Colorectal Cencer

1. Colorectal Cancer
Hossam Ghoneim, MD

2. Epidemiology
• RC incidence and mortality rates vary
markedly around the world. Globally, CRC is
the third most commonly diagnosed cancer in
males and the second in females

3. Risk factors
• Age is a major risk factor for sporadic CRC.
Large bowel cancer is uncommon before the
age of 40; the incidence begins to increase
significantly between the ages of 40 and 50

4. Risk factors
• Environmental and genetic factors can
increase the likelihood of developing CRC
– Familial adenomatous polyposis (FAP) and its
variants (Gardner's syndrome, Turcot's syndrome,
and attenuated adenomatous polyposis coli)
– Lynch syndrome or hereditary non-polyposis
colorectal cancer (HNPCC) is an autosomal
dominant syndrome, which is more common than
FAP, and accounts for approximately 3 to 5
percent of all colonic adenocarcinomas

5. Risk factors
• Personal or family history of sporadic CRCs or
adenomatous polyps
• Alcohol
• Obesity
• Smoking
• IBD

6. Protective factors
• Physical activity
• Diet
– Fiber
– Folic acid
– Vit B6, vit D
– Calcium and dairy products
– Vegatbles
– Garlic
– Fish consumption
• Aspirin and NSAIDs

7. Clinical presentation
• Asymptomatic (screening)
• Bleeding
• Vague abd discomfort
• Intestinal obstruction

8. Diagnosis
• COLONOSCOPY
• Others
– Lab .. Tumour markers, FOBT
– Imaging .. CT colonogrophy, barium enema

12. Screening
• National Comprehensive Cancer Network consensus
guidelines — The National Comprehensive Cancer
Network (NCCN), a multispecialty panel, issued revised
screening guidelines for CRC in December 2013
• . These guidelines recommend colonoscopy every 10
years, when available, as the preferred screening
strategy. Suggested alternatives are annual stool
testing with guaiac or immunochemical reagent or
sigmoidoscopy every five years with or without annual
stool testing. The NCCN did not come to consensus
regarding CT colonography as a screening modality.

13. • general recommendation that screening begin
at age 40 if there is a history of early
colorectal cancer in a first-degree relative
• begin screening 10 years before the age the
cancer was diagnosed in the affected relative

14. ACG guidelines in patients with family
history
• Screen with colonoscopy.
• If a single first-degree relative was diagnosed at age 60
years or older with CRC or an advanced adenoma (≥1
cm, or high-grade dysplasia, or villous elements),
screening with colonoscopy is recommended every 10
years beginning at age 50, consistent with one option
for average risk screening.
• If a single first-degree relative was diagnosed before 60
years with CRC or an advanced adenoma, or two or
more first-degree relatives had colorectal cancer or
advanced adenomas at any age, screening with
colonoscopy is recommended at age 40 or 10 years
before the youngest relative's diagnosis, to be repeated
every five years.

15. Thank you