Colorectal
Cancer
Update
Prepared By Dr.Anees AlSaadi
Community Medicine Training Program- Qatar
May 2014 1
Colorectal
Cancer
• Outline:
–Introduction &
Definition.
–Burden.
–Risk factors
–Presentation
–Prevention.
2
Colorectal Cancer
Introduction and Definition:
3
• (1941-1993) Captain of the England team.
• Won the 1966 World Cup.
• Th...
4
What Do you
KNOW
about
Colorectal Cancer ….. ?
Colorectal Cancer
The most common type
of gastrointestinal cancer.
It is a multifactorial
disease process.
Etiology transc...
Colorectal Cancer
Burden: Globally
10%
The Cancer
Incidence
Burden.
2nd
F(614 000)
3rd
M
(746000)
4th
mortality
cancer.
(6...
7
Which Country
With
Highest Incidence Rate
of
Colorectal Cancer ….. ?
Colorectal Cancer
Burden: Globally
65% of New Cases in
Countries With High
Human Development
50% of the New Cases
Occurred...
Colorectal Cancer
Burden: Internationally
USA
9
Colorectal Cancer
Burden: Globally UK
10
Colorectal Cancer
Burden: Internationally India
11
Colorectal Cancer
Burden: Globally
Rates tend to be relatively
low in many African
countries.
As with
incidence, mortality...
13
Which Country
With
High Mortality Rate
of
Colorectal Cancer ….. ?
Colorectal Cancer
Burden: Globally
14
Colorectal Cancer
Burden: Internationally
15
USA
Colorectal Cancer
Burden: Internationally UK
16
Colorectal Cancer
Burden: Internationally India
17
Colorectal Cancer
Burden:
The scale of the colorectal
cancer incidence burden is
key marker of human
development transitio...
Colorectal Cancer
Burden: EMR
19
20
21
228000 Cases
170000 Deaths
239000 Cases
153000 Deaths
22
Which Arab Country
With
Highest Incidence Rate
of
Colorectal Cancer ….. ?
Colorectal Cancer
Burden: Regional
23
Colorectal Cancer
Burden: Regional
24
Colorectal Cancer
Burden: Regional
25
Colorectal Cancer
Burden: Regional
26
Colorectal Cancer
Burden: Regional
27
Colorectal Cancer
Burden: Regional
28
0
20
40
60
80
100
120
140
160
1996 1998 2000 2002 2004 2006 2008 2010 2012
NumberofCases
Years
Breast
Cancer
Bone
marrow
C...
Colorectal Cancer
Burden: Locally
30
Colorectal cancer is 2nd
after breast cancer.
Age Standardized
Incidence 3.0-3.4
9% o...
Colorectal Cancer: Etiology
Colorectal
Cancer
Genetic
Susceptibility
Environmental
Exposures
31
Colorectal Cancer:
Risk Factors
Non Modifiable
• Age
• Personal History
• Family History
• Race
Modifiable
• Diet
• Physic...
Colorectal Cancer:
Non Modifiable Risk Factors: Age
Can young adults develop colorectal cancer?
After which age the chance...
Colorectal Cancer:
Non Modifiable Risk Factors: Personal
History
History of
adenomatous
polyps
(adenomas).
First colorecta...
Colorectal Cancer: Non Modifiable
Risk Factors: Family History
• Mostly without a family history of colorectal cancer.
• 1...
Colorectal Cancer: Non Modifiable
Risk Factors: Family History
Familial Adenomatous Polyposis (FAP)
Hereditary Non-Polypos...
Colorectal Cancer: Non Modifiable
Risk Factors: Race
• African Americans have
the highest incidence rate
in the United Sta...
Colorectal Cancer:
Risk Factors
Non Modifiable
• Age
• Personal History
• Family History
• Race
Modifiable
• Diet
• Physic...
Colorectal Cancer: Modifiable
Risk Factors
39
Colorectal Cancer: Modifiable
Risk Factors:
Diet
Read Meat
Processed
Meat
Grilling
Cooking
Vegetables
and Fruits 40
What I...
Colorectal Cancer: Modifiable
Risk Factors:
Physical
Inactivity
High levels of physical activity
50%.
In both gender recre...
Colorectal Cancer: Modifiable
Risk Factors:
Overweight or obese is
associated with a higher
risk of CRC
Observed in men th...
