NO IF AND OR BUTT

Guidelines for Colorectal Screening

Did you know?

1. Ontario has one of the highest rates of colorectal cancer in the world;
2. Colon cancer is one of the most preventable forms of cancer. If screened and caught early – the chance of survival increases by90%;
3. Unfortunately, nearly half of those diagnosed find out too late;
4. Estimated that1 in 14 men will develop colorectal cancer in their lifetime and 1 in 27 will die of it;
5. Estimated that1 in 15 women will develop colorectal cancer during their lifetime and 1 in 31 will die of it;
6. *In Canada, in 2010, colorectal cancer is the second-leading cause of cancer deaths;
7. *An estimated3,400 Ontarians (1,850 men; 1,550 women) will die of colorectal cancer in 2010.

Enough can’t be said about the importance of screening in preventing, detecting, and curing cancer. It is simply your best line of defense when it comes to protecting yourself from this disease. Your body is not see-through. Screening is the best way to stop colorectal cancer in its tracks or prevent it from developing in the first place. This is why the Government of Ontario, in collaboration with Cancer Care Ontario, has created a province – wide screening program.

* Statistics provided by Canadian Cancer Society

There are two common methods of screening for colorectal cancer.

1. Fecal Occult Blood Test (FOBT)
2. Colonoscopy

Fecal Occult Blood Test can detect the presence of blood in your stool. A positive test requires a colonoscopy.
There is a high incidence of false positive/negative results with these tests. If blood is detected then a follow up colonoscopy will be required to determine if colorectal cancer is present.

Colonoscopy can be performed in a hospital (high risk patients) or a specialized endoscopy clinic and is an examination of the lining of your rectum and colon using a long flexible tube with a camera on the end. It is recommended for individuals over the age of 50 on a regular basis.

Risk Factors

There is no “single cause” for developing colorectal cancer but there are several risk factors:

• A family history of colorectal cancer;
• Increasing age (risk increases from the age of 50);
• Polyps present in the colon or rectum;
• A diet high in fat/red meat;
• An inactive lifestyle;
• Obesity; and
• Inflammatory bowel disease of long duration and especially if it is associated with scierosing cholangitis, a chronic liver condition of unknown cause.

This list has grown to include many other situations of less clear significance.

Signs and Symptoms

• Change in bowel habits;
• Blood in stool;
• Abdominal discomfort;
• Weight loss for no apparent reason;
• Feeling that the bowel is not emptying completely;
• Narrower than usual stools; and
• Feelings of weakness or feeling more tired than normal.

It is important to remember that colon cancer in the early stages may cause no symptoms.

Screening Guidelines

Average Risk:
Cancer Care Ontario believes that preventing colorectal cancer (and not just finding it early) should be a major reason for getting tested. Finding and removing polyps will prevent you from getting colorectal cancer. Tests that have the best chance of finding both polyps and cancer are preferred. Colonoscopy when performed after proper and adequate bowel cleaning has the maximum potential for detection and removal of polyps and for confirming the diagnosis for cancer with biopsies. Barium X rays and CT scan of the colon may help to detect polyps larger than 5 mm but they have to be followed up with colonoscopies. False positive test due to retained fecal matter and the potential to miss smaller polyps do occur more with these examinations.

Current recommendation:
Beginning at age 50, both men and women(at average risk for developing colorectal cancer) should be screened with colonoscopy. If no polyps are found the current recommendation is to have repeat colonoscopy every 10 years until age 75, so long as one remains free of colonic symptoms.

Increased Risk:
Patients with a history of polyps on prior colonoscopy exam/diagnosis of colorectal cancer and those who have a family history are recommended to have screening colonoscopies starting at age 40 or ten years below the age of the youngest family member at diagnosis of either colonic polyps or cancer and it is to be repeated every five years until age 75.

The recommendations for people who are found to have polyps are as follows:

1. People with small hyperplastic polyps do not have any increased risk for colon cancer – Their follow-up is same as for those with average risk.
2. People with 1 or 2 small (less than 1 cm) tubular adenomas with low-grade dysplasia – repeat colonoscopy in 5 to 10 years after polyps are removed.
3. For people with larger and more number of adenomas or any adenomas with high-grade dysplasia or villous features as well as people with sessile adenomas that are removed in pieces will need closer follow-up. Your specialist will recommend individualized follow-up examinations sooner and more frequently as the situations warrant. Once the polyps are examined under the microscope, if the excision is not considered to be complete especially in polyps with high grade dysplasia or focal cancer, a limited bowel resection may be recommended to be safe and to prevent the potential for recurrence and spread and to guarantee a cure.

Special High Risk
Where colonoscopy is recommended every 1-2 years:

1. Familial adenomatous polyposis (FAP) diagnosed by genetic testing, or suspected FAP without genetic testing – screen age 10 to 12.
2. Hereditary non-polyposis colon cancer – screen age 20 to 25 years or 10 years before the youngest case in the immediate family.
3. Chronic inflammatory bowel disease – ulcerative colitis and crohn’s colitis, usually after seven years from onset of symptoms will require periodic colonoscopies and colon biopsies for dysplasia surveillance every 3 years and after 20 years from onset they may need colonoscopies every 1-2 years. Close long term follow-up by the specialist is recommended.

This pamphlet is prepared to assist family physicians and their patients in determining the best way to prevent colorectal cancer.