Colon cancer
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Colorectal cancer from community or preventive medicine point of view.

Colorectal cancer from community or preventive medicine point of view.

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Colon cancer Colon cancer Presentation Transcript

  • 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. • 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 What Do you KNOW about Colorectal Cancer ….. ?
  • 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
  • Colorectal Cancer Burden: Globally 10% The Cancer Incidence Burden. 2nd F(614 000) 3rd M (746000) 4th mortality cancer. (694 000) deaths. 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 in Europe + Americas. Highest Incidence Rates in Slovakia Hungary Czech Republic 8
  • 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 rates are lower in women than in men, except in the Caribbean. 12
  • 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 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
  • 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 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
  • 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
  • Colorectal Cancer: Etiology Colorectal Cancer Genetic Susceptibility Environmental Exposures 31
  • Colorectal Cancer: Risk Factors Non Modifiable • Age • Personal History • Family History • Race Modifiable • Diet • Physical Activity • Obesity • Smoking • Alcohol Use 32
  • 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
  • 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
  • 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
  • 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
  • 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
  • Colorectal Cancer: Risk Factors Non Modifiable • Age • Personal History • Family History • Race Modifiable • Diet • Physical Activity • Obesity • Smoking • Alcohol Use 38
  • Colorectal Cancer: Modifiable Risk Factors 39
  • 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
  • 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
  • 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
  • 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
  • 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 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 HRT
  • 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.
  • Colorectal Cancer: Diagnosis 50
  • Colorectal Cancer: Preventive Program PRIMARY SECONDARY TERTIARY Risk Factors Targeting Screening Management Obesity Diet Physical Activity Smoking Medical Surgical Rehabilitation 51
  • 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
  • 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
  • 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 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 Physical Activity Smoking Medical Surgical Rehabilitation 57
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  • 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 Physical Activity Smoking Medical Surgical Rehabilitation 63
  • 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. Targeting of the common risk factors even at primordial level. Collaboration across individual registries across the region and globally 65
  • 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
  • Colorectal Cancer: Summary •Most colorectal carcinomas develop through an adenoma–carcinoma sequence. • Underpinning screening colonoscopy for adenomatous polyp removal as a preventive option. 67
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