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About Colorectal Cancer
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Colorectal Cancer An Overview S. Maitra
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Colorectal Cancer
Colon
Rectum 2/3rd
1/3rd Equal in both sexes
More common in men
Lung Colorectal
Prostate
Breast
Men
Women
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Incidence Mortality, Colorectal Cancer, England
Crude Inc Rate/ 100,000 Deaths 2000 Mortality/100,000
Site ICD No regd 10 1999
M W M W M W M W
Colon C18 8822 9013 35.9 35.8 4814 4740 19.5 18
Rectal C19 20 6009 3970 24.5 16.8 2605 1895 10.5 7.5
Anus C21 255 382 1.0 1.5 78 104 0.3 0.4
office of national statistics
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• And the problem is increasing.
• Ageing of the population
• Lifestyle Factors

lt 45- very low risk 45 55- 25/100,000 gt 75-
300/100,000
More meat , less vegetable Obesity Smoking
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Risk of Colon Cancer by Family H/O
Relative Risk
Family History
Category- 1 No family H/O 2 One first
degree relative gt 45 at diagnosis 3 One first
degree relative lt 45 at diagnosis 4 Two first
degree relatives
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• Other risk factors
• Familial Adenomatous Polyposis(FAP)
• Hereditary Non polyposis Colorectal Cancer
• (HNPCC)
• Inflammatory Bowel Disease

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Clinical Presentation
Early

• PR Bleeding
• Persistent change in
• bowel habits
• Anaemia

Usually progresses slowly from polyps over 10 yrs
Late

• Weight loss
• Abdo pain
• Abdo mass

20 arrive through A/E
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Diagnostic Methods
Flexible sigmoidoscopy (can pick up 60 of
tumours)
Colonoscopy Double contrast barium enema
Rigid sigmoidoscopy
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Newer Diagnostic Method
Some evidence better than Barium enema Almost as
accurate as Colonoscopy for larger Polyps(gt10mm
) only Potential complications (including
perforation) similar to other procedures
Alternative to Barium enema Useful in frail
elderly as initial screening
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Diagnostic Issues Who to be tested?
To pick up cancer /polyp at early stage. What
is the Benefit Risk Ratio?

• Symptomatic patients
• High Risk group (Surveillance)
• 3. General Population Screening

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• Symptomatic Patients
• (Urgent Referral Criteria)

Sign,Symptom or Combination Age threshold
Rectal bleeding with new diarrhoea for 6 weeks Any age
Definite palpable right abdo mass Any age
Definite palpable rectal( not pelvic) mass Any age
Rectal bleeding WITHOUT anal symptoms gt 60 yrs
New diarrhoea WITHOUT rectal bleed for 6 weeks gt 60 yr
IDA ( Hb lt 11 in men and lt 10 in postmenopausal women) without obvious cause No age criterion
Maximum threshold. Local Network may elect lower
values IDA Iron Deficiency Anaemia

Department of health
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Which Test for Whom?
1.Rectal bleeding/
- Flexi sigi Change in bowel
habit (chance of missing
(ie left sided symptoms)
cancer is 0.2)
2.Right abdo pain -
Colonoscopy IDA
if unsuccessful or

frail/elderly
Barium
enema/
CT Colonography
3.Palpable abdo mass -
CT scan or
CT Colonography
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2. Surveillance
Disease Group Procedure First Screening Repeat
Colon Adenoma
1-2 bothlt 1cm Colonoscopy None or at 5 yrs Stop after one negative
3-4 or at least 1gt 1cm Colonoscopy Three years 3 yearly till two Negative
gt4 or gt 2 with 1 at least gt1 cm Colonoscopy One year Annually till out of this grp
IBD Colonoscopy Bx every 10cm 8yrs-pancolitis 15yrs- left sided 2nd dec- 3yrly 3rd dec- 2yrly gt3rd - annually
FAP Genetic test OGD Flexi Puberty Annually
2 FDR or 1 FDR lt 45 yrs Colonoscopy 1st visit or 35- 40 yrs If initial Colonoscopy clear then at 55
BSG Guidelines
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3. Population Screening
NHS Colorectal Cancer Screening Programme
35 million 8 training centers 650 new
endoscopists
Due to start from April 2006
FOBTs- in men women gt 60 years
if positive Colonoscopy
Flexible Sigmoidoscopy as a pilot study in men
gt 50
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FOBT (Faecal Occult Blood Test)
Reduces Mortality ( 3 American 2 European RCTs)
Pre test dietary restriction for 3 days
(Avoid red meat, horseradish, Vitamin C) High
fibre diet advised
Six guiac strips to be smeared two each 3
consecutive stool
Any amount of blue in any one strip
is positive ( Guainoic acid
Guanicum blue
Haemoglobin
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Treatment
Dukes Stage Definition Frequency 5year Survival
A Cancer localized within bowel wall 11 83
B Cancer penetrating bowel wall 35 64
C Cancer in lymph nodes 26 38
D Distant metastases 29 3
Duke A, B- Curative surgery
attempted Duke C- Surgery
Adjuvant Chemo Duke D- Surgery
liver resection (in 8)
or
Palliative chemo/radiotherapy or stent St
Vincent Hospital Dublin
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Survival
Relative survival () 1 year after diagnosis
Country
Colon Rectum
M
W
M
W
England 64.9 64.2 70.5 71.8
Scotland 65.7 65.7 71.3 71.3
Wales 53.5 52.5 64.5 63.9
Europe 69.2 69.8 73.7 75.2
1990- 1994 data from International agency for
research on Cancer
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Home
Colossal Colon Tour
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The Colossal Colon Tour        
Colossal Colon
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Tour Schedule
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Get Involved        
About Colorectal Cancer
The Online Tour        
Take the Pledge        
 
Frequently Asked Questions
Press        
NCRCAM
20
Home
Colossal Colon Tour
National Tour Partners
Individuals
Online Tour
The Pledge
About the Tour
The Colossal Colon Tour        
Colossal Colon
National Tour Sponsors
Organizations
Take the Tour
Take the Pledge
Tour Schedule
Educational Stations
Community Action Kit
Graphics
Nat'l Tour Partners Sponsors        
Tour Messages
Press Releases
Tour Schedule
Press Kit
Get Involved        
About Colorectal Cancer
The Online Tour        
Take the Pledge        
 
Frequently Asked Questions
Press        
NCRCAM

The Colossal Colon was created in memory of
Amanda Sherwood Roberts, who lost her battle with
colon cancerat age 27 on Jan. 27, 2002.