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ColonCancerPrevention
OutlineColonCancerFactsGettingTestedPreventiveStrategies
Whatiscoloncancer?
Beginsinthecolonorrectum
(colorectalcancer)Usuallydevelopsfrompre-cancerouschangesorgrowthsintheliningoftheseorgansThesegrowthsarecalledpolypsColonPolyptoCancertakesabout10-15yearsTypesofColonCancer
Whytalkaboutit?2ndleadingcauseofcancerdeaths3rdmostcommoncancerinmenandwomenFlorida:
10,200newcases 3,900deathsNationwide:
147,500newcases 57,100deaths2023CancerDeathEstimatesOneofthemostpreventablecancers!Datarepresents2023colorectalcancerestimates
Whydon’twetalkaboutit?UncomfortabletopicUnawareofriskfactorsAvoidanceofdoctorcheck-upsFearofgettingtestedPerceivedas“man’sdisease”Nosymptoms,noproblemEmbarrassmentorfearworthlosingyourlife?Women’sIssues:
Womenare…DiagnosedwithcoloncancerequallyasmenLesslikelytogetscreeningthanmenPreferfemaleendoscopists(>50%)
RiskFactorsNearly90%ofcoloncancerpatientsareovertheageof50.
Otherriskfactorsinclude:
familyorpersonalhistoryofcoloncancerorpolypschronicinflammatoryboweldiseasehereditarycolorectalsyndromesuseofcigarettesandothertobaccoproducts
high-fat/lowfiberdietphysicalinactivityRiskincreaseswithage
SymptomsSignsandsymptomstypicallyoccuronlyinadvancedcoloncancer.Symptomsmayinclude:ChangeinbowelhabitslastingmorethanafewdaysBleedingfromtherectumBloodinthestoolCrampingorgnawingstomachpainsWeaknessandfatigueJaundice(yellow-greencoloroftheskin&whitepartoftheeye)
Earlycoloncancerusuallyhasnosymptoms
Whygettested?Testingcanhelpdetectpre-cancerouspolypsRemovingthepolypearlymaypreventitfrombecomingcancerGetthetest.Getthepolyp.Getthecure.Sincesomecoloncancerscannotbeprevented,findingthemearlyisthebestwaytoimprovethechanceofacure.
90%survivalrateifcaughtearlyBenefitsofScreeningFive-YearRelativeSurvivalRatesforColorectalCancerbyStageatDiagnosis,1995-2023
Whoshouldgettested?AmericanCancerSocietyrecommendsthatallaverageriskwomenandmenbeginregularcoloncancerearlydetectiontestingatage50.ColonCancerTestsFecaloccultbloodtesting(FOBT)BariumenemaFlexiblesigmoidoscopyColonoscopyVirtualColonoscopyGetthetest.Getthepolyp.Getthecure.
ColonoscopyColonoscopyAdvantagesDetects>90%polypsandcancerProvidesdiagnosisandtherapyMedicarecoversaverage-riskLimitationsRisksAvailabilityCostComplianceGetthepolyp.Getthecure.
PolypectomyTechnique
ColonCancerTesting
IsEFFECTIVE!!TheflatpolypTechniquestoimprovedetectionNarrow-bandimagingChromoendoscopyEndocytoscopySoitenkoetal.JAMAMarch2023NarrowBandImagingLeftsidedulcerativecolitisUlcerativecolitiswithextensivepseudopolypsTestingratesremainfartoolowArepeoplegettingtested?FewerthanhalfofAmericansoverage50reporthavinghadarecentcolorectalcancerscreeningtestBecauseoflowtestingrates,only39%ofcolorectalcancersaredetectedattheearliest,mosttreatablestageIsembarrassmentorfearworthlosingyourlifeover?Whyaren’tpeoplegettingtested?UncomfortabletopicUnawareofriskfactorsNotawarethatcoloncancerisahealththreatFearofgettingtestedPerceivedas“man’sdisease”NosymptomsSomedoctorsdon’tconsistentlyoffertopatientsEthnic/RacialdifferencesPercentagewhohaveneverhadscreeningcolonoscopyHispanics-67%Black-55.8%White,non-Hispanic–47%Nevermarried60%Educationlessthanhighschooldiploma58%vs52%completedhighschoolvs46%withsomecollegeeducation2023data,AHRQDon’twaitforyourdoctorWhyaren’tpeoplegettingtested?Themostcommonreasonpeoplegivefornotbeingtestedis:“Mydoctornevertalkedtomeaboutit!”Howisyourstatedoing?UMColonCancerTests
NewTechniquesFutureAlternativesforColonCancerScreening
VirtualColonoscopyVirtualColonoscopySpiralCTtogenerate3DimagesCleaningofbowel,distensionwithairNoninvasive,nocomplicationsNot
endorsedforCRCscreening
VirtualColonoscopy
LimitationsVirtualColonoscopy
VariableresultsNoscreeningstudiesNolongitudinalstudiesCostDoesnotallowfortherapyStoolDNANowrecommendedbyACSandUSMSTFforaverageriskindividualsMulti-targetDNAstoolassayrequiredtoachieveadequatesensitivityanddetectthevariousgenemutationsK-rasAPCP53BAT-2621separatepointmutationsDIAVideoCapsuleColonoscopyIntheprocessofdevelopmentBatterylifeNoclinicaldataavailableAnticipatetoseeclinicaltrialsColonCancerTests
AverageRisk
AverageRiskIndividualsNoSymptomsAge50NoriskfactorsCurrentRecommendations
AverageRisk*PreferredstrategybyACGTestInterval(years)FOBTYearlySigmoidoscopyEvery5FOBT+SigmoidoscopyYearly,every5ColonoscopyEvery10*BariumenemaEvery5ApproachtoColonCancerTestingAsymptomaticMenandWomenAge<50yrNofamilyHxNoScreeningHNPCCorFAPGeneticCounseling1first-degree
60yrsAverage-riskscreening,startingage40YESfamilyHx2ormorefirst-degreeor1first-degree<60yrsColonoscopyevery5yrs,startingage40
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