By Julia Williams, John Nicholls
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From the age of 14 years, annual rigid sigmoidoscopy is commenced, looking for polyps in the rectum. When polyps are present, it is usual for one or two to be visible in the rectum, but they Familial adenomatous polyposis 33 can be overlooked, and there may even be rectal sparing. For this reason, colonoscopy is usually advised, being performed first at the age of 20 and 5 yearly thereafter. Colonoscopy is not advocated earlier because cancer is unusual in youngsters with polyposis, and on the rare occasion that it does occur, the polyposis tends to be dense and easily recognizable on rigid sigmoidoscopy.
Gender The most comprehensive data on gender difference in colorectal cancer incidence and mortality are available from the USA. These data, derived for the Surveillance, Epidemiology and End Results (SEER) programme, indicate that there is a significant difference in age-adjusted colorectal cancer mortality between males and females, and that blacks are more frequently affected than whites. Changes in incidence and mortality by gender and time SEER data indicate that the incidence of colorectal cancer increased in males in the period 1950–84, whilst it fell slightly in females.
The importance of these is, however, minor compared with the importance of their large bowel disease. Surgical options The surgical choices are: • colectomy with IRA; • restorative proctocolectomy with the construction of an ileo-anal pouch (RPC); • proctocolectomy with permanent end-ileostomy. A proctocolectomy and permanent end-ileostomy should really now only ever be considered in the presence of a low rectal cancer. In this day and age, patients advised to have this operation should be counselled to seek a second opinion in order to be sure that it really is necessary and that they have indeed given their full consent to it.