 317)

233

94.8

5.6

  CIBH to more frequent alone

836

11.3

15

3.5

1.8

56 (34, 100)

0

0.0

0

—

15

100

0.0

 Total

3031

41.1

236

55.0

7.8

13 (12, 15)

13

10.2

0.4

234 (137, 438)

248

95.2

5.2

  1. aFive patients had both a distal and proximal cancer diagnosed. These patients are included in both the distal and proximal cancer columns. Of these five patients, two had anaemia, one had rectal bleeding and a change in bowel habit (CIBH) (more frequent), one had a CIBH (more frequent) and bloating, and one had a CIBH (unspecified) alone
  2. bIn patients with blood count data, anaemia was defined by the WHO (broad) definition [haemoglobin (Hb) level <13 g/dL in men or <12 g/dL in women]. In patients without blood count data, anaemia was defined by whether the investigation of anaemia was indicated as a reason for referral
  3. cIncludes bloating/flatulence (n = 203), tiredness/weakness (n = 152), anal symptoms (n = 97), nausea/vomiting (n = 44), back pain (n = 13), upper gastrointestinal symptoms (n = 10), faecal occult blood test (FOBT) positivity (n = 113), family history (n = 117), history of polyps (n = 23), cancer antibodies (n = 3), elevated C-reactive protein (n = 4), and liver problems (n = 9)
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