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Screening and Early Diagnosis of Colorectal Cancer

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Presentation on theme: "Screening and Early Diagnosis of Colorectal Cancer"— Presentation transcript:

1 Screening and Early Diagnosis of Colorectal Cancer
Shaimaa M.Nagy Faculty of Medicine, Benha University

2 Incidence of CRC CRC is the 3rd most common form of cancer diagnosed in men and women in the US CRC is the 2nd leading cause of cancer deaths in the US The number of people dying from CRC has declined over the past 20 years with better screening, diagnosis and treatments

3 of CRC in Egypt: • Relative frequency 10-12% • High male predominance 3:1 • More than 1/3 under age 45 (early onset) • Large tumor size 4.5 cm • rectal 51%, poor histology 58% • Associated bilharzial colitis 12% • Associated polyps 5% • Sporadic , HNPCC

4 Symptoms and signs A change in bowel habits: diarrhea, constipation, or a feeling that the bowel does not empty completely Bright red or dark blood in the stool Stools that appear narrower or thinner than usual Discomfort in the abdomen, including frequent gas pains, bloating, fullness, and cramps Unexplained weight loss, constant tiredness, or unexplained anemia (iron deficiency)

5 Colorectal Cancer 80% present with early disease
RCF-10 CRC Slides Section A 4/19/2017 3:42 AM Colorectal Cancer 80% present with early disease 20% present with metastatic disease. Among patients diagnosed with early-stage disease, 40% will suffer recurrence. Stage at Diagnosis Distant (Stage IV) 20% Localized (Stage I/II) 50% Numbers for stage at diagnosis may not add up to 100% due to the presence of unknown stage or unstaged disease in patients at diagnosis.1 Only 39% of CRC cases are diagnosed early in stage I and II. This reflects the often asymptomatic nature of early disease. The majority of CRC cases (57%) are diagnosed in later disease stages. Nineteen percent are diagnosed with distant metastases (stage IV). Among patients with metastatic disease, the median 5-year survival is only ~10%. 1. Jemal A, et al. CA Cancer J Clin. 2007;57;43-66. Regional (Stage III) 30% 5

6 Risk Factors for CRC Age >50 (average risk) Racial, ethnic factors
RCF-10 CRC Slides Section A Risk Factors for CRC 4/19/2017 3:42 AM Age >50 (average risk) Racial, ethnic factors – African-Americans have increased risk Dietary factors – high animal fat, low fiber diet Lifestyle – Sedentary – Obesity – Smoking – Alcohol -genetic factors -sporadic 6

7 Lifestyle Risk Factors for Colorectal Cancer
RCF-10 CRC Slides Section A 4/19/2017 3:42 AM Lifestyle Risk Factors for Colorectal Cancer Decrease Risk Exercise Folic acid Aspirin Calcium, vitamin D Screening Increase Risk Obesity Red meat Alcohol Smoking 7

8 Colorectal Cancer (CRC)
RCF-10 CRC Slides Section A 4/19/2017 3:42 AM Sporadic (average risk) (75-80%) Family history (10-15%) Rare syndromes (<0.1%) Hereditary non-polyposis colorectal cancer (HNPCC) (3-5%) Familial adenomatous polyposis (FAP) (1-2%) 8

9 Precancerous lesions:
Polyps IBD

10 Histological classification of polyps
type single multiple neoplastic Adnoma ( T,V,TV) adenocarcinoma adenomatosis hyperplastic Hyperplastic polyposis hamartomatous Juvenile polyp Peutz-jegher syndrom Peutz jegher cowden inflammatory Parasitic psuedolymphoid Parastic, inflammatory

11 Natural History Advanced cancer Polyp
RCF-10 CRC Slides Section A 4/19/2017 3:42 AM Advanced cancer Polyp • Age 50, 25% risk of developing polyps • Age 75, 50-75% risk of developing polyps 11

12 RCF-10 CRC Slides Section A
4/19/2017 3:42 AM 12

13 IBD: Classification of Dysplasia
• Negative for dysplasia Normal Inactive colitis Active colitis • Indefinite for dysplasia • Positive for dysplasia Low-grade dysplasia High-grade dysplasia

14 Carcinoma in Inflammatory Bowel Disease
• Extensive colitis 13% • < 10 years < 1% • 15 years 4.5% • 20 years 13% • 30 years 34% • Crohn’s disease 3%

15 Colorectal Cancer and Early Detection
Colorectal cancer can be prevented through regular screening and the removal of polyps Early diagnosis means a better chance of successful treatment Screening should begin at age 50 for all “average risk” individuals or sooner if you have a family history of colorectal cancer, symptoms, or a personal history of inflammatory bowel disease

16 Screening Methods for Colorectal Cancer
History and general examination • Rectal examination Colonoscopy (currently the best way to prevent and detect colorectal cancer) Virtual colonography Sigmoidoscopy Fecal occult blood test Double contrast barium enema Digital rectal examination • Serum CEA, CA 19-9, CA 72.4 CBC, ESR, Ca and folic acid detection

17 Fecal Occult Blood Test (FOBT)
Recommended to be done yearly Checks for hidden blood in the stool Your doctor gives you a test kit At home, you place a small amount of your stool from 3 bowel movements on test cards. You then return the cards to your doctor’s office or a lab where the stool samples are tested for hidden blood. If blood is found, a colonoscopy will be needed. A disadvantage of this test The test is often negative in people who have adenomatous polyps and colorectal cancer

18 Flexible Sigmoidoscopy (Flex Sig)
Recommended every 5 years Examines the lining of rectum and lower part of colon Uses a thin, flexible, lighted tube called a sigmoidoscope It is inserted into your rectum and lower part of your colon. If polyps or lesions are found, a follow-up test is needed. Disadvantages: Patient discomfort – but not painful Only looks at lower part of colon, therefore polyps in the upper colon can go undetected. If a polyp is found, it needs to be followed by a colonoscopy to remove the polyp

19 Combination FOBT and Flex Sig
Some experts recommend using both of these tests to increase the chance of finding polyps and cancers. It is recommended every 5 years

20 Colonoscopy Similar to the Flexible Sigmoidoscopy except:
It allows the doctor to look at the lining of your rectum and entire colon. Done as an outpatient procedure Done with “conscious sedation” An IV line is inserted to help you remain calm and comfortable. Some patients sleep though the procedure. Not everyone needs sedation. Uses a thin, flexible, lighted tube called a colonoscope It is inserted into your rectum and colon. The doctor can also find and remove polyps and some cancers using the colonoscope. It is recommended every 10 years for: Individuals with no family or personal history of colon cancer and no symptoms.

21 Colonoscopy (continued) …
Procedure takes 15–30 minutes. May take longer if polyps are removed. Called a polypectomy A wire loop is passed through the scope to cut the polyp from the lining of the colon using an electrical current. Polyps are collected and sent to the lab for evaluation.

22 Double Contrast Barium Enema (DCBE)
This test allows the doctor to see an x-ray image of the rectum and entire colon. First you are given an enema with a liquid called barium that flows from a tube into your colon, followed by an air enema. The barium and air create an outline around your colon, allowing the doctor to see if anything is wrong. Recommended every 10 years. Many disadvantages: Detects only 50 percent of adenomatous polyps greater than 1 cm in size and only 33 percent of polyps .5 cm in size May miss up to 15 percent of colorectal cancers Does not allow removal of polyps



25 Take Home Message

26 Screening = Prevention & Early Detection
Prevention = polyp removal Decreased Incidence Early Detection Decreased Mortality


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