2. Intervention for Prevention Marigo Werner

3.  Define colon cancer  Discuss pathophysiology of colon cancer  Discuss morbidity and mortality statistics  Discuss detailed plan for intervention  Discuss evaluation methods  Discuss implementation of intervention plan

4. *A tumor is abnormal tissue and can be benign (not cancer) or malignant (cancer). *A polyp is a benign (non-cancerous) tumor. *Adenomatous polyps (adenomas) are polyps that can change into cancer. *Hyperplastic polyps and inflammatory polyps, in general are not pre- cancerous. *Dysplasia is an area in the lining of the colon or rectum where the cells look abnormal (but not like true cancer cells) when viewed under the microscope. (American Cancer Society, 2012).

5.  Adenocarcinomas are a type of colorectal cancer. They make up 95% of colon cancers.  Carcinoid tumors start from specialized hormone producing cells in the intestine.  Gastrointestinal stromal tumors start from interstitial cells of cajal. (American Cancer Society, 2012)

6.  Lymphomas are cancers of the immune system cells that typically start in lymph nodes.  Sarcomas start in blood vessels as well as in muscle and connective tissue in the wall of the colon and rectum. Sarcomas of colon and rectum are rare. (American Cancer Society, 2012).

7.  Tumors of the right (ascending) and left (descending) colon include pain, a palpable mass in the lower right quadrant, anemia, and dark red or mahogany-colored blood mixed with the stool. (Huether, 2010, p. 1501)

8.  Manifestations of tumors of the left, or descending colon include progressive abdominal distention, pain, vomiting, constipation, need for laxatives, cramps and bright red blood on the surface of the stool (Huether, 2010, p.1051).

9.  Approximately 150,000 new cases of colorectal cancer are diagnosed each year and nearly 50,000 people die from this disease each year. Colorectal cancer accounts for 10% of all cancer deaths in the U.S.  Colon cancer is a significant health problem in Kentucky-it is the second leading cause of cancer death in Kentucky (“Kentucky Colon”, 2012).

10. (National Cancer Institute, 2012)

12. Rates of Getting Colorectal Cancer by State The number of people who get colorectal cancer is called the colorectal cancer incidence. In the United States, the risk of getting colorectal cancer varies from state to state. Colorectal Cancer Incidence Rates,* by State, 2008 † (National Cancer Institute, 2012)

13. (Kentucky Cancer Registry, 2012)

14. (National Cancer Institute, 2012)

15.  (Kentucky Cancer (Kentucky Cancer Registry, 2012)

16.  Age-more than 9 out of 10 people diagnosed with colon cancer are at least 50 years old.  Personal history of colorectal polyps or colorectal cancer.  Colorectal cancer removed-more likely to develop new cancers in other areas of the colon and rectum (American Cancer Society, 2012).

17.  Personal history of inflammatory bowel disease. Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease, which are conditions in which the colon is inflamed over a long period of time. People who have had IB for many years often develop dysplasia.  Family history of colorectal cancer. 1 in 5 people who develop colorectal cancer have other family members who have been affected by this disease(American Cancer Society, 2012).

18.  Inherited syndromes-about 5% to 10% of people who develop colorectal cancer have inherited gene defects (mutations) that cause the disease.  Two of the most common inherited syndromes linked with colorectal cancer are familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC) (American Cancer Society, 2012).

19.  Diet high in red meat (beef, lamb, or liver), processed meat (hot dogs and some luncheon meats).  Cooking at high temperature (frying, broiling, or grilling)  Obesity  Smoking (American Cancer Society, 2012).

20.  Colon cancer prevention and early detection should be the primary goal of CRC screening.  Screening an average-risk individual can reduce CRC mortality by detecting cancer at an early curable stage and by detecting and removing adenomas. It has also been shown to be cost-effective compared to other screening programs (NCCN guidelines, 2012).

21.  Colon cancer screening for the average risk person should begin at age 50.  Colonoscopy every 10 years  Flexible sigmoidoscopy every 5 years  CT colonography every 5 years (NCCN guidelines, 2012)

22.  Screening modalities that primarily detect cancer are stool-based screening.  Guiac-based testing annually (requires 3 successive stool specimens).  Immunochemical based testing annually  Stool DNA test with high sensitivity (NCCN guidelines, 2012).

23.  Intensive surveillance program should be initiated for high risk patients.  Colonoscopy is recommended rather than flexible sigmoidoscopy because of the predominant proximal location of cancer. It should be offered every one to two years, beginning between the age of 20 to 25 years  (American Cancer Society, 2012).

24.  Raise awareness in the community about colon cancer and the importance of colon cancer screening. Screening an average-risk individual can reduce CRC mortality (NCCN guidelines, 2012).  Form a task for composed of members from the local hospital, local cancer center, health department, Kentucky Cancer Program, American Cancer Society Representative, local school board, civic organizations, churches, representative from local medical society, representative from local nurse practitioners, and volunteers.

