Early Detection for Colorectal Cancer: ASCO Resource-Stratified Guideline

PURPOSE To provide resource-stratified, evidence-based recommendations on the early detection of colorectal cancer in four tiers to clinicians, patients, and caregivers. METHODS American Society of Clinical Oncology convened a multidisciplinary, multinational panel of medical oncology, surgical oncology, surgery, gastroenterology, health technology assessment, cancer epidemiology, pathology, radiology, radiation oncology, and patient advocacy experts. The Expert Panel reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus-based process with additional experts (Consensus Ratings Group) for two round(s) of formal ratings. RESULTS Existing sets of guidelines from eight guideline developers were identified and reviewed; adapted recommendations form the evidence base. These guidelines, along with cost-effectiveness analyses, provided evidence to inform the formal consensus process, which resulted in agreement of 75% or more. CONCLUSION In nonmaximal settings, for people who are asymptomatic, are ages 50 to 75 years, have no family history of colorectal cancer, are at average risk, and are in settings with high incidences of colorectal cancer, the following screening options are recommended: guaiac fecal occult blood test and fecal immunochemical testing (basic), flexible sigmoidoscopy (add option in limited), and colonoscopy (add option in enhanced). Optimal reflex testing strategy for persons with positive screens is as follows: endoscopy; if not available, barium enema (basic or limited). Management of polyps in enhanced is as follows: colonoscopy, polypectomy; if not suitable, then surgical resection. For workup and diagnosis of people with symptoms, physical exam with digital rectal examination, double contrast barium enema (only in basic and limited); colonoscopy; flexible sigmoidoscopy with biopsy (if contraindication to latter) or computed tomography colonography if contraindications to two endoscopies (enhanced only).

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Screening Strategies for Colorectal Cancer: A Systematic Review of the Evidence

Canadian Journal of Gastroenterology ◽

10.1155/2001/284746 ◽

2001 ◽

Vol 15 (10) ◽

pp. 647-660 ◽

Cited By ~ 24

Author(s):

Robin S McLeod ◽

Keyword(s):

Colorectal Cancer ◽

Flexible Sigmoidoscopy ◽

Occult Blood ◽

Fecal Occult Blood Testing ◽

Fecal Occult Blood ◽

Average Risk ◽

Hereditary Nonpolyposis Colon Cancer ◽

Fecal Occult ◽

Hereditary Nonpolyposis ◽

Asymptomatic Individuals

BACKGROUND: Colorectal cancer is the third most common cancer in Canada. It is well recognized that there are improved survival rates if the disease is treated in its early stages, and indeed this may be a preventable disease. This paper systematically reviews the effectiveness of specific screening techniques for colorectal cancer in asymptomatic individuals at normal or above average risk.METHODS: MEDLINE was searched for articles published between January 1966 and January 2001 by using the MESH terms 'screening' and 'colorectal neoplasia'. The reference sections of review articles published before January 2001 were checked, and content experts were surveyed. The evidence was evaluated using the standardized methodology of the Canadian Task Force on Preventive Health Care.RSULTS AND DISCUSSION: For individuals at normal risk, there is evidence to support the use of annual or biennial fecal occult blood testing and flexible sigmoidoscopy for asymptomatic individuals over age 50 years. The evidence regarding whether only one or both of fecal occult blood testing and sigmoidoscopy should be performed is unclear, as is the evidence regarding the use of colonoscopy as an initial screen. For individuals at above average risk, the evidence supports either genetic testing or flexible sigmoidoscopy of individuals at risk in familial adenomatous polyposis kindreds, and screening with colonoscopy of patients in kindreds with hereditary nonpolyposis colon cancer. The evidence regarding colonoscopy for individuals who have a family history of colorectal polyps or cancer but do not fit the criteria for hereditary nonpolyposis colon cancer is unclear. Development of better risk stratification for screening is a high research priority, and further research, including randomized, controlled trials, into the effectiveness and feasibility of other screening modalities is necessary.

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Fecal DNA Versus Fecal Occult Blood for Colorectal-Cancer Screening in an Average-Risk Population

Yearbook of Medicine ◽

10.1016/s0084-3873(08)70569-8 ◽

2006 ◽

Vol 2006 ◽

pp. 413-414

Author(s):

J.S. Barkin

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Occult Blood ◽

Fecal Occult Blood ◽

Average Risk ◽

Fecal Dna ◽

Risk Population ◽

Fecal Occult

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Use of RNA isolated from feces as a promising tool for the early detection of colorectal cancer

The International Journal of Biological Markers ◽

10.5301/jbm.2012.9107 ◽

2012 ◽

Vol 27 (2) ◽

pp. 82-89 ◽

Cited By ~ 4

Author(s):

Giuliano Bernal

Keyword(s):

Colorectal Cancer ◽

Early Detection ◽

Low Cost ◽

Occult Blood ◽

Detection Methods ◽

Fecal Occult Blood ◽

Public Health Services ◽

Promising Alternative ◽

Altered Expression ◽

Fecal Occult

Colorectal cancer is one of the most common forms of cancer worldwide. Early detection would allow patients to be treated surgically and halt the progression of the disease; however, the current methods of early detection are invasive (colonoscopy and sigmoidoscopy) or have low sensitivity (fecal occult blood test). The altered expression of genes in stool samples of patients with colorectal cancer can be determined by RT-PCR. This is a noninvasive and highly sensitive technique for colorectal cancer screening. According to information gathered in this review and our own experience, the use of fecal RNA to determine early alterations in gene expression due to malignancy appears to be a promising alternative to the current detection methods and owing to its low cost could be implemented in public health services.

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