DOCSLIB.ORG

Update in the Treatment of Colon and Rectal Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Update in the Treatment of Colon and Rectal Cancer UPDATE IN THE MANAGEMENT AND TREATMENT OF COLORECTAL CANCER Edwin A. Empaynado, MD Advocare Colon and Rectal Surgical Specialists WHAT IS COLON CANCER? WHAT CAUSES COLORECTAL CANCER? WHAT ARE THE RISK FACTORS SYMPTOMS DIAGNOSIS AND SCREENING STAGING OF COLON CANCER MEDICAL AND SURGICAL TREATMENT SURVIVORSHIP AND FOLLOW-UP PREVIEW OF PRESENTATION Common Types Estimated New Estimated Rank HOW COMMON IS of Cancer Cases 2018 Deaths 2018 Breast Cancer COLORECTAL 1. 266,120 40,920 (Female) CANCER? Lung and 2. Bronchus 234,030 154,050 Cancer 3. Prostate Cancer 164,690 29,430 3rd most common cause of Colorectal 4. 140,250 50,630 Cancer cancer in men and women of Melanoma of the U.S. or 8.1% of all new 5. 91,270 9,320 the Skin cancer cases in 2018 6. Bladder Cancer 81,190 17,240 Non-Hodgkin 7. 74,680 19,910 Lymphoma 2nd leading cause of cancer Kidney and 8. Renal Pelvis 65,340 14,970 death among men and Cancer women of the U.S. or 8.3% of all 9. Uterine Cancer 63,230 11,350 cancer deaths in 2018 10. Leukemia 60,300 24,370 1 National Cancer Institute WHAT AGE GROUP GETS COLORECTAL CANCER? Median age at diagnosis is 67 NCI, SEER 18 2011-2015 WHO DIES FROM COLORECTAL CANER? Median age at death 73 Rates of newly diagnosed cases of CRC have been decreasing 2.6% per year over past 10 years Rates of death from CRC cases have been decreasing 2.4% per year over past 10 years TRENDS IN NEW CASES OF COLORECTAL CANCER AND DEATH RATES NCI, SEER 9 1975-2015 TRENDS IN SURVIVAL RATES FOR COLORECTAL CANCER Percent surviving past 5 years from diagnosis of CRC 64.5 NCI, SEER 1975-2010 Population Health Data from 2013-2015 34.4/100,000 new cases diagnosed per year 14.5/100,000 number of deaths per year 4.5% lifetime risk of being diagnosed with colorectal cancer 1,332,085 people diagnosed with CRC in U.S. in 2015 PREVALENCE OF COLORECTAL CANCER 1 National Cancer Institute WHAT IS COLON CANCER? • Carcinoid tumors • Gastrointestinal stromal tumors (GIST) • Lymphomas • Sarcomas • Metestatic tumors (ie – endometrial, ovarian, melanoma, etc.) • Adenocarcinoma – 96% of all colorectal cancers Cancer cells that arise from adenomatous polyps of mucous producing cells that normally help lubricate the inside lining of the colon and rectum Cancers can be caused by changes in the DNA inside our cells called DNA mutations These mutations leads to uncontrolled cell growth and the development of cancerous tumors Inherited gene mutations occurs in about 10% cases Acquired gene mutations most common cause of CRC where a person acquires a mutation during a lifetime rather than inherited. WHAT CAUSES COLORECTAL CANCER? SYMPTOMS OF A change in bowel habits COLORECTAL CANCER Rectal bleeding or blood in your stool Abdominal discomfort and/or fullness that persists or recurs Feelings of incomplete evacuation Progressive weakness or fatigue Unexplained weight loss Anemia on recent bloodwork STOOL-BASED TESTS SCREENING FOR COLORECTAL CANCER Highly sensitive fecal immunochemical test (FIT) every year Highly sensitive guaiac-based fecal American Cancer Society (ACS) occult blood test (gFOBT) every year recommends average risk screening for CRC to start at age 45 through to Multi-targeted stool DNA test (MT-sDNA) age 75 at 10 year intervals every 3 years Ages 76 through 85 screening is based VISUAL EXAMS OF THE COLON AND RECTUM on overall medical health and patient preferences Colonoscopy every 10 years CT colonoscopy (virtual colonoscopy) People over 85 should no longer get every 5 years colorectal screening Flexible sigmoidoscopy (FSIG) every 5 years 2 American Cancer Society Average risk patients DO NOT have the following Personal history of colorectal cancer or colon polyps Family history of colorectal cancer Personal history of inflammatory bowel WHAT IS AVERAGE RISK disease SCREENING? A confirmed hereditary colorectal cancer syndrome Personal history of abdominal and/or pelvic radiation to treat prior cancer WHAT ARE THE RISK Older age FACTORS FOR COLORECTAL CANCER? African-American race Personal history of colorectal cancer or polyps Crohn’s Disease Inflammatory intestinal conditions Ulcerative Colitis Inherited syndromes Lynch Syndrome Family history of colon cancer Familial Adenomatous Polyposis (FAP) Low-fiber, high fat diet Sedentary lifestyle Diabetes Obesity Smoking Alcohol Radiation therapy for cancer Patients at increased risk for SCREENING FOR PEOPLE colorectal cancer may need WHO ARE AT HIGHER RISK? screening prior to age 45 and screened at more frequent intervals with colonoscopy Strong family history of colon cancer or Start screening prior to age 45 polyps Personal history of colon cancer and/or Consider more frequent polyps screening, ie- every 3 to 5 years Personal history of inflammatory bowel Screening at earlier age disease and every 1 to 2 years Known family history of hereditary colorectal Start as early as teenage years with cancer syndrome more frequent intervals Personal history of abdominal and/or pelvic radiation for treatment of prior cancer Earlier age of screening and every 3 to 5 years PROS SCREENING MODALITIES • Stool collection can done at home Highly sensitive fecal immunochemical test (FIT) • No prep required • No need for sedation CONS • Fails to detect some polyps and cancers • Certain foods and medications may need to be avoided • If positive, additional tests are needed to determine the source • False-positive results Check stool samples for hidden (occult) blood. Test is done annually PROS SCREENING MODALITIES • Does not require a bowel prep Multi-targeted stool DNA test • You can eat, drink and take your (MT-sDNA) medications as usual before the test • Stool collection done at home to avoid disruption of your daily routine CONS • DNA stool test is less sensitive than colonoscopy at detecting precancerous polyps • If abnormal, additional tests would be needed Stool sample is used to look for DNA • False-positive rates as high as 10-15% changes that would suggest the presence of colon cancer or precancerous conditions. Repeated every 3 years. PROS • Sedation is not required • Less extensive bowel prep requirement SCREENING MODALITIES Flexible sigmoidoscopy (FSIG) • Biopsies and/or other therapies can be performed through the scope CONS • Upper colon abnormalities are not seen • An enema prep is usually required • You may need to change your diet and/or medication prior to test • Rare complication of bowel injury and/or bleeding can occur • Cramping and bloating after exam Tiny video camera that allows visualization of the rectum and lower part of the colon (sigmoid colon). Repeated every 5 years PROS • Test does not require sedation or insertion of SCREENING MODALITIES a scope into the rectum CT colonoscopy (virtual colonoscopy) CONS • Requires a thorough bowel cleansing before the test • May not detect small polyps or cancers • Dietary and/or medication changes would be required • Radiation exposure • Purely diagnostic procedure; abormal findings would need colonoscopy follow-up • Cramping and bloating CT scan produces initial cross-section images of abdominal organs that can be reconstructed in 3D images by a computer to detect abnormalities. Repeated every 5 years. PROS • The most sensitive test currently available for SCREENING colon cancer screening. MODALITIES • Visualize the entire colon Colonoscopy • Abnormal tissues can be biopsied and/or removed through the scope CONS • Thorough bowel cleansing is required before the test • Diet changes are required and medications may need to altered • Sedation is usually required and would require someone to take you home • Rare complication of bowel injury and/or bleeding from therapeutic sites • Cramping and bloating after procedure Flexible tube with fiberoptic video camera is inserted into the rectum to detect abnormalities. Repeated every 10 years. SHAPE o PEDUCULATED o SESSILE o SEMI-PEDUCULATED CELL PATTERN TUBULAR VILLOUS TUBULOVILLOUS HYPERPLASTIC DYSPLASIA SERRATED LOW-GRADE DYSPLASIA HIGH-GRADE ADENOMATOUS POLYPS DYSPLSIA Polyps are tissue growth from the inner lining of the colon that can be benign (non-cancerous) or grow into cancers (precancerous). Adenomatous feature is a description of a cell when viewed under a microscope that is different from normal cell appearance. DIFFERENTIATION WELL DIFFERENTIATED MODERTELY DIFFERENTIATED POORLY DIFFERENTIATED HISTOLOGY INVASION MUCIN PRODUCING SIGNET-CELL VASCULAR LYMPHATIC LYMPHOVASCUALR INVASIVE ADENOCARCINOMA Adenocarinoma is a type of cancer from cells that form mucous producing glands lining the colonic wall. Invasive is a cell description suggesting spread