Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Bowel Cancer
7/21/2016
Risk Factors?
7/21/2016
Age of 1st
Colonoscopy
Interval
1/6-10
50
5 yearly
CRC in 2 FDR
degree
kinship) mean age <60
1/6-10
50
5 yearly
1/12
55
One off
1/12
55
One off
History
Gut 2010;59:666-690
7/21/2016
(Stage I)
93.2%
Dukes B
(Stage II)
77.0%
Dukes C
(Stage III)
47.7%
Dukes D
(Stage IV)
6.6%
So.
Early diagnosis makes a difference..
BUT
Adenoma-Carcinoma Sequence
7/21/2016
FOBT-Based BCSP
Process:
60-74 yrs
Biennial FOBT
Positive FOBT invited for colonoscopy
High Quality Colonoscopy
7/21/2016
UK Colorectal Cancers
7/21/2016
Effect of Screening.
Regardless of compliance, every 4 screening
colonoscopy lists will prevent:
1 Colorectal cancer death
1 person developing colorectal cancer
Important Points
Fewer patients present with advanced disease
15-16% Mortality reduction
Up to 20% reduction in CRC incidence
Costs?
1.50/head population/year for screening
0.20/head population/year for surgery
7/21/2016
Flexi-Sig Screening
UK Flexi-Sig Trial
11 years follow-up
Cumulative incidence (including prevalent)
cancer reduced by:
50% for distal cancers (rectum/sigmoid)
33% for colorectal cancer overall
7/21/2016
2 Week Rule
NICE 2015
7/21/2016
CEA?
Follow-up Tool
Not useful in diagnosis
Dont waste the money..
10
7/21/2016
Referrals
Straight to test?
Which test?
Fit for investigation? Fit for treatment?
Rationalisation of TWR?
Strict adherence to criteria
Direct contact for concerning patients not fitting
box
?CRC
CEA
Family History
Dont be falsely reassured by FOBT
U&E Please! (Frimley Lab or copy results)
Anaemia: MCV/Ferritin
Questions?
Contacts:
Secretary: Jane
01276 604236
henry.tilney@fhft.nhs.uk
Mobile
07958697273
11
7/21/2016
gastric carcinoma,
pancreatic carcinoma,
lung carcinoma
breast carcinoma
medullary thyroid
carcinoma
ulcerative colitis
pancreatitis,
cirrhosis,
COPD
Crohn's disease
Hypothyroidism
smokers
Cauliflower
Cucumber
Carrot
Cabbage
Potato
Pumpkin
Zucchini
Parsley
12
7/21/2016
FIT vs gFOBT
Population Outcomes
Per million population with 60% Uptake
600 Colonoscopies/year
65 Cancers
200 high risk polyps
39 lives per year saved
13