1. Barium Enema in the detection of Colon Cancer
Radiology Rotation Presentation
Karen Joynt
November 25, 2003

2. Case History Mr. J. is a 68 yo African-American male
Presents for routine colon cancer screening, urged by his sister, whose husband recently passed away due to colon cancer
Asymptomatic; no h/o GI bleed, no constipation, no diarrhea

3. Case History, continued
PMHx: HTN, asthma in childhood, gout
SocHx: lives with wife, retired engineer
Allergies: NKDA
Meds: Norvasc, aspirin
Presents for routine screening, via barium enema

4. Barium Enema Bowel preparation the night before
Three stages: filling with barium, gas insufflation, and radiography
Smooth-muscle relaxant (20 mg of buscopan or 0.5–1 mg of glucagon) can be utilized to decrease cramping
Requires considerable patient cooperation and mobility

5. Radiographic Findings: Normal

6. Radiographic Findings: Normal

7. Radiographic Findings: Polyp

8. Radiographic Findings: Polyp

9. Colon Polyps
Most colorectal CA arises from adenomatous polyps; progression generally takes >10 years
2/3 of polyps are adenomas; prevalence of adenomas is 25% by age 50 and 50% by age 70
Hyperplastic polyps account for the remaining 1/3 and do not generally progress
Current recommendations are that all adults over 50 should be screened for colon cancer
Less than 40% of Americans for whom screening is indicated receive it

10. DCBE vs. the others
DCBE detects half of adenomas larger than 1.0 cm and 39 percent of all polyps
Abnormalities must be followed by colonoscopy
False positives from retained stool, air, and other causes of mucosal irregularity
Advantages: entire colon, relatively safe
No studies evaluating effectiveness of DCBE in the prevention of CRC deaths
(note: DCBE identifies lesions better than FOBT, which has been shown to lower CRC mortality)

11. DCBE vs. the others, continued
Other screening options include
FOBT yearly (cheap, but only 2% true-positive, doesn’t detect most polyps)
Sigmoidoscopy every 5 years (more expensive, can see only half of the colon)
Colonoscopy every 5-10 years (most expensive, most complications, but most sensitive and specific)
No obvious winner in cost-effectiveness
Final decision depends on patient preferences

13. References
Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging, 4th Edition, 2001
UpToDate: uptodateonline.com, “Screening for colorectal cancer”