colon cancer

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Colorectal C a n c e r

U p d a t e

Prepared By Dr.Anees AlSaadiCommunity Medicine Training Program- QatarMay 2014

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Colorectal Cancer

• Outline: –Introduction &

Definition.–Burden. –Risk factors–Presentation–Prevention.

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Colorectal Cancer Introduction and Definition:

• (1941-1993) Captain of the England team.• Won the 1966 World Cup. • The greatest player of all time.

• (1933-2009)11th President Philippines.• 1st female president in Asia.• "Icon of Philippine Democracy".

• ( 1900 -2002) wife of King George VI.• Mother of Queen Elizabeth II .

Bobby Moore

Corazon Aquino

Queen Elizabeth

The Queen Mother

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What Do you KNOW

about Colorectal Cancer ….. ?

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Colorectal Cancer

The most common type of gastrointestinal cancer.

It is a multifactorial disease process.

Etiology transcending genetic factors, environmental exposures and inflammatory conditions of the digestive

tract.

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Colorectal Cancer Burden: Globally

10%The Cancer Incidence Burden.

2nd F(614 000)

3rd M

(746000)

4th mortality cancer.

(694 000) deaths.

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Which Country With

Highest Incidence Rate of

Colorectal Cancer ….. ?

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Colorectal Cancer Burden: Globally

65% of New Cases in Countries With High Human Development

50% of the New Cases Occurred in Europe + Americas.

Highest Incidence Rates in

Slovakia

Hungary

Czech Republic

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Colorectal Cancer Burden: Internationally

USA

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Colorectal Cancer Burden: Globally UK

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Colorectal Cancer Burden: Internationally India

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Colorectal Cancer Burden: Globally

Rates tend to be relatively low in many African

countries.

As with incidence, mortality rates are lower in

women than in men, except in the Caribbean.

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Which Country With

High Mortality Rate of

Colorectal Cancer ….. ?

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Colorectal Cancer Burden: Globally

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Colorectal Cancer Burden: Internationally USA

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Colorectal Cancer Burden: Internationally UK

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Colorectal Cancer Burden: Internationally India

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Colorectal Cancer Burden:

The scale of the colorectal cancer incidence burden is

key marker of human development transitions.

Burden is increasing in many countries

transitioning towards higher levels of human

development.

Trends appear to be stabilizing or declining in

countries that have attained the highest levels of human development.

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Colorectal Cancer Burden: EMR

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228000 Cases170000 Deaths

239000 Cases153000 Deaths

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Which Arab Country With

Highest Incidence Rate of

Colorectal Cancer ….. ?

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Colorectal Cancer Burden: Regional

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Colorectal Cancer Burden: Regional

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Colorectal Cancer Burden: Regional

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Colorectal Cancer Burden: Regional

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Colorectal Cancer Burden: Regional

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Colorectal Cancer Burden: Regional

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1996 1998 2000 2002 2004 2006 2008 2010 20120

20

40

60

80

100

120

140

160

Breast Cancer

Bone mar-row

Colorectal Cancer

Years

Nu

mb

er o

f C

ases

The trend of the most common cancer types in Qatar between 1998 till 2010. Source Cancer Registry AlAmal Hospital. Qatar.

Colorectal Cancer Burden: Locally

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Colorectal Cancer Burden: Locally

Colorectal cancer is 2nd after breast cancer.

Age Standardized Incidence 3.0-3.4

9% of total cancer cases3rd most common cause of

mortality in Qatar is Cancer

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Colorectal Cancer: Etiology

Colorectal Cancer

Genetic Susceptibility

Environmental Exposures

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Colorectal Cancer:Risk Factors

Non Modifiable • Age • Personal History • Family History• Race

Modifiable • Diet• Physical Activity• Obesity• Smoking• Alcohol Use

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Colorectal Cancer:Non Modifiable Risk Factors: Age

Can young adults develop colorectal cancer?

After which age the chances to develop colorectal cancer increase?

About 9 out of 10 people diagnosed with colorectal cancer are at least 50 years old.

YES

50

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Colorectal Cancer:Non Modifiable Risk Factors: Personal History

History of adenomatous

polyps (adenomas).

First colorectal cancer at

younger age.

History of Inflammatory bowel disease

(IBD).

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Colorectal Cancer: Non Modifiable Risk Factors: Family History

• Mostly without a family history of colorectal cancer.

• 1 in 5 patients have family history of colorectal cancer or adenomatous polyps.

• 1st Degree relative diagnosed before age of 45.

• 1st Degree relative with premature death.

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Colorectal Cancer: Non Modifiable Risk Factors: Family History

Familial Adenomatous Polyposis (FAP)

Hereditary Non-Polyposis Colon Cancer (HNPCC) Lynch Syndrome

Turcot Syndrome

Peutz-Jeghers syndrome

MUTYH-associated polyposis

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Colorectal Cancer: Non Modifiable Risk Factors: Race

• African Americans have the highest incidence rate in the United States.

• Jews of Eastern European descent (Ashkenazi Jews)– I1307K APC mutation, is

present in about 6% of American Jews.

