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Colon and rectal cancers - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of colorectal cancer.

Alternative Names

Colorectal cancer

Highlights:

New Colorectal Cancer Screening Guidelines

American Cancer Society Recommendations. In 2008, the American Cancer Society, the American College of Radiology, and the U.S. Multi-Society Task Force on Colorectal Cancer released consensus guidelines for colorectal cancer screening in adults age 50 years and older with no significant risk factors for colorectal cancer. The guidelines recommend:

Flexible sigmoidoscopy every 5 years, or
Colonoscopy every 10 years, or
Double-contrast barium enema (DCBE) every 5 years, or
CT colongraphy (CTC), also called virtual colonoscopy, every 5 years (this test is new to screening recommendations)

Patients may also consider stool tests. If stool tests produce abnormal results, a colonoscopy must be performed. Stool test options include:

Guiaiac-based fecal occult blood test (FOBT) with high test sensitivity every year
Fecal immunochemical test (FIT) with high sensitivity every year
Stool DNA test (sDNA). This test is another new option. The frequency of testing has not yet been determined.

U.S. Preventive Services Task Force Recommendations. In 2008, the U.S. Preventive Services Task Force (USPSTF) released slightly different guidelines. The USPSTF recommends:

Annual screening with high-sensitivity FOBT, or
Sigmoidoscopy every 5 years, with high-sensitivity FOBT every 3 years, or
Colonoscopy every 10 years

These recommendations apply to people ages 50 - 75 with average risk for colorectal cancer. The USPTF does not recommend routine screening for adults ages 76 - 85 years old who have had negative screenings since age 50. The USPTF does not recommend any screening in people over age 85.

According to the USPTF, there is not yet enough evidence to make recommendations for virtual colonoscopy or stool DNA testing.

Resources

www.cancer.org -- American Cancer Society
www.cancer.gov -- National Cancer Institute
www.asco.org -- American Society of Clinical Oncology
www.cancer.net -- Cancer.Net
www.nccn.org -- National Comprehensive Cancer Network
www.fightcolorectalcancer.org -- Colorectal Cancer Coalition
www.cancer.gov/clinicaltrials -- Find clinical trials

References

Botteri E, Iodice S, Raimondi S, Maisonneuve P, Lowenfels AB. Cigarette smoking and adenomatous polyps: a meta-analysis. Gastroenterology. 2008 Feb;134(2):388-95. Epub 2007 Nov 4.

Ciardiello F, Tortora G. EGFR antagonists in cancer treatment. N Engl J Med. 2008 Mar 13;358(11):1160 74.

Figueredo A, Coombes ME, Mukherjee S. Adjuvant therapy for completely resected stage II colon cancer. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD005390.

Johnson CD, Chen MH, Toledano AY, Heiken JP, Dachman A, Kuo MD, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008 Sep 18;359(12):1207-17.

Jonker DJ, O'Callaghan CJ, Karapetis CS, Zalcberg JR, Tu D, Au HJ, et al. Cetuximab for the treatment of colorectal cancer. N Engl J Med. 2007 Nov 15;357(20):2040-8.

Karapetis CS, Khambata-Ford S, Jonker DJ, O'Callaghan CJ, Tu D, Tebbutt NC, et al. K-ras mutations and benefit from cetuximab in advanced colorectal cancer. N Engl J Med. 2008 Oct 23;359(17):1757-65.

Kim DH, Pickhardt PJ, Taylor AJ, Leung WK, Winter TC, Hinshaw JL, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. 2007 Oct 4;357(14):1403-12.

Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003432.

Imperiale TF, Glowinski EA, Lin-Cooper C, Larkin GN, Rogge JD, Ransohoff DF. Five-year risk of colorectal neoplasia after negative screening colonoscopy. N Engl J Med. 2008 Sep 18;359(12):1218-24.

Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008 May-Jun;58(3):130-60. Epub 2008 Mar 5.

Moghaddam AA, Woodward M, Huxley R. Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol Biomarkers Prev. 2007 Dec;16(12):2533-47.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Colon Cancer. V.3.2008

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer. V.3.2008.

U.S. Preventive Services Task Force. Routine aspirin or nonsteroidal anti-inflammatory drugs for the primary prevention of colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2007 Mar 6;146(5):361-4.

U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008 Nov 4;149(9):627-37. Epub 2008 Oct 6.

Weinberg DS. In the clinic. Colorectal cancer screening. Ann Intern Med. 2008 Feb 5;148(3):ITC2-1-ITC2-16.

Wolpin BM, Mayer RJ. Systemic treatment of colorectal cancer. Gastroenterology. 2008 May;134(5):1296-310.

Reviewed last on: 12/1/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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