beyond the inner lining of the colon. PRE-OP o < 5ng/mL STAGING TESTS o Can be higher in smokers Radiographic staging of tumor Helps determine chemotherapy and/or radiation treatment plans Assess tumor resectability Carcinoembryonic Antigen Test (CEA) CT scan 3T MRI TransRectal UltraSound (TRUS) PET/CT Scan 85% of patients who present with colonic obstruction have CRC Only 40% of patients with obstructing left-sided colon cancer can be resected without the need of a colostomy Stent placement provides an effective solution to acute colonic obstruction Allows for bridge to elective and more favorable operative conditions Palliative treatment for advanced stage colon cancer TREATMENTS ENDOSCOPY AND COLONIC STENTING Open Segmental colon resection Proximal diverting colostomy Laparoscopic colon resection Robotic colon resection Transanal full-thickness excision Transanal Endoscopic Microsurgery
Load more

Recommended publications
  • American Cancer Society Flufobt Program Implementation Guide for Primary Care Practices
    Health Care Solutions From the American Cancer Society American Cancer Society FluFOBT Program Implementation Guide for Primary Care Practices EIGHTY BY 2018 Reaching 80% screened for colorectal cancer by 2018 Table of Contents Introduction ................................................................................................................................. 2 Background Information and Education .................................................................................... 3 Why Have a FluFOBT Program? .................................................................................................. 4 Colorectal Cancer Screening Eligibility ...................................................................................... 5 Colorectal Cancer Screening Recommendations ....................................................................... 6 Patient Education ......................................................................................................................... 8 How to Set Up Your FluFOBT Program .................................................................................... 10 Staff Training for Your FluFOBT Program ................................................................................ 16 Summary ..................................................................................................................................... 19 Appendix A: FluFOBT Components and Logic Model ............................................................ 20 Appendix B: Colorectal Cancer Screening Recommendations
    [Show full text]
  • (NCCN Guidelines®) Colorectal Cancer Screening
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Colorectal Cancer Screening Version 2.2017 — November 14, 2017 NCCN.org Continue Version 2.2017, 11/14/17 © National Comprehensive Cancer Network, Inc. 2017, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN® NCCN Guidelines Version 2.2017 Panel Members NCCN Guidelines Index Table of Contents Colorectal Cancer Screening Discussion * Dawn Provenzale, MD, MS/Chair ¤ Þ Michael J. Hall, MD, MS † ∆ Robert J. Mayer, MD † Þ Duke Cancer Institute Fox Chase Cancer Center Dana-Farber/Brigham and Women’s Cancer Center * Samir Gupta, MD/Vice-chair ¤ Amy L. Halverson, MD ¶ UC San Diego Moores Cancer Center Robert H. Lurie Comprehensive Cancer Reid M. Ness, MD, MPH ¤ Center of Northwestern University Vanderbilt-Ingram Cancer Center Dennis J. Ahnen, MD ¤ University of Colorado Cancer Center Stanley R. Hamilton, MD ≠ Scott E. Regenbogen, MD ¶ The University of Texas University of Michigan Travis Bray, PhD ¥ MD Anderson Cancer Center Comprehensive Cancer Center Hereditary Colon Cancer Foundation Heather Hampel, MS, CGC ∆ Niloy Jewel Samadder, MD ¤ Daniel C. Chung, MD ¤ ∆ The Ohio State University Comprehensive Huntsman Cancer Institute at the Massachusetts General Hospital Cancer Center - James Cancer Hospital University of Utah Cancer Center and Solove Research Institute Moshe Shike, MD ¤ Þ Gregory Cooper, MD ¤ Jason B. Klapman, MD ¤ Memorial Sloan Kettering Cancer Center Case Comprehensive Cancer Center/ Moffitt Cancer Center University Hospitals Seidman Cancer Thomas P. Slavin Jr, MD ∆ Center and Cleveland Clinic Taussig David W. Larson, MD, MBA¶ City of Hope Comprehensive Cancer Institute Mayo Clinic Cancer Center Cancer Center Dayna S.
