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A prospective study to assess the value of MMP-9 in improving the appropriateness of urgent referrals for colorectal cancer

By Angela V. Ryan, Dr Sue Wilson, Michael J. O. Wakelam, Sally A. Warmington, Janet A. Dunn, Richard F. D. Hodgkin, Ashley Martin and Tariq Ismail


Background\ud Bowel cancer is common and is a major cause of death. Most people with bowel symptoms who meet the criteria for urgent referral to secondary care will not be found to have bowel cancer, and some people who are found to have cancer will have been referred routinely rather than urgently. If general practitioners could better identify people who were likely to have bowel cancer or conditions that may lead to bowel cancer, the pressure on hospital clinics may be reduced, enabling these patients to be seen more quickly. Increased levels of an enzyme called matrix metalloproteinase 9 (MMP-9) have been found to be associated with such conditions, and this can be measured from a blood sample. This study aims to find out whether measuring MMP-9 levels could improve the appropriateness of urgent referrals for patients with bowel symptoms.\ud \ud Methods\ud People aged 18 years or older referred to a colorectal clinic will be asked to complete a questionnaire about symptoms, recent injuries or chronic illnesses (these can increase the level of matrix metalloproteinases) and family history of bowel cancer. A blood sample will be taken from people who consent to take part to assess MMP-9 levels, and the results of examination at the clinic and/or investigations arising from the clinic visit will be collected from hospital records. The accuracy of MMP-9 will be assessed by comparing the MMP-9 level with the resulting diagnosis. The combination of factors (e.g. symptoms and MMP-9 level) that best predict a diagnosis of malignancy (invasive disease or polyps) will be determined.\ud \ud Discussion\ud Although guidelines are in place to facilitate referrals to colorectal clinics, symptoms alone do not adequately distinguish people with malignancy from people with benign conditions. This study will establish whether MMP-9 could assist this process. If this were the case, measurement of MMP-9 levels could be used by general practitioners to assist in the identification of people who were most likely to have bowel cancer or conditions that may lead to bowel cancer, and who should, therefore, be referred most urgently to secondary care\u

Topics: RC0254
Publisher: BioMed Central Ltd.
Year: 2006
OAI identifier:

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  4. Institute: Colon and rectum cancer (invasive). Survival rates, by race, sex, diagnosis, year, stage and age.
  5. (2001). Intelligence Centre: Deaths,
  6. (1970). Manual for the State-Trait Anxiety Inventory California: Consulting Psychologists Press;
  7. (2004). MR: The Department of Health's "two week standard" for bowel cancer: is it working? Gut doi
  8. (1999). NJ: Proteolysis in human breast and colorectal cancer. doi
  9. (1998). RJC: Gelatinase (MMP-2 and -9) expression in gastrointestinal malignancy. doi
  10. (1996). SD: A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care doi
  11. (2002). Sigmoidoscopy Screening Trial Investigators: Single flexible sigmoidoscopy screening to prevent colorectal cancer: baseline findings of a UK multicentre randomised trial. Lancet doi
  12. (2001). Urist MM: Role of Matrix Metalloproteinases in Colorectal Carcinogenesis. Annals of Surgery doi
  13. (1999). Vatn MH: Flexible sigmoidoscopy or colonoscopy as a screening modality for colorectal adenomas in older age groups? Findings in a cohort of the normal population aged 63–72 years. Gut doi

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