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Guest column

Iron deficiency could be indication of colon cancer

By V. UPENDER RAO
Published August 22, 2005


Anemia is frequently encountered in the elderly. It is merely a sign of decreased hemoglobin content for which there are many reasons, including chronic kidney disease, liver disease, rheumatologic diseases, chronic and acute leukemias, nutritional deficiencies, a variety of primary bone marrow disorders and iron deficiency, to name some.

Iron deficiency is usually seen in the underdeveloped countries and in young menstruating women. Its presence in post menopausal women and elderly men might be a sign of colorectal cancer.

A report from Royal Gwent Hospital in Newport, South Wales, says 60 percent of newly diagnosed patients with colorectal cancer have iron deficiency. Of these, 70 percent have anemia associated with iron deficiency, which is suggestive on review of the complete blood picture.

A good 30 percent, however, have iron deficiency without significant anemia, which makes it difficult to diagnose on casual examination alone because the complete blood count, or CBC, does not reveal the usual clues to iron deficiency.

It requires a high index of suspicion, microscopic examination of the peripheral blood smear, laboratory evaluation of the body's iron reserves and consideration of the various clinical signs of anemia such as irritability, weakness, fatigue, headache, palpitation, loss of appetite and exercise intolerance among many others.

Early diagnosis of iron deficiency anemia can help doctors diagnose colorectal cancer at an earlier and more curable stage.

Researchers from Royal Gwent found iron deficiency more frequently associated with cancers of the right side of the colon as compared to the left-sided cancers and cancers of the rectum. The presence of iron deficiency, however, did not correlate with the stage of the cancer in the report.

The two tests for iron deficiency evaluation in common clinical practice are the transferring saturation and serum ferritin. While the serum ferritin fluctuates in response to various acute and chronic diseases, the transferring saturation is more stable and a better indicator of iron deficiency.

While anemia is common in the elderly, its causes are many. Accurate diagnosis is important for proper treatment. Oral iron supplements usually suffice, but some patients who are intolerant of oral iron can be treated with intravenous iron replacement.

Diagnosis and treatment of iron deficiency is important, but referral of these patients for complete endoscopic evaluation to rule out a benign or malignant lesion of the GI tract is even more important.

--V. Upender Rao, M.D., FACP, practices at the Cancer and Blood Disease Center in Lecanto.

[Last modified August 22, 2005, 01:07:12]


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