What the research says
bleeding and change of bowel habit ; the latter being found as the most associated bowel symptom to cancer . However , this study did not specifically look at rectal bleeding as an isolated symptom as suggested in its proposal and did not report the location of the bowel cancer .
What the research says
The ‘ one- stop ’ rectal bleeding clinic is a relatively new idea and published evidence of its effectiveness is limited . Although it is starting to be implemented across the UK , it has been discussed in the literature prior to changes in government agendas such as that by Toomey et al ( 1998 ). Although this study is over 20 years old , the authors recognised the high number of referrals for rectal bleeding into the NHS . Their aim was to determine whether a flexible sigmoidoscopy was beneficial in a one stop rectal bleeding clinic . They reported that it is essential for all patients to have an investigation as 3 cancers out of the 344 investigated were missed in patients that were just treated as having haemorrhoids . One interesting finding was that the cancers were found in those over 50 which raises the point to whether a one - stop rectal bleeding clinic should just be a targeted service for over this age group .
A more recent study by Agaba ( 2006 ) reported their findings from a one-stop rectal bleeding clinic . They used this clinic to address and streamline the number of referrals regarding rectal bleeding . They outlined the importance of investigating rectal bleeding with an endoscope although they did not differentiate between the reasons of using flexible sigmoidoscopy for some patients and colonoscopy for others in their methods . Cancer was found in 4 patients ( 1.6 %), polyps in 36 patients ( 14.4 %) no incidences of abnormality was found in 98 patients ( 39 %). The remaining patients had benign conditions including haemorrhoids and diverticula disease . One important finding was that the patients having rectal bleeding , nearly all the cancers found were left sided and within easy reach of a flexible sigmoidscope . Agaba ( 2006 ) study was limited in the number of people and duration , but it does support the effectiveness of a straightto – test flexible sigmoidoscopy in finding early left sided bowel cancers . Their research supports earlier studies by Toomey et al ( 1998 ) and Mathew et al ( 2004 ) that cancer findings in those patients below the age of 45 was very low . A further study that supports a straight – to test rectal bleeding clinic is that by Chapius et al ( 1985 ). Again , this is an older study but shows that the predictive value for a left sided tumour with people with rectal bleeding was 34 % compared to 0.9 % in right sided tumours supporting the investigative test being a flexible sigmoidoscopy for rectal bleeding .
There is further evidence to support a onestop rectal bleeding clinic . Badger et al ( 2005 ) investigated flexible sigmoidoscopy as a preferred initial investigation through a one stop clinic . The most common finding was haemorrhoids and 1 % of the patients were found to have a malignant neoplasm . However , their study only looked at patients below the age of 50 compared to Vellacott et al ( 1987 ) whose study looked at patients over 50 with rectal bleeding and had a higher finding of colorectal cancer at 4.1 %. This could again outline that the straight- to – test clinic would be more effective in those aged over 50 . Jones et al ( 2001 ) further examined a one- stop colorectal clinic . They found that this process speeded up the diagnostic process however , the yield of bowel cancers diagnosed was low at 5 patients out of the 215 patients investigated . A later study by Toit et al ( 2006 ) supported investigations for rectal bleeding in their cohort study which found that one in 10 patients aged 45 or more had a colonic neoplasm , 5.7 % of these were cancers . Interestingly , the Royal College of Surgeons ( 2013 ) further outlined in their commissioner guide that rectal bleeding can indicate colorectal cancer in 8 % of patients over 50 . These studies reflect the need for rectal bleeding to be investigated due to the incidence of left sided bowel cancers being found and it is evident to be more effective in those aged over 50 .
Research into a one stop rectal bleeding clinic is low and slightly outdated . The main findings are that bowel cancers are commonly found in patients aged over 50 and with bright red rectal bleeding , these are found in the left side of the bowel . The studies included support that a one stop clinic speeds up the diagnostic process by