Colorectal Cancer: Modifiable
Risk Factors:
Smoking
• Sufficient evidence that
tobacco smoking causes
colorectal cancer.
•...
Colorectal Cancer: Factors with
uncertain, controversial:
44
Previous
treatment for
certain cancers
e.g. Prostate
3 nights...
45
What are the most
INFLUENTIAL
Risk Factor
For
Colorectal Cancer ….. ?
46
47
Colorectal Cancer: Modifiable
Preventive Factors:
Reducing
CRC
Risk
Vegetables
Fruits
FibersCalcium
Drugs
48
Aspirin
NSAID...
Colorectal Cancer: Signs and
symptoms
• Often detected during screening procedures.
49
Iron-deficiency anemia
Rectal bleed...
Colorectal Cancer: Diagnosis
50
Colorectal Cancer: Preventive
Program
PRIMARY SECONDARY TERTIARY
Risk Factors
Targeting
Screening Management
Obesity
Diet
...
52
ACS:
Preventing colorectal cancer should be a major
reason for getting tested.
Tests finding both polyps and cancer are...
Beginning at age 50, both men and
women at average risk:
Tests that find Polyps & Cancer
 Flexible Sigmoidoscopy every
5 ...
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 ...
55
Which TEST is the most
Sensitive & Specific
For
Colorectal Cancer
Screening and Diagnosis.. ?
56http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/cartzaubtab2.htm
Colorectal Cancer: Preventive
Program
PRIMARY SECONDARY TERTIARY
Risk Factors
Targeting
Screening Management
Obesity
Diet
...
58
59
50%
60
Health Promotion for Colorectal Cancer
61
http://www.youtube.com/watch?v=0MBaNe
Moobc
62
Colorectal Cancer: Preventive
Program
PRIMARY SECONDARY TERTIARY
Risk Factors
Targeting
Screening Management
Obesity
Diet
...
Prediction of Disease Free
64
http://nomograms.mskcc.org/Colorectal/index.a
spx
Future Perspectives
Development of regional and national
registries
Allocation of resources and personnel to
fight CRC.
Ta...
Colorectal Cancer: Summary
•Colorectal cancer is one of the most common
cancers representing almost 10% of the global canc...
Colorectal Cancer: Summary
•Most colorectal carcinomas develop through an
adenoma–carcinoma sequence.
• Underpinning scree...
68
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  • Colon cancer

    1. 1. Colorectal Cancer Update Prepared By Dr.Anees AlSaadi Community Medicine Training Program- Qatar May 2014 1
    2. 2. Colorectal Cancer • Outline: –Introduction & Definition. –Burden. –Risk factors –Presentation –Prevention. 2
    3. 3. Colorectal Cancer Introduction and Definition: 3 • (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
    4. 4. 4 What Do you KNOW about Colorectal Cancer ….. ?
    5. 5. 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. 5
    6. 6. Colorectal Cancer Burden: Globally 10% The Cancer Incidence Burden. 2nd F(614 000) 3rd M (746000) 4th mortality cancer. (694 000) deaths. 6
    7. 7. 7 Which Country With Highest Incidence Rate of Colorectal Cancer ….. ?
    8. 8. 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 8
    9. 9. Colorectal Cancer Burden: Internationally USA 9
    10. 10. Colorectal Cancer Burden: Globally UK 10
    11. 11. Colorectal Cancer Burden: Internationally India 11
    12. 12. 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. 12
    13. 13. 13 Which Country With High Mortality Rate of Colorectal Cancer ….. ?
    14. 14. Colorectal Cancer Burden: Globally 14
    15. 15. Colorectal Cancer Burden: Internationally 15 USA
    16. 16. Colorectal Cancer Burden: Internationally UK 16
    17. 17. Colorectal Cancer Burden: Internationally India 17
    18. 18. 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. 18
    19. 19. Colorectal Cancer Burden: EMR 19
    20. 20. 20
    21. 21. 21 228000 Cases 170000 Deaths 239000 Cases 153000 Deaths
    22. 22. 22 Which Arab Country With Highest Incidence Rate of Colorectal Cancer ….. ?
