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Gastroenterology. 2015 Jul;149(1):89-101.e5. doi: 10.1053/j.gastro.2015.03.011. Epub 2015 Mar 18.

Identification of Extracolonic Pathologies by Computed Tomographic Colonography in Colorectal Cancer Symptomatic Patients.

Collaborators (182)

Dadswell E, Kanani R, Wooldrage K, Rogers P, Shah U, Kralj-Hans I, Ghanouni A, Waddingham J, Pack K, Thomson A, Turner L, Monk C, Verjee A, Ghanouni A, Smith S, von Wagner C, Wardle J, Lilford RJ, Yao G, Zhu S, Burling D, Higginson A, Kay CL, Maskell GF, Taylor A, Hayward SJ, Cade D, Morton D, Dhingsa R, Jobling JC, Jackson SA, Blunt D, Neelala MK, Sukumar SA, Slater A, Ziprin P, Edwards D, Woolfall P, Dadswell E, Kanani R, Ghanouni A, Muckian J, Bastable D, Gibbons N, Flashman K, Coni L, Martin J, Stephenson S, Jackson C, Beech D, Lynn C, Arumugam H, Wilkinson S, Scothern J, Pickles L, Hennedy A, Larkin T, Pearson P, Preston S, Smith L, Wright L, Blackstock J, Thomas R, Allen S, Young L, Adamson V, Butler-Barnes J, Larcombe T, Bradshaw V, Chapman S, Slater M, Stylan J, Wood D, Bradbury J, Breedon J, Coakes M, Crutch L, Leyland A, Pringle W, Rowe L, White M, Kumar D, Worley A, Gandy M, Whitehead E, Pascoe J, Avery M, Shivapatham D, Thomas S, Ong C, Poppinga-Scholz B, Stove J, Pearson K, Wood J, Cook W, Memory Y, Turner L, Fellows K, Duffy A, Usansky A, Shanahan B, Naim F, Bohra V, Prabhudesai S, Lancelotte N, Hayes M, James T, Johnston S, Stevenson J, Whetter D, Bartram C, Gupta A, Marshall M, Taylor SA, Atchley J, Lowe A, Wormald A, Bloor C, Tan E, McGregor J, Philips A, Noakes M, Zaman S, Guest P, McCafferty I, Riley P, Tattersall D, Fox BM, Shirley J, Roddie M, Owen A, Hughes N, Northover JM, Saunders B, Goggin P, O'Leary D, Ausobsky J, Beckett C, Davies J, Griffith J, Steward M, Arumugam PJ, Bronder C, Brown C, Crighton I, Higham A, Lea R, Meaden C, Morgan W, Patel P, Nasmyth G, Williamson M, Scholefield J, Hosie K, Bansi D, Buchanan G, Dawson P, Martin J, Smith G, Theodorou NA, Thillainayagam A, Conlong P, Rameh B, Rate A, Richards D, Hyde GM, Jones DJ, O'Dwyer ST, Cunningham C, Travis S, Burton S, Fabricius P, Gudgeon M, Jourdan I, Rutter M, Dixon A, Faulds-Wood L, Marteau T, Valori R, Altman DG, Steele R, Walker A.

Author information

University College London, London, United Kingdom. Electronic address:
Imperial College London, London, United Kingdom.
University College London, London, United Kingdom.
Queen Mary University of London, London, United Kingdom.
Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, United Kingdom.
University of Southampton, Southampton, United Kingdom.
University of Warwick, Warwick, United Kingdom.
University of Birmingham, Birmingham, United Kingdom.



Symptoms suggestive of colorectal cancer may originate outside the colorectum. Computed tomographic colonography (CTC) is used to examine the colorectum and abdominopelvic organs simultaneously. We performed a prospective randomized controlled trial to quantify the frequency, nature, and consequences of extracolonic findings.


We studied 5384 patients from 21 UK National Health Service hospitals referred by their family doctor for the investigation of colorectal cancer symptoms from March 2004 through December 2007. The patients were assigned randomly to groups that received the requested test (barium enema or colonoscopy, n = 3574) or CTC (n = 1810). We determined the frequency and nature of extracolonic findings, subsequent investigations, ultimate diagnosis, and extracolonic cancer diagnoses 1 and 3 years after testing patients without colorectal cancer.


Extracolonic pathologies were detected in 959 patients by CTC (58.7%), in 42 patients by barium enema analysis (1.9%), and in no patients by colonoscopy. Extracolonic findings were investigated in 142 patients (14.2%) and a diagnosis was made for 126 patients (88.1%). Symptoms were explained by extracolonic findings in 4 patients analyzed by barium enema (0.2%) and in 33 patients analyzed by CTC (2.8%). CTC identified 72 extracolonic neoplasms, however, barium enema analysis found only 3 (colonoscopy found none). Overall, CTC diagnosed extracolonic neoplasms in 72 of 1634 patients (4.4%); 26 of these were malignant (1.6%). There were significantly more extracolonic malignancies detected than expected 1 year after examination, but these did not differ between patients evaluated by CTC (22.2/1000 person-years), barium enema (26.5/1000 person-years; P = .43), or colonoscopy (32.0/1000 person-years; P = .88).


More than half of the patients with symptoms of colorectal cancer are found to have extracolonic pathologies by CTC analysis. However, the proportion of patients found to have extracolonic malignancies after 1 year of CTC examination is not significantly greater than after barium enema or colonoscopy examinations. International Standard Randomised Controlled Trials no:


Colon Cancer; Detection; Diagnostic; Digestive System

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