Prevalence of left-sided colorectal cancer and benefit of flexible sigmoidoscopy: a county hospital experience.

The best way to evaluate the colon for both diagnosis of symptoms and surveillance is colonoscopy. However, access to colonoscopy is often restricted. Our objective was to assess the anatomic distribution and stage at presentation of colorectal cancer (CRC) in a county hospital population, the prevalence and distribution of CRC in younger patients, and the utility of flexible sigmoidoscopy for early diagnosis of left-sided cancers in this population. We performed a retrospective chart review of 151 patients who underwent colorectal resection from 2001 to 2003. Overall, 66.9 per cent of patients underwent resection for left-sided CRC. Forty-two (27.8%) of 151 were under age 50. In patients over 50, 66.1 per cent were found to have left-sided CRC compared with 69 per cent of patients under 50. Fifty per cent (50.3%) of patients had stage III or IV (advanced) disease. Forty-nine and a half per cent of patients over 50 and 52.3 per cent under 50 had advanced disease. Forty-eight and a half per cent of patients with left-sided CRC had advanced stage disease compared with 54% of patients with right-sided CRC. In patients under 50, the rates were 55.2 per cent and 46.1 per cent respectively. Two-thirds of the CRC occurred in the left side of the colon in both older and younger population. Flexible sigmoidoscopy should be considered as an early tool in the diagnosis of CRC.