    [Show full text]
  • High Quality Fecal Occult Blood Testing (FOBT) for CRC Screening: Evidence and Recommendations
    High Quality Fecal Occult Blood Testing (FOBT) for CRC Screening: Evidence and Recommendations Rationale for use of FOBT High sensitivity fecal occult blood testing (FOBT) is one of the colorectal cancer screening methods recommended in guidelines from the American Cancer Society, the US Preventive Services Taskforce, and every other major medical organization. In spite of this widespread endorsement, primary care clinicians often express conviction that colonoscopy is the “gold standard” test for colorectal cancer screening and that the use of FOBT represents sub-standard care. These beliefs persist in spite of well-documented shortcomings of endoscopy (missed adenomas and cancers, higher complication rates and higher one-time costs than other screening methodologies), and the fact that access to endoscopy is limited or non- existent for a significant proportion of the U.S. population. Many clinicians are also unaware that randomized controlled trials of FOBT screening have demonstrated decreases in colorectal cancer incidence and mortality, and modeling studies suggest that the years of life saved through a high quality FOBT screening program are essentially the same as with a high quality colonoscopy based screening programs. Recent advances in stool blood screening include the emergence of new tests and improved understanding of the impact of quality factors on testing outcomes. This document provides state-of-the-science information about high quality stool testing. Types of Fecal Occult Blood Tests Two main types of FOBT are available – guaiac and immunochemical. Both types of FOBT have been shown to have reasonably high detection rates for colon and rectal cancers; adenoma detection rates are appreciably lower.
    [Show full text]
  • Colorectal Cancer Screening
    | PATIENT RESOURCE | Colorectal Cancer Screening You have choices when it comes to colorectal cancer screening The best test is the one that gets done * Colonoscopy Multi-target Stool DNA Test* FIT/FOBT (visual exam) (Cologuard®) (fecal immunochemical test/ fecal occult blood test) Uses a scope to look for and Finds abnormal DNA and Detects blood in How does it work? remove abnormal growths blood in the stool sample the stool sample in the colon/rectum Who is it for? Adults starting at age 45 Adults starting at age 45 Adults starting at age 45 How often? Every 10 years† Every 3 years Once a year Moderately invasive, done at Yes, done at home Yes, done at home Non-invasive? hospital or doctor office Yes, however preps have greatly No No/Yes‡ Prep required? improved in recent years Prep: night before Time to collect and mail sample Time to collect and mail sample Time it takes? Procedure: next day Covered?§ Covered by most insurers Covered by most insurers Covered by most insurers Abnormal growths (polyps) If positive, a follow-up If positive, a follow-up removed during colonoscopy Next steps colonoscopy is needed colonoscopy is needed » for evaluation *All positive results on non-colonoscopy screening tests should be followed up with a timely colonoscopy. †For adults at high risk, testing may be more frequent and should be discussed with your health care provider. ‡FIT does not require changes to diet or medication. FOBT requires changes to diet or medication. §Insurance coverage can vary; only your insurer can confirm how colon cancer screening would be covered under your insurance policy.
