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Dig Dis Sci (2009) 54:208211 DOI 10.1007/s10620-008-0356-1
REVIEW
Low Caliber Stool and Pencil Thin Stool are Not Signs of Colorectal Cancer
Fathali Borhan-Manesh
Received: 19 October 2007 / Accepted: 3 June 2008 / Published online: 6 August 2008 Springer Science+Business Media, LLC 2008
Abstract Over the past several years, primary care providers have been referring a large number of their patients to gastroenterologists for colonoscopy because of low caliber stool or pencil thin stool. Most textbooks of internal medicine and gastroenterology consider small caliber stool as one of the presenting signs of colorectal cancer (CRC). A review of the literature reveals that this rather lay misconceptioni.e. presence of tumor results in narrowing of the colon, which in turn decreases the caliber of the stoolwas conceived late in the nineteenth century. In the absence of reliable data to support this concept, the authors of gastroenterology textbooks in the mid-twentieth century practically dismissed the concept. Nevertheless, this misconception somehow permeated the standard textbooks of medicine and even the newer editions of text-books of gastroenterology. Our own everyday experience shows that low caliber stool is noticed whenever we have loose stool. Since diarrheal states are much more common than CRC, in the absence of authentic symptomatology of CRC, such as rectal bleeding, change in the bowel habit, tenesmus, left-sided abdominal cramps, anemia, etc., the referral of these patients for colonoscopy based solely on decreased stool caliber is unwarranted. Such unwarranted referrals expose the patients to unnecessary risks and discomforts and put a strain on an already over-stretched healthcare resources.
Keywords Colon cancer Colon cancer signs
Colorectal cancer Low caliber stool
Introduction
For the past several years, gastroenterologists have been receiving a good number of patient referrals for colonos-copy, mainly from primary care providers (PCP), for low caliber stool or pencil thin stool.
In my long experience as a gastroenterologist, I have never encountered a patient complaining of low caliber stool who was later found to have cancer of colon, and those who had colorectal cancer (CRC) never mentioned low caliber stool as one of their complaints.
Historical Review
A review of the literature on colorectal diseases demonstrates that the lay concept of stool deformity, such as ribbon stool or pencil shape stool, was probably introduced to the...