About Colorectal Cancer

About Colorectal Cancer

In both men and women, colorectal cancer is the third most commonly diagnosed cancer and third leading cause of cancer death.*

There were approximately 141,210 new cases of colorectal cancer in 2011 and 49,380 deaths*

72% of cases arise in the colon and 28% in the rectum.*

90% of new cases occur in people age 50 or older*

Colorectal Cancer incidence and mortality rates are highest in African American men and women. Incidence rates are 20% higher and mortality rates are 45% higher than those in whites. *

If caught early (in stage I), the relative five-year survival rate is 90%; five-year survival rates for patients diagnosed at the regional and distant stage are 70% and 12% respectively.*

 

The American College of Gastroenterology guidelinesinclude:

Preferred CRC screening recommendations:

  • Cancer prevention tests should be offered first. The preferred CRC prevention test is colonoscopy every 10 years, beginning at age 50. (Grade 1 B) Screening should begin at age 45 years in African Americans (Grade 2 C)
  • Cancer detection test. This test should be offered to patients who decline colonoscopy or another cancer prevention test. The preferredcancer detection test is annual FIT for blood (Grade 1 B)

 

Alternative CRC prevention tests:

  • Flexible sigmoidoscopy every 5 – 10 years (Grade 2 B)
  • CT colonography every 5 years (Grade 1 C)

 

Alternative cancer detection tests:

  • Annual Hemoccult Sensa (Grade 1 B)
  • Fecal DNA testing every 3 years (Grade 2 B)

Recommendations for screening when family history is positive but evaluation for HNPCC considered not indicate:

  • Single first-degree relative with CRC or advanced adenoma diagnosed at age ≥ 60 years

Recommended screening: same as average risk (Grade 2 B)

  • Single first-degree with CRC or advanced adenoma diagnosed at age < 60 years or two first-degree relatives with CRC or advanced adenomas.
  • Recommended screening: colonoscopy every 5 years beginning at age 40 years or 10 years younger than age at diagnosis of the youngest affected relative (Grade 2 B)

 

FAP (familial adenomatous polyposis)

  • Patients with classic FAP (>100 adenomas) should be advised to pursue genetic counseling and genetic testing, if they have siblings or children who could potentially benefit from this testing (Grade 2 B)
  • Patients with known FAP or who are at risk of FAP based onfamily history (and genetic testing has not been performed)should undergo annual flexible sigmoidoscopy or colonoscopy, as appropriate, until such time as colectomy is deemed by physician and patient as the best treatment (Grade 2 B)
  • Patients with retained rectum after subtotal colectomy should undergo flexible sigmoidoscopy every 6 – 12 months (Grade 2 B)
  • Patients with classic FAP, in whom genetic testing is negative, should undergo genetic testing for bi-allelic MYH mutations. Patients with10 – 100 adenomas can be considered for genetic testing for attenuated FAP and if negative, MYH associated polyposis (Grade 2 C)

 

HNPCC (hereditary non-polyposis colorectal cancer)

  • Patients who meet the Bethesda criteria should undergo microsatellite instability testing of their tumor or a family member’stumor and/or tumor immunohistochemical staining for mismatchrepair proteins (Grade 2 B)
  • Patients with positive tests can be offered genetic testing. Thosewith positive genetic testing, or those at risk when genetic testing is unsuccessful in an affected proband, should undergo colonoscopy every 2 years beginning at age 20 – 25 years, until age 40 years, then annually thereafter (Grade 2 B)

*American Cancer Society, www.cancer.org
***American College of Gastroenterology www.gi.org

 

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