colon cancer
DESCRIPTION
Colorectal cancer from community or preventive medicine point of view.TRANSCRIPT
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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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