Colorectal Cancer

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Colorectal Cancer

Diagnosis, Imaging, and Screening

NEWS:

Colon Cancer Screening Sooner? Prevalence Of Pre-cancerous Masses In Colon Same In Patients In Their 40s And 50s “"Our results support the theory that adenomas, which later may lead to cancer, form at an age earlier than we screen for today," said Alfred I. Neugut, MD, PhD, professor of medicine and epidemiology at Columbia University Medical Center and head of cancer prevention and control for the Herbert Irving Comprehensive Cancer Center of Columbia University Medical Center and New York-Presbyterian Hospital. "With this information in hand, it is logical to think that if we were to recommend screening for colon cancer at age 40, we may be able to decrease its prevalence even further and save more people from having to battle the disease." “

Colonoscopies Could Miss Dangerous Lesions: Report

Colonoscopy Significantly Reduces Death From Left-sided Colon Cancer But Not From Right-sided “The researchers suggest several reasons why colonoscopy may be less effective in preventing death from right-sided colorectal cancer. First, some colonoscopies considered "complete" may not evaluate the entire right colon. Second, bowel preparation may be worse in the right colon. Third, right and left colonic cancers and polyps may differ biologically. Right-sided growths may be less likely to have a fleshy stalk and are occasionally flat, which makes them harder to identify and remove, or they may grow more rapidly.”

Colonoscopy Study Finds a Growth More Dangerous Than Polyps “The findings come from a study of colonoscopy, in which a camera-tipped tube is used to examine the lining of the intestine. Generally, doctors search for polyps, abnormal growths that stick out from the lining and can turn into cancer. But another type of growth is much more dangerous, and harder to see because it is flat or depressed and similar in color to healthy tissue. Japanese researchers became concerned about these flat lesions in the 1980s and ’90s, but studies here had mixed results and American doctors tended to think that flat growths were less common and less dangerous in the United States. The new study, to be published Wednesday in the Journal of the American Medical Association, suggests otherwise. Some doctors in this country were already alert to flat lesions, but the findings will pose a challenge to others, because it takes a trained and vigilant eye to see the growths and special techniques to remove them. The results also mean it is especially important that patients take the harsh laxatives that many dread in advance of the test. The flat lesions, hard to find even under the best conditions, will be impossible to see if any waste is left in the bowel. “

Colorectal cancer screening: ensuring benefits outweigh the risks “It is clearly important that participants are encouraged to develop realistic expectations about screening’s capacity to prevent cancer. An important unintended outcome of screening can be the “certificate of health effect”, a sense of immunity developing as a result of a negative test. Interpreting screening as a panacea against disease can strengthen unhealthy routines and the idea that regular screening rather than healthy lifestyle maintains health. Screened individuals still need to be encouraged to continue to limit red meat and fat intake, stop smoking and increase their physical activity, not only to reduce their subsequent colorectal cancer risk, but also to improve their general health status.”

Flat and Depressed Colorectal Growths May Change Screening

Less-invasive colon cancer screenings urged “Medical experts recommended Wednesday that a less invasive procedure known as a virtual colonoscopy and a stool DNA test join the arsenal of screenings for colon cancer in the hopes that more people would get checked out.”

Nonpolyp Neoplasms More Likely Than Polyps to Lead to Colorectal Cancer “Until now, colorectal cancer has been thought to arise mainly from polyps, but new research shows that nonpolypoid neoplasms are relatively common and are more likely than polyps to be malignant. These nonpolypoid colorectal neoplasms (NP-CRNs) are often flat or depressed and are difficult to see on colonoscopy.“

Task Force: Colon Cancer Screenings Can Stop at 75

ARTICLES:

Screening Guidelines for Colorectal Cancer: A Twice-Told Tale

JOURNAL ARTICLES:

A self administered reliable questionnaire to assess lower bowel symptoms (BMC Gastroenterol. 2008)

Accuracy of CT Colonography for Detection of Large Adenomas and Cancers (NEJM 2008)

Cochrane Systematic Review of Colorectal Cancer Screening Using the Fecal Occult Blood Test (Hemoccult): An Update (Am J Gastroenterol. 2008)

Prevalence of Colon Polyps Detected by Colonoscopy Screening in Asymptomatic Black and White Patients (JAMA. 2008) “Conclusion Compared with white individuals, black men and women undergoing screening colonoscopy have a higher risk of polyps sized more than 9 mm, and black individuals older than 60 years are more likely to have proximal polyps sized more than 9 mm.”

Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement (Annals 2008)

Small and diminutive polyps detected at screening CT colonography: a decision analysis for referral to colonoscopy. (AJR Am J Roentgenol. 2008) “CONCLUSION: For diminutive polyps detected at CTC screening, the very low likelihood of advanced neoplasia and the high costs associated with polypectomy argue against colonoscopic referral, whereas removal of large CTC-detected polyps is highly effective. The yield of colonoscopic referral for small polyps is relatively low, suggesting that CTC surveillance may be a reasonable management option.”

Upstaging benefits and accuracy of sentinel lymph node mapping in colorectal adenocarcinoma nodal staging. (J Surg Oncol. 2008)

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