    23. 23. Colorectal Cancer Burden: Regional 23
    24. 24. Colorectal Cancer Burden: Regional 24
    25. 25. Colorectal Cancer Burden: Regional 25
    26. 26. Colorectal Cancer Burden: Regional 26
    27. 27. Colorectal Cancer Burden: Regional 27
    28. 28. Colorectal Cancer Burden: Regional 28
    29. 29. 0 20 40 60 80 100 120 140 160 1996 1998 2000 2002 2004 2006 2008 2010 2012 NumberofCases Years Breast Cancer Bone marrow Colorectal Cancer The trend of the most common cancer types in Qatar between 1998 till 2010. Source Cancer Registry AlAmal Hospital. Qatar. 29 Colorectal Cancer Burden: Locally
    30. 30. Colorectal Cancer Burden: Locally 30 Colorectal cancer is 2nd after breast cancer. Age Standardized Incidence 3.0-3.4 9% of total cancer cases 3rd most common cause of mortality in Qatar is Cancer
    31. 31. Colorectal Cancer: Etiology Colorectal Cancer Genetic Susceptibility Environmental Exposures 31
    32. 32. Colorectal Cancer: Risk Factors Non Modifiable • Age • Personal History • Family History • Race Modifiable • Diet • Physical Activity • Obesity • Smoking • Alcohol Use 32
    33. 33. 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. 33
    34. 34. 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). 34
    35. 35. 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. 35
    36. 36. 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 36
    37. 37. 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. 37
    38. 38. Colorectal Cancer: Risk Factors Non Modifiable • Age • Personal History • Family History • Race Modifiable • Diet • Physical Activity • Obesity • Smoking • Alcohol Use 38
    39. 39. Colorectal Cancer: Modifiable Risk Factors 39
    40. 40. Colorectal Cancer: Modifiable Risk Factors: Diet Read Meat Processed Meat Grilling Cooking Vegetables and Fruits 40 What Is The Colon Cancer Food Connection? http://www.youtube.com /watch?v=twgBajFhHsI
    41. 41. 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. 41
    42. 42. 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. 42 Overweight & Obesity
    43. 43. 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. 43
    44. 44. Colorectal Cancer: Factors with uncertain, controversial: 44 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
    45. 45. 45 What are the most INFLUENTIAL Risk Factor For Colorectal Cancer ….. ?
    46. 46. 46
    47. 47. 47
    48. 48. Colorectal Cancer: Modifiable Preventive Factors: Reducing CRC Risk Vegetables Fruits FibersCalcium Drugs 48 Aspirin NSAID HRT
    49. 49. Colorectal Cancer: Signs and symptoms • Often detected during screening procedures. 49 Iron-deficiency anemia Rectal bleeding Abdominal pain Change 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.
    50. 50. Colorectal Cancer: Diagnosis 50
    51. 51. Colorectal Cancer: Preventive Program PRIMARY SECONDARY TERTIARY Risk Factors Targeting Screening Management Obesity Diet Physical Activity Smoking Medical Surgical Rehabilitation 51
    52. 52. 52 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=WWbe QCUh418
    53. 53. 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 53
    54. 54. 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)) 54
    55. 55. 55 Which TEST is the most Sensitive & Specific For Colorectal Cancer Screening and Diagnosis.. ?
    56. 56. 56http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/cartzaubtab2.htm
    57. 57. Colorectal Cancer: Preventive Program PRIMARY SECONDARY TERTIARY Risk Factors Targeting Screening Management Obesity Diet Physical Activity Smoking Medical Surgical Rehabilitation 57
    58. 58. 58
    59. 59. 59 50%
    60. 60. 60
    61. 61. Health Promotion for Colorectal Cancer 61 http://www.youtube.com/watch?v=0MBaNe Moobc
    62. 62. 62
    63. 63. Colorectal Cancer: Preventive Program PRIMARY SECONDARY TERTIARY Risk Factors Targeting Screening Management Obesity Diet Physical Activity Smoking Medical Surgical Rehabilitation 63
    64. 64. Prediction of Disease Free 64 http://nomograms.mskcc.org/Colorectal/index.a spx
    65. 65. 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 65
    66. 66. 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. 66
    67. 67. Colorectal Cancer: Summary •Most colorectal carcinomas develop through an adenoma–carcinoma sequence. • Underpinning screening colonoscopy for adenomatous polyp removal as a preventive option. 67
    68. 68. 68
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