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Colorectal Cancer
Proposal of a Screening Program for Developing Countries with Emphasis on Costs
Presentator: Alessandro L. Loiola, MD
• Atendant of Coloproctology at the Specialties´ Regional Referral Center, Vitoria / ES - Brazil
• Developer of Health Contents for Boasaude.com.br
• E-mail: [email protected]
Objectives
• Create a consciousness of the problem for third-world countries
• Access some relevant features in the diagnosis of Colorretal Cancer
• Sugest steps for a screening program
Recommended articles
• BOND JH. Screning for colorectal cancer. Hosp Prac, Jan 15:59-74, 1997.
• SELBY JV et alii. Effect of fecal occult blood testing on mortality from colorectal cancer. Am Col Phys, 118:1-6, 1993.
Recommended websites:
•Colorectal Cancer Homepage at http://home.swipnet.se/crc/
•Colorectal Forum at www.colorectal-forum.org/
• NCI CancerNet Database at www.meb.uni-bonn.de/cancernet/
Creating a Consciouness for screening: did you
know that . . . • Colorectal cancer kills more than AIDS and
Diabetes ?• In some countries (Brazil included) colorectal
cancer causes more deaths per year than ovarian, uterine, prostate or even lung cancer ?
Relevant Features of Colorectal Cancer
Special Risk Factors Decade of ocurrance Clinical manifestations Pathology
Relevant Features of Colorectal Cancer:
1 - Special risk factors
• Diet habits• Inflamatory bowel diseases• Familial adenomatous polyposis syndrome
• Strong incidence of cancer in the family
Relevant Features of Colorectal Cancer:
2 - Decade of occurrance
0100200300400500600700800900
1st 2nd 3rd 4th 5th 6th 7th 8th andover
Relevant Features of Colorectal Cancer:
3 - Clinical manifestations
• Low intestinal bleeding
• Altered bowel habits
• Unexplained weight loss
Relevant Features of Colorectal Cancer:
4 - Pathology
• 90% of Colorectal malignant tumors are Carcinomas
• 60-70% of the lesions are located in the last 1/3 part of large bowel
• 30% of all lesions can be reached by digital exam only
Steps of the Colorectal Cancer Screening Program
Barium EnemaConsider before going to step 3
Step 3Colonoscopy
Step 2Sigmoidoscopy
Step 1Faeccal-occult-blood test
Colorectal Cancer Screening Program - Step
1
• Faecal-occult-blood test (FOBT) in people after age 50 and/or with known risk factors and/or physical evidences
suggesting colorretal cancer
Colorectal Cancer Screening Program - Step
1a
• Patients with negative FOBT, without evidences at physical examination
and/or without risk factors: • repeat FOBT every year
Colorectal Cancer Screening Program - Step
1b
• Patients with negative FOBT but with sustained clinical suspicion and/or with risk
factors: go to Step 2
Colorectal Cancer Screening Program - Step
1c
• Patients with positive FOBT: go to Step 2 (sigmoidoscopy)
Colorectal Cancer Screening Program - Step
2
• Sigmoidoscopy (flexible if possible)
Colorectal Cancer Screening Program Step 2a - Negative
Sigmoidoscopy
• Patients without clinical suspicion and any risk factor: follow up with FOBT every year, one sigmoidoscopy each 3-5 years and one colonoscopy each 10 years.
Colorectal Cancer Screening Program Step 2b - Negative
Sigmoidoscopy
• Patients with sustained clinical suspicion and/or any risk factor: consider Barium enema. One can choose promptly performing a Colonoscopy (Step 3)
• If all negative: follow up as Step 2a.
Colorectal Cancer Screening Program Step 2c - Positive Sigmoidoscopy
• Go to Step 3 (Colonoscopy), after collecting samples.
Colorectal Cancer Screening Program
Step 3 - Colonoscopy
• To further exam the extention of a particular lesion and to identify more lesions
• Patients with negative colonoscopy: follow up as Step 2a.
Colorectal Cancer Screening Program
Hole of Barium Enema
• Detect other lesions
• Can be replace (with restrictions) colonoscopy where this exame is not obtainable
