Change in stool caliber

Ultima Vez Modificado:: 14 de septiembre de 2003

Question:

Dear OncoLink "Ask The Experts,"
I'm a 57-year-old female. I was treated for breast cancer 9 years ago. For the past 9-12 months I've had a change in bowel habits in the form of narrow stool. (No other symptoms.)
Six months ago my internist ordered a barium enema w/contrast--which came back clear. Narrow stools continue. Am I just a worrier, or would you recommend further tests?

Answer:

Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:

A change in stool caliber generally implies some change in stool characteristics that allow it to be narrower. Usually this is because the stools are softer. They can be molded by a tumor that narrows the diameter of the stool or be due to a colonic or anal motility problem. When this occurs, one wants to rule out a colon cancer. The barium enema should be a good exam to do this. However, it may have difficulty evaluating the distal colon and rectum and when a BE is done, it is usually accompanied by a flexible sigmoidoscopy. Alternatively a colonoscopy could also be done. In any case, the lower rectum needs to be cleared by directly visualizing it.

I hope this answers your question. While you didn't ask this directly, I would mention that, while breast cancer might spread to the abdomen, I would have expected to see it on the barium enema if it were causing any symptoms. Additionally, there is also some controversy as to whether a personal history of breast cancer increases one's risk for colon cancer. If it does, it is only by a very small amount and does not put someone at high risk for colon cancer. I don't perform greater surveillance testing in these patients.


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