Journal of Cancer and Tumor International

Background: Colorectal cancer is the fourth most common cancer and the second largest cause of cancer mortality in the United Kingdom. According to World Health Organization, there were 1.8 million new cases and almost 861,000 deaths in 2018, globally. In United Kingdom over 42,000 patients are diagnosed with bowel cancer every year. Anaemia is often a presenting sign in colorectal cancer patients, with reported incidences of > 30%. This is due to the morphological features of these tumours in the right colon leading to chronic blood loss and anaemia.

Aim: This study aimed to establish the relationship between right-sided colonic tumour and unexplained anaemia especially in patient with associated abdominal symptoms such as right-sided pain and change in bowel habit. To increase awareness of the role of right-sided colonic cancer in persistent anaemia. To emphasize need for colonic examination in adult patients with unexplained anaemia.

Methods: This is a case series design, that involved a total of four patients who had similar symptoms and unexplained anaemia with delayed diagnosis of right-sided colonic tumour. They all underwent colonoscopic examination following standard steps of pre-endoscopic evaluation and bowel preparations, lesions identified and then biopsy taken with histology showing colonic adenocarcinoma in all the patients. CASE 1: C.E, A 67year old female who presented to the accident and emergency with complaints of dizziness, weakness, abdominal pain. On physical examination, patient was pale, anicteric, pulse: 105bpm Blood pressure of 130/70mmhg. Abdominal examination showed full abdomen, soft and moves with respiration with a palpable mass at the right lumbar region. Colonoscopy done showed an ulcerative ascending colonic tumor. Histology showed adenocarcinoma. CASE 2: T.N a 45year old female who presented to the clinic with complaints of generalized body weakness of 4 months duration and intermittent dull abdominal pain more on the right. On physical examination patient was pale, cachectic, Pulse: 102bpm, Blood pressure of 110/80 mmhg, Temp of 36.7 oC, respiratory rate of 20breath/ min. Abdominal examination showed a full abdomen, soft with vaguely localized tenderness in the right lower abdomen, no palpable intra-abdominal mass. Colonoscopy revealed an ulcerative proliferative growth in the ascending colon. Histopathology showed moderately differentiated adenocarcinoma of the colon. CASE 3: A.T, a 54year old female who presented with complaints of unexplained weight loss and generalized body weakness. The patient presented with a several-month history of progressive weight loss with loss of appetite. On examination, she was markedly pale, anicteric; Pulse rate: 108bpm, BP: 110/60mmhg. Abdominal examination showed mild abdominal fullness with right hypochondrial tenderness and palpable mobile intra-abdominal right hypochondrial mass. Colonoscopy showed Ulcerative mass located at the hepatic flexure. Histopathology showed Adenocarcinoma of the colon. Case 4: B.S, a 58year old male who presented with abdominal pain of 5months duration. The pain was insidious in onset and progressive, pain is located around the upper abdomen and there was generalized body weakness. On examination there was mild pallor, anicteric, afebrile. Abdomen was full, and moves with respiration, soft with epigastric and right hypochondrial tenderness with a palpable mass in the right upper quadrant that was firm, irregular, non-tender, mobile. Colonoscopy done showed ulcerative tumor at the proximal transverse colon, likely malignant in appearance. Histopathology confirmed adenocarcinoma of the colon.

Summary of Findings/Results: Analysis of this series showed a total of four patients, 3 were females and one male with ages 67years, 45years, 54years and 58years respectively. They were all adult patients who were initially managed as a case of persistent anaemia, some started self-medications with haematinics to correct anaemia for some time prior to seeking professional care due to non-remitting symptoms. One of the patients had non-palpable mass on abdominal examination but presented with troublesome anaemia like the other patients. Colonoscopy done for these patients showed that all the lesions were ulcerative and fungating which are features of right-sided colonic tumours leading to blood loss and therefore persistent anaemia. The cause of this anaemia were initially misdiagnosed as was seen.

Conclusion: Chronic occult bleeding from right-sided tumors is the primary mechanism leading to iron deficiency. Iron-deficiency anaemia often serves as an important early diagnostic clue for colorectal cancer. Delayed recognition of the cause of anaemia contributed to late diagnosis of right-sided colon cancers in these patients. This highlights the importance of increased awareness and relevance of this article.