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Colorectal Cancer Screening and Surveillance

Colorectal Cancer Screening and Surveillance. Johnny Altawil , M.D. PGY- VI 09/19/2012. Why should we screen for colorectal cancer?. Why should we screen?. Common: Worldwide, CRC is 2 nd in women and 3 rd in men Over 600,000 deaths in 2008

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Colorectal Cancer Screening and Surveillance

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  1. Colorectal Cancer Screening and Surveillance Johnny Altawil, M.D. PGY- VI 09/19/2012

  2. Why should we screen for colorectal cancer?

  3. Why should we screen? • Common: • Worldwide, CRC is 2nd in women and 3rd in men • Over 600,000 deaths in 2008 • In US, CRC is 2nd leading cause of cancer death • 1 in 3 people who develop CRC die of this disease • Lifetime incidence for patients at average risk is 5% • 90% of cases occurring after age 50

  4. Why should we screen? Available (we can!): many options Knowledge: adenoma-carcinoma sequence Effective: removal of premalignant adenomas can prevent the cancer and removal of localized cancer may prevent CRC-related death Screening rates for CRC in US are below national targets, 52.3 to 65.4% (50 to 75 years old) 2002-2010

  5.  The adenoma-carcinoma sequence. Adenoma-carcinoma sequence Brosens L A A et al. Gut 2005;54:1034-1043

  6. Colon

  7. Right-sided versus left-sided lesions

  8. Average vs. High Risk individuals • High risk patient: • Symptoms • Prior colorectal cancer or adenomatous polyps • Inflammatory bowel disease (IBD): ulcerative colitis (UC) or Crohn's disease (CD) • Family history of CRC or adenomatous polyps • Familial Syndromes: mainly Lynch Syndrome (Hereditary nonpolyposis colon cancer) and Familial adenomatouspolyposis (FAP)

  9. Stool Based Tests

  10. Sigmoidoscopy

  11. Colonoscopy

  12. CT Colonography

  13. Advantages, Limitations, and Uncertainties of Screening Tests to Detect Colorectal Cancer Lieberman D. N Engl J Med 2009;361:1179-1187

  14. Sensitivity of One-Time Colorectal-Cancer Screening Tests Lieberman D. N Engl J Med 2009;361:1179-1187

  15. U.S. Colorectal-Cancer Screening Guidelines, 2008 Lieberman D. N Engl J Med 2009;361:1179-1187

  16. Considerations for Colorectal-Cancer Screening Lieberman D. N Engl J Med 2009;361:1179-1187

  17. Surveillance GASTROENTEROLOGY , September 2012;143:844–857

  18. Surveillance HRA is defined as 3 or more adenomas, tubular adenoma 10 mm, adenoma with villous histology, or HGD. LRA is defined as 1–2 tubular adenomas 10 mm. GASTROENTEROLOGY , September 2012;143:844–857

  19. Personal Hx of IBD GASTROENTEROLOGY 2008;134:1570–1595

  20. Familial Syndromes GASTROENTEROLOGY 2008;134:1570–1595

  21. Patients With Hx of CRC GASTROENTEROLOGY 2008;134:1570–1595

  22. Patients With Family Hx of CRC or Adenomatous Polyps GASTROENTEROLOGY 2008;134:1570–1595

  23. Questions?????

  24. Thank you!

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