Doctor, by the way, I have more bowel opening these days… Does it matter?

Abstract

Introduction: Amongst the elderly, constipation is the leading bowel habit problem faced by family physicians. However, when an elderly patient mentions the contrary, ‘I’ve more bowel movement recently’, would that set your alarm bells ringing? Method: Case report A 79-year old woman attended regular general outpatient clinic (GOPC) follow up in March 2019. Her chronic diseases were stable. Towards the end of the consultation, she casually mentioned to the doctor, ‘I have more bowel opening in the past few months. Does it matter?’ She reported having several bowel movements in the morning with tenesmus. Yet, no per-rectal bleeding nor other red flags. Per-rectal examination, however, revealed an irregular circumferential nodularity with contact bleeding. She was referred immediately to the colorectal specialist. Her haemoglobin was normal but Carcinoembryonic Ag (CEA) elevated. Colonoscopy showed a circumferential tumor at 1cm from anal verge extending 1.5cm into the rectum. Biopsy confirmed adenocarcinoma. CT showed no distant metastasis. MRI showed levator ani muscle and lower vagina wall involvement. Curative neoadjuvant CTRT followed by surgery was recommended. Result: The patient and her family accepted the suggestions and proceeded accordingly. Discussion: Colorectal cancer is the commonest cancer in Hong Kong. 1 It accounted for 17.3% of all new cancer cases in 2016. The incidence rate for both sexes was on an upward trend between 1983 and 2016. However, many elderly patients are unaware of the significance of bowel habit changes and may not put it high on their consultation agenda especially when they have many co-morbidities. Family physicians play a crucial role in being vigilant against the disease. Conclusion: Family physicians should be alerted to the possibility of colorectal cancer even when seemingly trivial bowel concerns are raised by patients.