Abstract
Purpose: Recent studies showed that in patients with iron deficiency anemia (IDA) predictive factors of malignancy are male sex, age≥50 years and presentation's hemoglobin (Hb) of ≤ 9.0 g/dL. The National Institute for Health & Clinical Excellence (NICE) published guidelines suggesting urgent colonoscopy for males & females with unexplained IDA if Hb ≤11gr/dL & ≤10gr/dL respectively, while urgent gastroscopy is advised for any level of unexplained IDA. We aimed to check whether the degree of anemia and the RBC indices differ amongst patients with upper GI (UGI) and lower GI (LGI) cancers; furthermore, to assess the safety of the “alarm level” of Hb (NICE-LGI cancer guidance) and if a similar level can be used in the UGI cancer guidance. Methods: Retrospective study; patients investigated for “anemia” between April 2002 and 2005 were identified using the electronic endoscopy register. All patients with confirmed malignancy (histopathology reports) were included in the study. The lowest values for Hb, Mean Corpuscular Volume (MCV) and Red Cell Distribution Width (RDW) -up to six months prior to endoscopy- were analysed using Stata 8.2. Results: Ninety-three (N = 93) patients included; 32 had UGI and 61 LGI cancers. Mean ages were 73.2 years (54–92) vs. 76.5 years (53–95), with male predominance in both groups (M:F; UGI 1.7: 1 vs. LGI 1.4: 1). In the UGI group; 24 were gastric, 4 gastro-esophageal junction's and 3 esophageal adenocarcinomas • one MALToma was found. In the LGI group, all were adenocarcinomas. Thirty-two were right sided, 22 left-sided while, 4 patients had synchronous lesions and 3 presented with hepatic metastases. The mean [UGI] Hb vs. [LGI] Hb level was: 8.9g/dL (SD = 1.5) vs. 9.1g/dL (SD = 1.4), mean MCV 79.2fL (SD = 9.4) vs. 78.7fL (SD = 10) & mean RDW 17.2% (SD = 3.5) vs. 17.7% (SD = 4.1). The difference of the parameters was statistically non-significant (p values: 0.2, 0.8 and 0.3 respectively). Conclusions: The degree of anemia and the RBC indices are similar in patients with UGI and LGI cancers and therefore, poor predictor of its site. The suggested Hb level seems safe for our population; furthermore, potential use of the same Hb level in the suspected UGI cancer guidance seems reasonable.Table: Hematology Parameters in Patients with GI Cancers
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