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Double-Contrast Barium Enema for Colorectal Cancer Screening

A Review of the Issues and a Comparison with Other Screening Alternatives

Seth Glick1

1 Department of Radiology, MCP-Hahnemann University, Broad and Vine Sts., Philadelphia, PA 19102.



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  		Fig. 1A. —62-year-old man with constipation. Spot radiograph obtained during barium enema of sigmoid colon shows 5-mm sessile polyp (arrows).

 


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  		Fig. 1B. —62-year-old man with constipation. Overhead radiograph obtained during barium enema shows subtle flat elevation in proximal transverse colon (arrows). Patient had carcinoma confined to muscularis propria. If patient were screened with flexible sigmoidoscopy and colonoscopy only after finding adenoma larger than 1 cm, early cancer would not have been discovered.

 


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  		Fig. 2A. —59-year-old man with rectal bleeding. Anteroposterior image of rectum from barium enema shows enface appearance of 3.5-cm flat discoid filling defect (arrows).

 


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  		Fig. 2B. —59-year-old man with rectal bleeding. Lateral image shows lesion in tangent (arrows). Patient had early cancer confined to muscularis propria.

 


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  		Fig. 3. —65-year-old woman with right lower quadrant pain. Anteroposterior image of rectum shows 1.3-cm lobulated sessile polyp (arrow) with wide irregular base. Lesion was not visible during initial colonoscopy. After subsequent polypectomy, lesion was identified as tubulovillous adenoma containing carcinoma extending into submucosa.

 

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