    [Show full text]
  • Colorectal Cancer Tests Save Lives: the Best Test Is the Test That Gets Done
    November 2013 Colorectal Cancer Tests Save Lives The best test is the test that gets done Colorectal cancer (CRC) is the second leading cancer killer of men and women in the US, following lung cancer. The US Preventive Services Task Force (USPSTF) recommends three CRC screening tests that are effective 90% at saving lives: colonoscopy, stool tests (guaiac fecal occult About 90% of people live 5 or more blood test-FOBT or fecal immunochemical test-FIT), and years when their colorectal cancer sigmoidoscopy (now seldom done). is found early through testing. Testing saves lives, but only if people get tested. Studies show that people who are able to pick the test they prefer are more likely to actually get the test done. Increasing the use of all recommended colorectal cancer tests can save 1 in 3 more lives and is cost-effective. To increase testing, doctors, nurses, and health About 1 in 3 adults systems can: (23 million) between 50 and ◊ Offer all recommended test options with advice about each. 75 years old is not getting tested as recommended. ◊ Match patients with the test they are most likely to complete. ◊ Work with public health professionals to: ■ Get more adults tested by hiring and training “patient navigators,” who are staff that help people 1 in 10 learn about, get scheduled for, and get procedures done like colonoscopy. 10% of adults who got tested for colorectal cancer ■ Create ways to make it easier for people to get used an effective at-home FOBT/FIT kits in places other than a doctor’s office, stool test.
    [Show full text]
  • (NCCN Guidelines®) Colorectal Cancer Screening
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Colorectal Cancer Screening Version 1.2015 NCCN.org Continue Version 1.2015, 06/01/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN® NCCN Guidelines Version 1.2015 Panel Members NCCN Guidelines Index Colorectal Screening TOC Colorectal Cancer Screening Discussion * Dawn Provenzale, MD, MS/Chair ¤ Þ Francis M. Giardiello, MD, MBA ¤ Patrick M. Lynch, MD, JD ¤ Duke Cancer Institute The Sidney Kimmel Comprehensive The University of Texas Cancer Center at Johns Hopkins MD Anderson Cancer Center * Kory Jasperson, MS, CGC/Vice-chair/Lead ∆ Huntsman Cancer Institute Samir Gupta, MD ¤ Robert J. Mayer, MD † Þ at the University of Utah UC San Diego Moores Cancer Center Dana-Farber/Brigham and Women’s Cancer Center Dennis J. Ahnen, MD ¤ Amy L. Halverson, MD ¶ University of Colorado Cancer Center Robert H. Lurie Comprehensive Cancer Reid M. Ness, MD, MPH ¤ Center of Northwestern University Vanderbilt-Ingram Cancer Center Harry Aslanian, MD ¤ Yale Cancer Center/ Stanley R. Hamilton, MD ≠ M. Sambasiva Rao, MD ≠ ¤ Smilow Cancer Hospital The University of Texas Robert H. Lurie Comprehensive Cancer MD Anderson Cancer Center Center of Northwestern University Travis Bray, PhD ¥ Hereditary Colon Cancer Foundation Heather Hampel, MS, CGC ∆ Scott E. Regenbogen, MD ¶ The Ohio State University Comprehensive University of Michigan Jamie A. Cannon, MD ¶ Cancer Center - James Cancer Hospital Comprehensive Cancer Center University of Alabama at Birmingham and Solove Research Institute Comprehensive Cancer Center Moshe Shike, MD ¤ Þ Mohammad K.
    [Show full text]
  • Colorectal Cancer Screening New York State Adults 2010
    BRFSS Brief Number 1201 The Behavioral Risk Factor Surveillance System (BRFSS) is an annual statewide telephone survey of adults developed by the Centers for Disease Control and Prevention and administered by the New York State Department of Health. The BRFSS is designed to provide information on behaviors, risk factors, and utilization of preventive services related to the leading causes of chronic and infectious diseases, disability, injury, and death among the noninstitutionalized, civilian population aged 18 years and older. Colorectal Cancer Screening New York State Adults 2010 Introduction and Key Findings Colorectal cancer (cancer that starts in the colon or rectum) is the third leading cause of cancer deaths for men (following lung and prostate) and for women (following lung and breast), in New York State (NYS). There are approximately 10,200 new cases of colorectal cancer diagnosed each year in NYS and about 1,700 men and 1,800 women die from the disease annually.1 Early detection of colorectal cancer, through regular screening, can substantially improve survival rates. When colorectal cancer is found and treated early, it can often be cured. In some cases, screening can actually prevent the development of colorectal cancer by detecting and removing adenomatous polyps before they become cancerous. Men and women aged 50 to 75 years, and at average risk for colorectal cancer, should be screened for colorectal cancer with one of the following: a yearly take-home multiple sample fecal test (fecal occult blood test [FOBT] or fecal immunochemical test [FIT]), OR a flexible sigmoidoscopy every 5 years, OR a colonoscopy every 10 years.
