There was no consistency in the way symptoms were elicited or interpreted in the studies. Neither the clinical setting (primary or specialist care) nor study type was associated with accuracy. There was no significant association of colorectal cancer or polyps with change in bowel habit, constipation, diarrhoea or abdominal pain. Neither of these symptoms was associated with the presence of polyps. ResultsĬolorectal cancer was associated with rectal bleeding (AUC 0.66 LR+ 1.9 LR- 0.7) and weight loss (AUC 0.67, LR+ 2.5, LR- 0.9). Summary ROC analysis was used to assess the diagnostic performance of symptoms to detect colorectal cancer and polyps.
The search procedure, quality appraisal, and data extraction was done twice, with disagreements resolved with another reviewer. For inclusion in the review, papers from cross sectional, case control and cohort studies had to provide a 2×2 table of symptoms by diagnosis (colorectal cancer or polyps) or sufficient data from which that table could be constructed. We searched the literature extensively up to December 2008, using MEDLINE and EMBASE and following references. The objective of this study is to systematically review the evidence about the association between bowel symptoms and colorectal cancer or polyps.
However, the evidence for this practice is unclear. Investigation of bowel symptoms for this purpose is recommended by numerous clinical guidelines. Bowel symptoms are often considered an indication to perform colonoscopy to identify or rule out colorectal cancer or precancerous polyps.
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