Colorectal carcinoma detected initially with barium enema examination: site distribution and implications

The authors analyzed the site distribution of 122 consecutive cases of colorectal carcinoma in which a barium enema examination was available for review. The carcinoma was detected initially with barium enema studies in 82 cases (67%), sigmoidoscopy in 18 (15%), colonoscopy in 12 (10%), digital rectal examination in seven (6%), and computed tomography in three (3%). Thirty (37%) of the 82 cases found initially at barium examination were located in the cecum and ascending colon, which is a considerably higher proportion than that reported in studies based on cancer registry data or in surgical series. Thirty-eight (95%) of the 40 carcinomas first detected with other techniques were located distal to the hepatic flexure; 18 of those were identified initially with sigmoidoscopy. Because many distal carcinomas were first detected with nonradiologic techniques, an unusually high percentage of carcinomas in the cecum and ascending colon were found initially with barium enema studies. These findings suggest that barium enema evaluation of the right side of the colon needs to be at least as detailed as that of the rectum and sigmoid colon, areas that are increasingly assessed with sigmoidoscopy before barium enema studies are performed.