    [Show full text]
  • Colorectal Cancer Screening Facts
    How Screening Saves Lives Screening Tests for Colorectal Cancer Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the Below is a list of several tests that are available to screen for colon or rectum. Screening tests can find colorectal cancer. Some are used alone, while others are used in combination with each other. Talk with your doctor about polyps, so they can be removed before they which screening test is best for you. turn into cancer. Screening tests can also find colorectal cancer early, when treatment Fecal Occult Blood Test (FOBT, Hemoccult, works best. Stool Guaiac) This test checks for occult (hidden) blood in the stool. You receive a test kit from your doctor. You may be asked to follow When Should I Begin Screening? a special diet before and during the test. At home, you place a Colorectal Cancer Screening Facts small amount of your stool from three bowel movements in a You should begin screening for colorectal cancer when you row on test cards. You return the cards to your doctor's office turn 50, then continue at regular intervals. However, you may or lab, where the stool samples are checked for hidden blood. need to be tested earlier or more often than other people if: ! You or a close relative have had colorectal polyps or Flexible Sigmoidoscopy colorectal cancer, or This test allows the doctor to examine the lining of your ! You have inflammatory bowel disease. rectum and lower part of your colon using a thin, flexible, lighted tube called a sigmoidoscope. The tube is inserted into What is Colorectal Talk with your doctor about when you should begin screening your rectum and lower part of the colon.
    [Show full text]
  • Colonoscopy Instructions -Suprep Bowel Preparation- FSK-PK-KGS
    Steven Helft, MD 600Westage Bus Ctr Dr Daniel Kaufman, MD Fishkill, NY 12524 Varun Kumar, MD Phone: 845-231-5600 Roxan Saidi, MD Stuart Weinberger, MD 1561 Ulster Ave, Rte 9W Gastroenterologists Lake Katrine, NY 12449 30 Columbia Street Phone: 845-231-5600 Poughkeepsie, NY 12601 Phone: 845-231-5600 Colonoscopy Instructions – Suprep Bowel Preparation PLEASE READ AND FOLLOW ALL INSTRUCTIONS CAREFULLY Introduction Colonoscopy is a commonly performed procedure. At CareMount Medical, the Department of Gastroenterology collectively performs well over 10,000 colonoscopies per year. All of our gastroenterologists are board certified and exceed the national benchmark for adenoma detection rate in both males and females. A physician’s adenoma detection rate is the proportion of individuals undergoing a complete screening colonoscopy who have 1 or more adenomas (polyps), detected and excised. This measurement best reflects how carefully colonoscopy is performed, and ensures that you are receiving a high-quality examination. A colonoscopy is an examination in which a flexible thin video electronic instrument called a colonoscope is inserted into your rectum and guided through your entire colon (about five or six feet long). The major purpose of a colonoscopy is to search for and remove benign colon and rectal polyps. If polyps are removed, the incidence of colon and rectal cancer can be greatly diminished, as most colon cancers start as these benign polyps. Colonoscopy procedures have saved thousands of lives by removing these polyps and preventing cancer. Colonoscopy requires a cleansing preparation before the procedure that will give you much diarrhea. This packet has been prepared to help you better understand your procedure.