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Colorectal Cancer:Risk Factors

Non Modifiable • Age • Personal History • Family History• Race

Modifiable • Diet• Physical Activity• Obesity• Smoking• Alcohol Use

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Colorectal Cancer: ModifiableRisk Factors

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Colorectal Cancer: Modifiable Risk Factors:

Diet

Read Meat

Processed Meat

Grilling Cooking

Vegetables and Fruits

What Is The Colon Cancer Food Connection?

http://www.youtube.com/watch?v=twgBajFhHsI

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Colorectal Cancer: Modifiable Risk Factors:

Physical Inactivity

High levels of physical activity

50%.

In both gender recreational & occupational physical activity decrease risk.

Active later in life may also reduce their risk.

Moderate physical activities lower risk of colon cancer.

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Colorectal Cancer: Modifiable Risk Factors:

Overweight or obese is associated with a higher risk of CRC

Observed in men than in women

Abdominal obesity may be a more important risk factor.

Overweight & Obesity

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Colorectal Cancer: Modifiable Risk Factors:

Smoking• Sufficient evidence that

tobacco smoking causes colorectal cancer.

• The association appears to be stronger for rectal than for colon cancer.

Alcohol • Colorectal cancer has been

linked to even moderate alcohol use.

• Lifetime average of 2 to 4 alcoholic drinks per day have a 23% higher risk of colorectal cancer.

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Colorectal Cancer: Factors with uncertain, controversial:

Previous treatment for

certain cancers

e.g. Prostate

3 nights a month for 15 years may increase the risk of colorectal cancer in women 2X.

Diet Vitamin D Deficincy

http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-risk-factors

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What are the most INFLUENTIAL

Risk Factor For

Colorectal Cancer ….. ?

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Colorectal Cancer: Modifiable Preventive Factors:

Reducing CRCRisk

Vegetables

Fruits

FibersCalcium

Drugs

Aspirin

NSAID

HRT

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Colorectal Cancer: Signs and symptoms

• Often detected during screening procedures.

Iron-deficiency anemiaRectal bleedingAbdominal painChange in bowel habits

Intestinal obstruction or perforation

Early disease: Nonspecific findings (fatigue, weight loss) or none at all

Advanced disease: Abdominal tenderness. Macroscopic rectal bleeding. Palpable abdominal mass. Hepatomegaly and ascites.

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Colorectal Cancer: Diagnosis

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Colorectal Cancer: Preventive Program

PRIMARY SECONDARY TERTIARY

Risk Factors Targeting

Screening Management

Obesity

Diet

Physical Activity

Smoking

Medical

Surgical

Rehabilitation

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ACS:Preventing colorectal cancer should be a major reason for getting tested.

Tests finding both polyps and cancer are preferred if these tests are available.

CRC Screening http://www.youtube.com/watch?v=WWbeQCUh418

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Beginning at age 50, both men and women at average risk:

Tests that find Polyps & Cancer

Flexible Sigmoidoscopy every 5 years

Colonoscopy every 10 years

Double-contrast barium enema every 5 years

CT colonography (virtual colonoscopy) every 5 years

Tests that mainly find cancer

Fecal occult blood test (FOBT) every year

Fecal immunochemical test (FIT) every year

Stool

DNA te

st (s

DNA)

PR e

xam

inat

ion.

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People at increased

risk

A personal history of

CRC or AP

A personal history of IBD

A strong family history of CRC or AP

A known family history of a

hereditary CRC syndrome such

as familial adenomatous

polyposis (FAP))

Screening Before Age 50 and / o

r be

Screened M

ore Ofte

n

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Which TEST is the most Sensitive & Specific

For Colorectal Cancer Screening and Diagnosis.. ?

56http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/cartzaubtab2.htm

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Colorectal Cancer: Preventive Program

PRIMARY SECONDARY TERTIARY

Risk Factors Targeting

Screening Management

Obesity

Diet

Physical Activity

Smoking

Medical

Surgical

Rehabilitation

Awareness and H

ealth

Promotion o

f the S

creening

Program

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50%

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Health Promotion for Colorectal Cancer

http://www.youtube.com/watch?v=0MBaNeMoobc

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Colorectal Cancer: Preventive Program

PRIMARY SECONDARY TERTIARY

Risk Factors Targeting

Screening Management

Obesity

Diet

Physical Activity

Smoking

Medical

Surgical

Rehabilitation

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Prediction of Disease Free

http://nomograms.mskcc.org/Colorectal/index.aspx

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Future Perspectives

Development of regional and national registries

Allocation of resources and personnel to fight CRC.

Targeting of the common risk factors even at primordial level.

Collaboration across individual registries across the region and globally

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Colorectal Cancer: Summary

•Colorectal cancer is one of the most common cancers representing almost 10% of the global cancer incidence.

•Dietary composition, obesity, and lack of physical activity are established as contributing to risk of colorectal cancer.

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Colorectal Cancer: Summary

•Most colorectal carcinomas develop through an adenoma–carcinoma sequence.

• Underpinning screening colonoscopy for adenomatous polyp removal as a preventive option.

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