Colorectal Cancer Screening (eBook)

Preface 6
Contents 8
Contributors 10
Chapter 1: Colorectal Cancer Pathways 12
Chromosomal Instability or Suppressor Pathways 13
Microsatellite Instability or Mutator Pathway 13
CpG Island Methylator Pathway 16
References 16
Chapter 2: Risk Factors and Screening for Colorectal Cancer 18
Prospective Studies 18
Risk Factors 20
Red Meat 20
Fiber Intake 21
Physical Exertion 21
Gender 22
Alcohol 22
Tobacco 23
Obesity 23
Diabetes Mellitus 24
Race 24
Asymptomatic Screening Populations 25
Translation into Screening 26
Models 26
Screening Guidelines 27
New Problems in Screening 27
References 28
Chapter 3: Hereditary Adenomatous Colorectal Cancer Syndromes 35
Background 35
Recognizing the Patient with a HCCS 36
Hereditary Nonpolyposis Colorectal Cancer (HNPCC) 37
Genetics 37
Clinical Presentation 39
Diagnosis 40
Colon Cancer Surveillance 41
Extracolonic Screening and Management 41
Familial Adenomatous Polyposis 41
Genetics 42
Clinical Presentation 42
Diagnosis 44
Colon Cancer Screening and Surveillance 44
Extracolonic Screening and Surveillance 45
MYH-Associated Polyposis (MAP) 46
Genetics 46
Clinical Presentation 46
Screening and Surveillance 47
Conclusions 47
References 47
Chapter 4: Screening and Surveillance Guidelines 52
Background 52
Colorectal Cancer Screening 53
Best Evidence for CRC Screening 53
History of Screening Guidelines 54
Current Recommendations for Average Risk Screening 55
High Risk Screening 56
Family History 56
Tailored Screening 58
Race 59
Gender 59
Tobacco 59
Diabetes Melitus 60
Surveillance 60
Background 60
Personal History of Adenomas 61
Personal History of Colorectal Cancer 62
References 63
Chapter 5: Barriers to Colorectal Cancer Screening: Patient, Physician, and System Factors 65
Patient Barriers to CRC Screening 66
Provider Barriers to CRC Screening 69
Systems Barriers to CRC Screening 71
Reducing Barriers to CRC Screening 71
References 72
Chapter 6: Screening for Colorectal CancerUsing Colonoscopy 75
Rationale and Efficacy for Screening Colonoscopy 75
Failures of Colonoscopy to Prevent Proximal Colon Cancer 78
Maximizing Colorectal Cancer Prevention During Colonoscopy 83
Conclusions 84
References 84
Chapter 7: New Colonoscopic Technologies for Colorectal Cancer Screening 88
Introduction 88
Technologies for Improving Detection During Colonoscopy 89
Improving Mucosal Exposure 89
Imaging Technologies for Flat Lesions 91
Technologies That Allow Real-Time Histology 94
Conclusions 97
References 97
Chapter 8: Screening for CRC Using CT Colonography* 102
Introduction 102
Current Status of CT Colonography 103
Guidelines and Recommendations 106
Current Indications for CT Colonograpy 108
CRC Screening of Asymptomatic, Normal-Risk Adults 109
Failed Colonoscopy 111
Evaluation of Colon Proximal to an Obstructing Lesion 111
CRC Screening in Patients with Contraindications to Colonoscopy or Who Refuse Other Screening Options 112
Contraindications for CT Colonograpy 112
Qualifications and Training of Personnel 113
CT Scanning 113
Skill and Training to Interpret CT Colonography 113
Exam and Equipment Specifications 116
Colonic Preparation 116
CT Acquisition Technique 117
CT Colonography Interpretation and Polyp Reporting 118
Intracolonic Findings 118
Extracolonic Findings 120
Potential for Increased Screening Uptake 120
Integration of CT Colonogrpahy with Colonoscopy 121
Conclusions 121
References 122
Chapter 9: Noninvasive Screening Tests 129
Introduction 129
Guaiac-Based Fecal Occult Blood Testing (FOBT) 131
Test Mechanism 131
Tests Characteristics 131
Mortality Reduction 133
Population-Based Screening Programs 135
Immunochemical Fecal Occult Blood Tests 136
Test Mechanism 136
Test Characteristics 137
Quantitative FIT 138
FIT vs. g-FOBT 139
Comparative Performance of Various FITs 141
Sequential Stool Testing 144
Implementing FIT Screening 144
Current Guidelines (Table 9.2) 145
Fecal DNA Testing 146
Background 146
A Multicomponent Fecal DNA Assay 146
Other Fecal DNA Markers 148
What Is the Place of Fecal DNA Testing in ColorectalCancer Screening? 150
Blood-Based Screening Tests 150
Background 150
References 152
Chapter 10: Removal of Difficult Colon Polyps 157
Benign or Malignant? 158
Chromoendoscopy 159
General Criteria for Removal 161
Does the Patient Need Hospitalization? 162
Equipment for Polypectomy of the Difficult Polyp 163
Broad-Based Polyp (Is or IIa,b,c, LST) 164
The Nonlifting Sign 166
Configuration 166
Removal of Air to More Easily Capture a Polyp 168
Endoscopic Submucosal Dissection (ESD) 168
Bleeding During Polypectomy (Immediate Bleeding) 169
The Argon Plasma Coagulator 169
Plastic Cap on Endoscope 172
Accessories 172
Localization of Polypectomy Site 173
Retrieval of Specimens 174
What are the Limits of Colonoscopic Polypectomy? 175
The Malignant Polyp 176
Safety and Complications 177
Summary 178
References 179
Chapter 11: Screening for Colorectal Cancer in the Elderly 183
The Broad Perspective 183
Yield and Risks of Colonoscopy in the Elderly 184
Life Expectancy and Screening Outcomes 185
Screening Decisions 187
References 190
Chapter 12: Chemoprevention 192
Introduction 192
Nutrition 192
Obesity 193
Red Meat and Processed Meats 194
Fruits and Vegetables 194
Fiber 195
Calcium and Vitamin D 196
Folate 197
Antioxidants 198
Pharmaceuticals 199
Aspirin 199
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Cyclooxygenase 2 (COX-2) Inhibitors 200
Statins 201
Hormone Replacement Therapy (HRT) 202
References 202
Index 206