Background: Colorectal cancer is a disorder that occurs
exclusively in the colon or rectum and is caused by the colon’s aberrant
proliferation of glandular epithelial cells. Two commonly used strategies for
initial evaluation are Double Contrast Barium Enema (DCBE) and diagnostic lower
GI endoscopy. Barium enema is easy to perform, does not require sedation, is
inexpensive, and is readily available in Bangladesh. However, limited data are
available on its diagnostic accuracy in the local population.
Aim of the Study: This study aims to determine the
diagnostic value of barium enema in colorectal cancer.
Materials and Methods: A prospective study was carried out
on 50 cases presented with clinical features of colorectal cancer in
Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and
National Institute of Cancer Research & Hospital (NICRH) during the period
July 2000 to June 2001. Of the 50 patients, 30 were male, and 20 were female.
The mean age of the male patients was 46 ± 10.8 years, while that of the female
patients was 44.5 ± 11.2 years. All 50 cases underwent barium enema examination
under fluoroscopic control; single-contrast studies were performed in 11 cases,
and double-contrast studies were performed in 39 cases. The findings of barium
enema examination were confirmed by histologic examination of the specimens
obtained by colonoscopy, and in 10 cases, after operation. Moreover,
questionnaires, interviews, case history and clinical examinations were
conducted to collect all the relevant data and analysed statistically.
Results: No statistically significant difference was found
between the age and sex of the patients. In Western countries, colorectal
cancer typically occurs in late adulthood, most commonly in the sixth and
seventh decades of life; however, in this study, the highest incidence was
observed in the fourth and fifth decades, followed by the sixth decade. Males
predominate over females, and the rectum is more involved than the colon. It
was found that 96% of patients took meat and fat, and one patient had a family
history of colon cancer. Colorectal cancer was more common (44%) in better
socio-economic conditions than in low (4%). Constipation (70%) and per rectal
bleeding (64%) were predominant symptoms, and 68% cases had abnormality in per
rectal examination. Out of 40 cases, colonoscopy detected a lesion in 33 cases,
one was a false positive, and 7 cases were negative; of them, 3 cases were
false negatives, and 4 were true negatives. In 50 cases, barium enema detected
a lesion in 42 cases; 2 were false positives. 8 cases were negative in barium
enema, of them 5 were false negatives, and 3 were true negatives.
Histologically, 45 (90%) cases proved to be adenocarcinoma, among them 4 (8%)
cases were mucinous adenocarcinoma. Five cases were histologically negative.
The sensitivity and accuracy of barium enema were 88.9% and 86%, and those of
colonoscopy were 91.4% and 90%, respectively.
Conclusion: Though colonoscopy has greater sensitivity and
accuracy, it is less acceptable to the patients, has a high cost, is not easily
available, requires sedation and expertise and the entire colon is not seen in
2-40% of patients. The study concluded that barium enema may be considered a
suitable initial investigation for the diagnosis of clinically suspected
colorectal cancer. However, as this was a single-centre study with a small
sample size, future research should include larger sample sizes and multicenter
studies to validate these findings.
Author(s) Details
Md. Abdul Gafur
Chittagong Medical College, Chattogram, Bangladesh.
Please see the book here :- https://doi.org/10.9734/bpi/msup/v7/7108
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