25.  Task force will develop a publicity campaign.  Educational spots will be played on the radio  Ads will be placed in The Medical Leader  Speakers will give presentations at local churches and civic organizations  Literature on colon cancer will be passed out at local business such as Wal-Mart and Food City

26.  Task force will give presentation at local medical society meeting to promote colon cancer screening.  Instruction sheet for FOBT will be developed and provided for local family practice physicians to give to patients who are doing the FOBT.

27.  This is a hyperlink that shows a sample instruction sheet for collection of specimen for FOBT. Fecal Occult Blood Test Instructions.docx

28.  A comprehensive family history is one important way to identify at-risk individuals. Correctly recognizing Lynch Syndrome is essential for the application of appropriate screening and surveillance measures (Jang & Chung, 2010, p. 151).  This fact about family history will be reviewed with the medical society to encourage this practice.

29.  Life size colon will be displayed at annual Hillbilly Days Festival. This display allows people to walk through the inside of a colon and see polyps and tumors. This will be done in conjunction with the Kentucky Cancer Program.  Volunteers will be present at the display to answer questions and provide education material (Kentucky Cancer Program, 2012).

30.  An educational program will be developed with the local hospital employee education department that will be made available to healthcare provider.  A form letter will be developed and provided for family practice physicians to send to patients who have FOBT ordered.  Community Preventive Services Task Force recommends use client reminders to improve compliance with FOBT (2012).

31.  FOBT will be available through the local health department.  A free colon cancer screening will be provided by the local cancer center in conjunction with local general surgeons.  According to the Community Preventive Service Task force, the team found sufficient strong evidence that interventions using one-on-one education, client reminders, provider assessment and feedback and reducing structural barriers are effective in promoting colorectal cancer screening with FOBT. (2012).

32.  Colon Cancer education material will placed in family practice physicians’ offices.  Researchers concluded: “Low-cost education materials have the potential to contribute to public engagement with health promotion and disease prevention” (“New Findings”, 2007).

33.  The intervention plan will be evaluated by having family practice physicians or designated staff member keep a log of patients who have FOBT ordered.  This log will be collected monthly for six months and reviewed by the task to determine the amount of testing being done.

34.  A log of patients who undergo FOBT will also be kept by the health department, which will be collected and reviewed.  A log will be kept at the free colon cancer screening to determine the number of participants.

35.  The ultimate measure of success in a screening program is a demonstrable reduction in mortality in the screened population. However, this needs large numbers of individuals, and at least 10 years of assessment for most cancers (Siakora, 2011).

36.  It will take time to reveal the ultimate effectiveness of the intervention plan (Siakora, 2011).  This campaign to increase community awareness about colon cancer and encourage participation in FOBT will be launched in March which is National Colon Cancer Awareness Month.

37. American Cancer Society. (2012). American cancer society recommendations for colorectal cancer early detection. Retrieved from http://www.cancer.org/http://www.cancer.org/ cancer/colonandrectum Colon cancer prevention; New findings from university college in the area of colon cancer prevention described. (2007, January). Clinical Oncology Week, 28, 282. Retrieved from http://proquest.umi.compqdlink?did=1188666061&Fmt

38. Community Preventive Services Task Force. (2012). Task force recommendations and findings. Retrieved from http://www.thecommunityguide.org/cancer/screen Department of Health and Human Services Centers for Disease Control and Prevention. (2012). Cancer data by state. Retrieved from http://apps.nccd.gov/usc

39. Glittens, C. (2008, November). Limitations for colon cancer screening. Oncology Nursing News, 2(7), 24. Retrieved from http://rx9vhehy4rserialssolutions.com Huether, S. E., (2010). Pathophysiology the biologic basis for disease in adults and children. Alterations of digestive function (pp. 1452-1515).

40. Jang, E., & Chung, D. C. (2010). Hereditary colon cancer: Lynch syndrome. Gut and Liver, 4(2), pp.151-160. doi: 10.5009/gnl. 2010.4.2.151 Kentucky Cancer Registry. (Cartographer). (2012). Cancer Mortality Rates in Kentucky [Demographic map]. Retrieved from http://cancer_rates.info/common/new.htmlhttp://cancer_rates.info/common/new.html

41. Kentucky Cancer Registry. (Cartographer). (2012). Cancer Incidence Rates in Kentucky [Demographic map]. Retrieved from http://cancer_rates.info/ky/index.php National Cancer Institute. (Cartographer). (2012). Surveillance epidemiology and end results [Demographic chart]. Retrieved from http://seer.cancer.gov/statisticshttp://seer.cancer.gov/statistics

42. National Comprehensive Cancer Network Version 2012. (2012). Colorectal cancer screening. Retrieved from http://www.nccn.org/professionals/physicians_gls/ Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. (2008, November). Annals of Internal Medicine, 149(9), 627-637. Retrieved from http://rx9vh3hy4r.search.serialssolutions.com http://rx9vh3hy4r.search.serialssolutions.com

43.  Sikora, K. (2011). Cancer screening. Medicine, 40(1), pp. 24-28. Retrieved from http://liberty.summon.serialssolutions.com.ez