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ColoRectal Cancer
Dr.Abdullah Almusallam
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What is Your Answer?

Fatma Salem 52yr old, Kuwaiti woman with no chronic medical problem. During a routine exam, She says: I saw a medical program in TV about colonoscopy.She asks: Do I need a COLONOSCOPY ? A)You dont have to worry about that. Colon cancer is mainly a Man disease. B)Yes everyone should have a colonoscopy every year to check for colon cancer. C)Ill do rectal exam today,if there is no sign of blood, thats all you need

D)there is a number of different screening for Ca Colon. Lets talk about them, then decide whats right for you

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Colorectal Cancer
Colorectal cancer is the third most commonly diagnosed cancer in the world, and it is the second leading cause of cancer deaths. Globally greater than 1 million people get colorectal cancer yearly resulting in about 0.5 million deaths [Lancet 2010] In UK, 40.000 new cases registered each year [NICE 2011].
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What about Kuwait?

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Predisposing factors (Risk Factors)

Age

Diet: poor fibre diet, fast food, red meat, processed meat.
Alcohol. Sedentary lifestyle. Obesity.

History of IBD.
Family history of CRC or familial adenomatous polyposis (FAP).

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Clinical Features

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Clinical Examination

Where colorectal cancer is suspected clinically, the whole of the large bowel should be examined [SIGN 2011].

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Clinical examination
Rectal exam: this is appropriate because many carcinomas are found in the lowest 12cm and most can reached by the examining finger [Murtagh general practice]
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investigation

CBC to suspect an Iron Dificiency Anemia

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Referral for suspected CRC

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When referring, no examinations or investigations other than abdominal and rectal examination and full blood count are recommended as this may delay referral [NICE].
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Follow Up
Long F/U
Short F/U
Long-Term follow-up Colonoscopy may be offered at five-yearly intervals to check for new polyps or tumours Short-term follow-up in the weeks after ,should focus on post-operative problems, future planning

Evidence

Hospital vs. GP follow-up 1 small RCT compared immediate discharge to the GP with hospital follow-up over six months. GP follow-up was found to be equally satisfactory. LOGO

Rehabilitaion
Exercise program:

Minimize fatigue
Optimize physical function, safety and well-being Boost the immune system Improve bowel habits Improve flexibility

Reduce stress and anxiety

Minimize depression
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Rehabilitaion
Lymphedema Management: When lymph nodes are removed, lymph fluid can not easily flow as before, so causing swelling and pain. Physiotherapist will teach the ptients some techniques to alleviate the swelling and the pain.
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Screening
Personal Med.H.

Age (50-75)

Family History

Screening
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Risk Classification
1 Low Risk

2 Average Risk
3 Moderate Risk

4 High Risk
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Low Risk
Age under 50 year, AND
No personal history of colorectal adenomatous polyps or IBD, AND No family history of colorectal cancer.
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Average Risk
Age 50 yrs and over, AND
No personal history of colorectal adenomatous polyps or IBD, AND No family history of colorectal cancer.
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Moderate Risk
One or more 1st degree relative(s) [parent, sibling, child] with colorectal cancer. Personal history of colorectal adenomatous polyps or colorectal cancer.
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High Risk
Strong family history of CRC but no genitic syndrme identified.
Family history of Hereditary NonPolyposis colorectal cancer (HNPCC or Lynch Syndrome).

Personal history of IBD

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Low Risk Screening

No screening is recommended.

Advice people [SIGN 2011]: Eat at least five portions of vegetables and fruits each day and eat relatively unprocessed cereal with every meal. Keep consumption of red meat to less than 500 g per week and avoid processed meat.
Avoid Smoking and Alcohol. Brisk walking for a minimum of 30 minutes five days a week.
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Average Risk Screening

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Moderate Risk Screening

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High Risk Screening

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Thank You
References
1 2 3 4 NICE GUIDELINE 2011 SIGN GUIDELINE 2011 CLINICAL ADVISOR TOWARD OPTIMIZED PRACTICE GUIDELINE OF ALBERTA 2009

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WIKIPEDIA (COLORECTAL CANCER)

UNVERSITY OF MISSISSIPPI CANCER DEPARTMENT (REHABILITATION)

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CANCER TREATMENT CENTRE OF AMERICA (REHABILITAION)

MEDICINE AT GLANCE (COLORECTAL CANCER)

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