What does a GP need to know about colorectal surgery

1. What does a GP need to know about colorectal surgery? Mr Neil J Smith Consultant General & Colorectal Surgeon

2. You might like to know about� Screening for colorectal cancer The Two Week Rule Benign anorectal conditions Laparoscopic colorectal surgery ...& anything else (time permitting)

3. Colorectal Cancer screening Bowel cancer screening aims to detect bowel cancer at an early stage (in people with no symptoms), when treatment is more likely to be effective Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16% The NHS Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 69. �Rolled out� across England since 2006, �live� in Surrey since September 2008. Faecal Occult Blood test kit (FOBt)

5. What�s the significance of FOBt+? Around 98 in 100 people will receive a normal result and will be returned to routine screening. They will be invited for bowel cancer screening every two years if still within the eligible age range. Fewer than 20 in 1000 people will receive an abnormal result. They will be referred for further investigation and usually offered a colonoscopy. Almost 14 in 20 people who have a colonoscopy will have a normal result. About five in 20 will be found to have a polyp, which if removed may prevent cancer developing. One in 20 people with a positive FOB test will be found to have cancer when they have a colonoscopy.

6. Two Week Rule Patients must be seen by a specialist within two weeks of (receipt of) the decision to refer Initiate treatment within 62 days of decision to refer (and within 31 days of the diagnosis being confirmed).

7. Rectal bleeding with ?BH to looser stools (Any Age) >6/52 ?BH to looser stools and/or increased freq of defaecation (60+) Palpable abdominal or rectal mass consistent with colorectal tumour (Any Age) Persistent rectal bleeding without anal symptoms (60+) Unexplained IDA: Men Hb<11g/dl (Any Age) Women Hb<10g/dl (postmenopausal)

8. The Two Week Rule <10% of patients referred under TWR have cancer >50% of new colorectal cancers were referred as TWR

9. Rectal bleeding The history is everything: Painful or painless? Associated change in bowel habits? Associated prolapse/discharge Anything else?

10. Haemorrhoids Fissure Fistula-in-ano Pruritis ani Benign Anorectal conditions

11. Painless bright red rectal bleeding Itching / Prolapse (thrombosis) Differential diagnosis: fissure (painful) Perianal haematoma (skin-covered) Treatment: Injection / Banding / Surgery (we almost never use OTC preparations) Haemorrhoids

12. Painful bright red rectal bleeding Typically young women Differential diagnosis: Thrombosed haemorrhoid (easy to see) Perianal haematoma (skin-covered) Look for sentinel tag (midline, posterior) Treatment: 8/52 bd topical GTN or Diltiazem (rarely surgery) Fissure-in-ano

13. Hx of previous perianal sepsis (?I&D) Purulent offensive discharge, some bleeding Painful / itching / soreness External opening will be visible Treated by EUA +/- lay open / Seton. Fistula

14. Itching / soreness Exclude associated dermatological condition (lichen planus, dermatitis, etc) Exclude underlying haemorrhoids / fistula Avoid perfumed toiletries, ensure good hygeine Topical steroids may be helpful Pruritis Ani

15. Increasingly common practice Faster recovery times, smaller wounds Early discharge from hospital NB anastomotic leaks may now occur at home! Laparoscopic colorectal surgery

16. Anything else?