coloncancer大腸癌專題知識講座

1、coloncancer大腸癌專題知識講座coloncancer大腸癌專題知識講座第1頁OutlineColon Cancer FactsGetting TestedPreventive Strategiescoloncancer大腸癌專題知識講座第2頁 What is colon cancer? Begins in the colon or rectum(colorectal cancer) Usually develops from pre-cancerous changes or growths in the lining of these organs These growths are

2、 called polypscoloncancer大腸癌專題知識講座第3頁Colon Polyp to Cancer takes about 10-15 yearscoloncancer大腸癌專題知識講座第4頁Types of Colon Cancer coloncancer大腸癌專題知識講座第5頁Why talk about it? 2nd leading cause of cancer deaths 3rd most common cancer in men and womenFlorida: 10,200 new cases 3,900 deathsNationwide:147,500

3、new cases57,100 deaths Cancer Death EstimatesOne of the most preventable cancers!Data represents colorectal cancer estimatescoloncancer大腸癌專題知識講座第6頁Why dont we talk about it? Uncomfortable topic Unaware of risk factors Avoidance of doctor check-ups Fear of getting tested Perceived as “mans disease” N

4、o symptoms, no problemEmbarrassment or fear worth losing your life?coloncancer大腸癌專題知識講座第7頁Womens Issues: Women areDiagnosed with colon cancer equally as menLess likely to get screening than menPrefer female endoscopists (50%) coloncancer大腸癌專題知識講座第8頁Risk FactorsNearly 90% of colon cancer patientsare

5、over the age of 50.Other risk factors include: family or personal history of colon cancer or polyps chronic inflammatory bowel disease hereditary colorectal syndromes use of cigarettes and other tobacco products high-fat/low fiber diet physical inactivityRisk increases with age coloncancer大腸癌專題知識講座第

6、9頁SymptomsSigns and symptoms typically occur only in advanced colon cancer. Symptoms may include: Change in bowel habits lasting more than a few days Bleeding from the rectum Blood in the stool Cramping or gnawing stomach pains Weakness and fatigue Jaundice (yellow-green color of the skin & white pa

7、rt of the eye) Early colon cancer usually has no symptomscoloncancer大腸癌專題知識講座第10頁Why get tested? Testing can help detect pre-cancerous polyps Removing the polyp early may prevent it from becoming cancer Get the test. Get the polyp. Get the cure.Since some colon cancers can not be prevented, finding

8、them early is the best way to improve the chance of a cure. 90% survival rate if caught earlycoloncancer大腸癌專題知識講座第11頁Benefits of ScreeningFive-Year Relative Survival Rates for Colorectal Cancer by Stage at Diagnosis, 1995-coloncancer大腸癌專題知識講座第12頁Who should get tested?American Cancer Society recommen

9、ds that all average risk women and men begin regular colon cancer early detection testing at age 50.coloncancer大腸癌專題知識講座第13頁Colon Cancer TestsFecal occult blood testing (FOBT)Barium enemaFlexible sigmoidoscopyColonoscopyVirtual ColonoscopyGet the test. Get the polyp. Get the cure.coloncancer大腸癌專題知識講

10、座第14頁 Colonoscopycoloncancer大腸癌專題知識講座第15頁ColonoscopyAdvantagesDetects 90% polyps and cancerProvides diagnosis and therapyMedicare covers average-risk LimitationsRisksAvailabilityCostComplianceGet the polyp. Get the cure.coloncancer大腸癌專題知識講座第16頁 Polypectomy Techniquecoloncancer大腸癌專題知識講座第17頁Colon Canc

11、er Testing Is EFFECTIVE!coloncancer大腸癌專題知識講座第18頁The flat polypTechniques to improve detectionNarrow-band imagingChromoendoscopyEndocytoscopySoitenko et al. JAMA March coloncancer大腸癌專題知識講座第19頁Narrow Band Imagingcoloncancer大腸癌專題知識講座第20頁Left sided ulcerative colitis coloncancer大腸癌專題知識講座第21頁Ulcerative c

12、olitis with extensive pseudopolypscoloncancer大腸癌專題知識講座第22頁Testing rates remain far too lowAre people getting tested?Fewer than half of Americans over age 50 report having had a recent colorectal cancer screening testBecause of low testing rates, only 39% of colorectal cancers are detected at the ear

13、liest, most treatable stagecoloncancer大腸癌專題知識講座第23頁Is embarrassment or fear worth losing your life over?Why arent people getting tested?Uncomfortable topicUnaware of risk factorsNot aware that colon cancer is a health threatFear of getting testedPerceived as “mans disease”No symptomsSome doctors don

14、t consistently offer to patientscoloncancer大腸癌專題知識講座第24頁Ethnic/Racial differencesPercentage who have never had screening colonoscopyHispanics - 67%Black - 55.8%White, non-Hispanic 47%Never married 60%Education less than high school diploma 58% vs 52% completed high school vs 46% with some college ed

15、ucation data, AHRQcoloncancer大腸癌專題知識講座第25頁Dont wait for your doctorWhy arent people getting tested?The most common reason people give for not being tested is:“My doctor never talked to me about it !”coloncancer大腸癌專題知識講座第26頁How is your state doing?UMcoloncancer大腸癌專題知識講座第27頁Colon Cancer TestsNew Techn

16、iquesFuture Alternatives for Colon Cancer Screeningcoloncancer大腸癌專題知識講座第28頁 Virtual Colonoscopycoloncancer大腸癌專題知識講座第29頁Virtual ColonoscopySpiral CT to generate 3D imagesCleaning of bowel, distension with airNon invasive, no complicationsNot endorsed for CRC screeningcoloncancer大腸癌專題知識講座第30頁 Virtual

17、Colonoscopycoloncancer大腸癌專題知識講座第31頁 Limitations Virtual Colonoscopy Variable resultsNo screening studiesNo longitudinal studiesCostDoes not allow for therapycoloncancer大腸癌專題知識講座第32頁Stool DNANow recommended by ACS and USMSTF for average risk individualsMulti-target DNA stool assay required to achieve

18、 adequate sensitivity and detect the various gene mutationsK-rasAPCP53BAT-2621 separate point mutationsDIAcoloncancer大腸癌專題知識講座第33頁Video Capsule ColonoscopyIn the process of developmentBattery lifeNo clinical data availableAnticipate to see clinical trialscoloncancer大腸癌專題知識講座第34頁Colon Cancer TestsAve

19、rage Risk coloncancer大腸癌專題知識講座第35頁Average Risk IndividualsNo SymptomsAge 50No risk factorscoloncancer大腸癌專題知識講座第36頁Current RecommendationsAverage Risk*Preferred strategy by ACGTestInterval (years)FOBTYearlySigmoidoscopyEvery 5 FOBT + SigmoidoscopyYearly, every 5ColonoscopyEvery 10*Barium enemaEvery 5 coloncancer大腸癌專題知識講座第37頁Approach to Colon Cancer TestingAsymptomaticMen and WomenAge 50 yrNo family HxNo ScreeningHNPCC or FAPGene