coloncancer大腸癌專題知識講座

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