Colorectal cancer screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Roukoz A. Karam, M.D.[2] Elliot B. Tapper, M.D.; Saarah T. Alkhairy, M.D.

Overview

Early detection of premalignant colorectal masses or early-stage colorectal cancers is essential in treating these patients and possibly preventing cancer or colorectal cancer related death. According to the USPSTF (United States Preventive Services Task Force): Screening for colorectal cancer is recommended among adults older than 50 years of age and do not have an increased risk of developing the disease (average-risk adults).

Colorectal Cancer Screening

Early detection of premalignant colorectal masses or early-stage colorectal cancers is essential in treating these patients and possibly preventing cancer or colorectal cancer related death.

According to the USPSTF (United States Preventive Services Task Force):[1]

  • Screening for colorectal cancer is recommended among adults older than 50 years of age and do not have an increased risk of developing the disease (average-risk adults).
  • Decision to screen for colorectal cancer among adults aged 76 to 85 years is an individual one.
    • Screening would be more beneficial for healthier individuals that are able to undergo possible treatment.
  • Screening for colorectal cancer among adults aged 86 years and older is not recommended.
  • No preference is given to one screening modality over the other
    • Decision should be shared and according to the patient's preferences when it comes to choosing an option.
  • Screening options:[1]
    1. Colonoscopy
    2. FIT
      • Fecal immunochemical testing for occult blood
    3. Flexible sigmoidoscopy
    4. Flexible sigmoidoscopy + FIT
    5. CT colonography
    6. FIT-DNA
      • multitargeted stool DNA testing
    7. gFOBT
      • Guaiac-based fecal occult blood testing

Screening for colorectal cancer in individuals that are at increased risk of developing the disease is different and depends on several factors:[2][1]

  • Family history of colorectal cancer before age 50
    • Begin screening at an earlier age
  • Risk of rapid disease progression
    • Perform screening more frequently
  • Family history of HNPCC or FAP
    • Use most sensitive screening modality: colonoscopy
Screening protocols summarized in the figures below:

Protocols have been summarized according to USPSTF guidelines.[1]

Screening protocol for average risk patients


Screening protocol for moderate risk patients
Screening protocol for high risk patients

Types of Screening Methods

Fecal Occult Blood Testing

  • A fecal occult blood test is a test for blood in the stool.
  • There are two types of tests that can be used for detecting occult blood in stools:[1][3]
    1. FIT
      • Fecal immunochemical testing for occult blood
    2. gFOBT
      • Guaiac-based fecal occult blood testing
  • Use of low-sensitivity guaiac fecal tests is not recommended due to its of low sensitivity.[1]

Endoscopy

  • Documentation of prep quality
  • Photo documentation of cecal intubation
  • Withdrawal time of 6 minutes or more
  • Adenoma detection rate of greater than 25% in males and 15% in females greater than 50 years old

Colorectal cancer endo 2.jpg

CT colonography

  • Also known as Virtual Colonoscopy
  • Requires special workstation software in order for the radiologist to interpret
  • This technique is approaching colonoscopy in sensitivity for polyps
  • Any polyps found must still be removed by standard colonoscopy[5]

Fecal DNA testing

  • Multitargeted stool DNA testing
  • Ability to detect mutations from DNA shed by colorectal cancer[6]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 US Preventive Services Task Force. Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW; et al. (2016). "Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement". JAMA. 315 (23): 2564–2575. doi:10.1001/jama.2016.5989. PMID 27304597.
  2. Lieberman, David A. (2009). "Screening for Colorectal Cancer". New England Journal of Medicine. 361 (12): 1179–1187. doi:10.1056/NEJMcp0902176. ISSN 0028-4793.
  3. Duffy MJ, van Rossum LG, van Turenhout ST, Malminiemi O, Sturgeon C, Lamerz R; et al. (2011). "Use of faecal markers in screening for colorectal neoplasia: a European group on tumor markers position paper". Int J Cancer. 128 (1): 3–11. doi:10.1002/ijc.25654. PMID 20824704.
  4. 4.0 4.1 Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE; et al. (2006). "Quality indicators for colonoscopy". Am J Gastroenterol. 101 (4): 873–85. doi:10.1111/j.1572-0241.2006.00673.x. PMID 16635231.
  5. Morrin MM, LaMont JT (2003). "Screening virtual colonoscopy--ready for prime time?". N Engl J Med. 349 (23): 2261–4. doi:10.1056/NEJMe038181. PMID 14657435.
  6. Calistri D, Rengucci C, Bocchini R, Saragoni L, Zoli W, Amadori D (2003). "Fecal multiple molecular tests to detect colorectal cancer in stool". Clin Gastroenterol Hepatol. 1 (5): 377–83. PMID 15017656.


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