Colorectal bleeding

The pharmacokinetics of bevacizumab demonstrate a terminal half-life of 21 days, with a volume of distribution consistent with limited extravascular distribution.34 Bevacizumab has shown clinical activity in the treatment of colorectal, kidney, lung, breast, and head and neck cancer. Patients may develop hypertension requiring chronic medication during therapy. Impaired wound healing, thrombolembolic events, proteinuria, bleeding, and perforation are serious side effects. 

Haemoglobin 8.8 g/dL (normal range 12.0-14.7 g/dL) This result indicates anaemia and as already described, is a typical non-specific symptom of colorectal cancer. It may have resulted from either frank or occult bleeding. 

Orozco, H., Takahashi, T., Mercado, M.A., Prado-Orozco, E., Ferral, H., Hernandez-Ortiz, X, Esquivel, E. Colorectal variceal bleeding in patients with extrahepatic portal vein thrombosis and idiopathic portal hypertension. J. Clin. Gastroenterol. 1992 14 139-143... 

Morris DL, Fabricius PJ, Ambrose NS, Scammell B, Burdon DW, Keighley MRB. A high incidence of bleeding is observed in a trial to determine whetiier addition of metronidazole is neeeded with latamoxef for prophylaxis in colorectal surgery. JHosp Infect ( 9S4) 5, 398-408,... 

Observational studies In a prospective study of bevacizumab combined with chemotherapy for first-line treatment of metastatic colorectal cancer, bevacizumab-related adverse events were gastrointestinal perforation (1.9%), arterial thromboembolic events (2%), grade 3—4 bleeding (2.2%), and de novo hypertension requiring medication (22%) [81 =]. 

Bevacizumab plus first-line chemotherapy has been evaluated in the Bevacizumab Expanded Access Trial (BEAT) in patients with unresectable metastatic colorectal cancer [82 ]. The serious/grade 3-5 adverse events with bevacizumab included hypertension (5.3%), bleeding (3%), gastrointestinal perforation (2%), arterial thromboembolism (1%), proteinuria (1%), and wound-healing complications (1%). 

The indications for CTC closely follow the indications for conventional optical colonoscopy with few exceptions. These indications include screening asymptomatic high- and average-risk patient populations, pre-operative assessment of the colon proximal to an obstructing mass, evaluation of patients with change in bowel habits, surveillance of patients post colorectal cancer surgery, and incomplete or failed colonoscopy. Patients with bleeding diathesis, contraindications to sedation, and frail and elderly patients may also be better suited for CTC than conventional colonoscopy. 

A subset of patients, including the elderly, those with cardiovascular disease, bleeding diathesis and a history of failed colonoscopies, are better suited to undergo CTC for colorectal cancer screening compared to colonoscopy or DCBE. 

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