Colorectal cancer - the prediction of risk

In the year 2000, the UK government implemented the 2 Week Wait (2WW) rule and CRC guidelines to provide primary care (General Practitioners) and secondary care (hospitals) with a method to help streamline and prioritize colorectal referrals.;In spite of the best of intentions, the 2WW system has failed to perform to its expectations. The yield of CRC from the 2WW referral route has been consistently poor in most centres in the UK. The NHS guidelines even if properly implemented have been shown to be insufficiently specific to pick up most CRCs.;Selvachandran et al from Crewe, UK have developed a computer program based Patient Consultation Questionnaire (PCQ) which is easy to complete by the patient, provides a comprehensive history and a significantly improved, reliable and specific cancer risk assessment as compared to NHS guidelines. The Weighted Numerical Score (WNS) or Selva score derived from the PCQ reflects the patient's risk of having CRC. The higher the score, the better is the specificity and positive predictive value for detecting CRC. Our study has validated this questionnaire based cancer risk assessment tool in the large and ethnically diverse population of Leicester. We have shown that the PCQ based WNS improves specificity resulting in improved CRC detection rate in a significantly smaller urgently referred population. We have also assessed patient satisfaction with the use of the PCQ.;CRC presenting as an emergency continues to form a significant proportion of the total number of CRCs diagnosed in any centre. We have shown that these patients differ in their presentation and outcome from the elective patients. Lack of any specific colorectal symptoms may result in a delay in the diagnosis in some of these patients who have proximal colon cancers. Similarly, the incidence and presentation of CRC in the ethnic population differs significantly for that of the native population.