    [Show full text]
  • Screening of Average-Risk Individuals for Colorectal Cancer S.J
    Screening of average-risk individuals for colorectal cancer S.J. Winawer,' J. St. John,2 J. Bond,3 J.D. Hardcastle,4 0. Kronborg,5 B. Flehinger,6 D. Schottenfeld, N.N. Blinov,8 & the WHO Collaborating Centre for the Prevention of Colorectal Cancer9 Recent developments in screening, diagnosis and treatment of colon cancer could lead to a reduction in mortality from this disease. Removal of adenomas, identification of risk factors, appropriate application of accurate diagnostic tests, and aggressive anatomic-surgical resection of colon cancers may already be having a favourable impact. Screening ofaverage-risk populations over the age of 50 also offers promise in the control of this important cancer. The disease is of sufficient magnitude to deserve detection at an early stage with better prospects of patient survival, since screening tests with moderate sensitivity and high specificity are available. Flexible sigmoidoscopy and faecal occult blood tests are sufficiently acceptable to be included in case-finding among patients who are in the health care system. The results of current controlled trials involving more than 300 000 individuals for evaluating the impact of screening on mortality from colon cancer are needed before this approach can be recommended for general public health screening of the population. Further research is required to develop better screening tests, improve patient and physician compliance, and answer more definitively critical questions on cost-effectiveness. Mathematical modelling using current and new data can be used to determine the effectiveness of screening in conjunction with recommendations for primary prevention. Introduction relating to feasibility include the rate of positive tests, Colorectal cancer has an annual incidence worldwide sensitivity, specificity and predictiveness of the tests, ofmore than halfa million cases and ranks as the third and patient compliance.
    [Show full text]
  • A Retrospective Survey of Digital Rectal Examinations During the Workup of Rectal Cancers
    healthcare Article The Digital Divide: A Retrospective Survey of Digital Rectal Examinations during the Workup of Rectal Cancers Omar Farooq 1, Ameer Farooq 2,* , Sunita Ghosh 3, Raza Qadri 1, Tanner Steed 3, Mitch Quinton 1 and Nawaid Usmani 3,* 1 Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, AB T6G 2R3, Canada; [email protected] (O.F.); [email protected] (R.Q.); [email protected] (M.Q.) 2 Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, BC V6T 1Z4, Canada 3 Department of Oncology, University of Alberta, Edmonton, AB T6G 1Z2, Canada; [email protected] (S.G.); [email protected] (T.S.) * Correspondence: [email protected] (A.F.); [email protected] (N.U.) Abstract: Background: Digital rectal examination (DRE) is considered an important part of the physical examination. However, it is unclear how many patients have a DRE performed at the primary care level in the work-up of rectal cancer, and if the absence of a DRE causes a delay to consultation with a specialist. Methods: A retrospective patient questionnaire was sent to 1000 consecutive patients with stage II or stage III rectal cancer. The questionnaire asked patients to recall if they had a DRE performed by their general practitioner (GP) when they first presented with symptoms or a positive FIT test. Demographic data, staging data, and time to consultation with a specialist were also Citation: Farooq, O.; Farooq, A.; collected. Results: A thousand surveys were mailed out, and a total of 262 patients responded. Of Ghosh, S.; Qadri, R.; Steed, T.; the respondents, 46.2% did not recall undergoing a digital rectal examination by their primary care Quinton, M.; Usmani, N.
    [Show full text]
  • Colorectal Cancer Screening: Which Test Is Right for You?
    UNDERSTANDING COLORECTAL CANCER SCREENING Colorectal Cancer Screening: . Which test is right for you? » - COLORECTAL CANCER IS THE SECOND-LEADING CAUSE OF DEATH FROM CANCER IN THE U.S. FOR MEN AND WOMEN COMBINED. The best way to prevent Who is this death from colorectal cancer is to stay current with screening. decision aid for? » THERE ARE MANY SCREENING TESTS FOR COLORECTAL CANCER. You and your This decision aid is for health care provider have a decision to make about which screening test adults who: is right for you. The test you choose will depend on your preference and which tests are available to you. No matter which test you use, the most Are 45 years of important thing is to get tested. age or older » THE AMERICAN CANCER SOCIETY RECOMMENDS that adults ages 45 and older with an average risk of colorectal cancer get screened regularly Are at average with a stool test or a visual test. Part of screening is having a follow- risk for colorectal up colonoscopy for positive results on any screening test (besides cancer colonoscopy). What is colorectal cancer? Why should I get screened for Colorectal cancer is a cancer that colorectal cancer? starts in the colon or the rectum. With regular screening, most polyps can be found These cancers can also be named and removed before they have the chance to turn colon cancer or rectal cancer, into cancer. Screening can also find colorectal depending on where they start. cancer early, when it is smaller and easier to treat. Colon cancer and rectal cancer are ofen grouped together Colorectal cancer is the because they have many features in common.
    [Show full text]