Everyone needs a colonoscopy at 50 for colorectal cancer prevention, but what if…they simply refuse? They can’t afford it due to insurance issues? We seem to have forgotten that the updated ACG guidelines of 2009 for first time recommend use of annual stool FIT testing as “the preferred cancer detection test” if colonoscopy was not available or refused. How does FIT differ from our venerable stool guaiac testing? And is it finally time to discard gFOBT (AKA guaiac testing) as an insensitive and nonspecific diagnostic tool? Join our conversation and see how FIT testing fits our current screening guidelines, your patients’ financial limitations, and your excellent medical care.
Colorectal Cancer Screening - What does the evidence really say?Jarrod Lee
Colorectal cancer is one of the most common cancers around the world. Screening has been proven to detect cancers in early curable stages, and to even prevent them. Yet, few topics are as controversial as colorectal cancer screening in medicine today. We take an evidence based approach to examine what the science truly says about the different modalities of cancer screening.
March 2019 - Polyps and Prevention: The Importance of Screening for Colorecta...Fight Colorectal Cancer
This document summarizes a webinar on polyps and colorectal cancer screening. The webinar discusses how colon cancer develops from polyps, screening guidelines based on age and risk factors, and various screening options including colonoscopy and fecal immunochemical tests. It emphasizes that screening is effective at detecting cancer early by finding and removing polyps, but that uptake remains low, with factors at the patient, provider and systems levels influencing screening rates. Modifying diet and lifestyle, such as increasing fiber intake and physical activity, can also help to lower colon cancer risk.
Colorectal cancer screening aims to detect cancer early and prevent cancer by removing precancerous polyps. Screening decreases colorectal cancer incidence and mortality in those over 50 by finding cancer at earlier stages. However, incidence and mortality have increased in younger adults in recent decades. Current guidelines recommend starting screening at 45 or 50 depending on risk factors, but starting at 45 is controversial due to costs and potential strain on resources. The main objectives of screening are detecting cancer early and removing polyps to prevent cancer.
Tailoring Colorectal Cancer Treatment: Sidedness, Biomarkers - August 2018 CR...Fight Colorectal Cancer
This month’s FightCRC webinar, Dr. Kanwal Raghav will spend the hour diving into the research behind two biomarkers related to colorectal cancer: HER2 and sidedness. This informative session will talk about the biomarkers that researchers are studying, as they may affect your treatment plan. Knowing your biomarkers will allow you to be your own best advocate.
This document summarizes an expert presentation on upper GI cancers. It discusses trials investigating optimal treatment approaches for resectable gastric and esophageal cancers, including the role of chemotherapy and radiation therapy. Novel immunotherapies and targeted agents for gastric cancer are also reviewed, such as the FAST trial combining chemotherapy with an anti-CLDN18 antibody. For pancreatic cancer, the ESPAC-4 trial found that adding capecitabine to gemcitabine improved survival compared to gemcitabine alone.
The document discusses results from the CheckMate-142 trial evaluating nivolumab monotherapy for MSI-H metastatic colorectal cancer. It found that 34% of patients had an objective response to nivolumab and 62% had disease control. Responses were seen across patient groups regardless of number and type of prior therapies.
Colorectal Cancer Screening - What does the evidence really say?Jarrod Lee
Colorectal cancer is one of the most common cancers around the world. Screening has been proven to detect cancers in early curable stages, and to even prevent them. Yet, few topics are as controversial as colorectal cancer screening in medicine today. We take an evidence based approach to examine what the science truly says about the different modalities of cancer screening.
March 2019 - Polyps and Prevention: The Importance of Screening for Colorecta...Fight Colorectal Cancer
This document summarizes a webinar on polyps and colorectal cancer screening. The webinar discusses how colon cancer develops from polyps, screening guidelines based on age and risk factors, and various screening options including colonoscopy and fecal immunochemical tests. It emphasizes that screening is effective at detecting cancer early by finding and removing polyps, but that uptake remains low, with factors at the patient, provider and systems levels influencing screening rates. Modifying diet and lifestyle, such as increasing fiber intake and physical activity, can also help to lower colon cancer risk.
Colorectal cancer screening aims to detect cancer early and prevent cancer by removing precancerous polyps. Screening decreases colorectal cancer incidence and mortality in those over 50 by finding cancer at earlier stages. However, incidence and mortality have increased in younger adults in recent decades. Current guidelines recommend starting screening at 45 or 50 depending on risk factors, but starting at 45 is controversial due to costs and potential strain on resources. The main objectives of screening are detecting cancer early and removing polyps to prevent cancer.
Tailoring Colorectal Cancer Treatment: Sidedness, Biomarkers - August 2018 CR...Fight Colorectal Cancer
This month’s FightCRC webinar, Dr. Kanwal Raghav will spend the hour diving into the research behind two biomarkers related to colorectal cancer: HER2 and sidedness. This informative session will talk about the biomarkers that researchers are studying, as they may affect your treatment plan. Knowing your biomarkers will allow you to be your own best advocate.
This document summarizes an expert presentation on upper GI cancers. It discusses trials investigating optimal treatment approaches for resectable gastric and esophageal cancers, including the role of chemotherapy and radiation therapy. Novel immunotherapies and targeted agents for gastric cancer are also reviewed, such as the FAST trial combining chemotherapy with an anti-CLDN18 antibody. For pancreatic cancer, the ESPAC-4 trial found that adding capecitabine to gemcitabine improved survival compared to gemcitabine alone.
The document discusses results from the CheckMate-142 trial evaluating nivolumab monotherapy for MSI-H metastatic colorectal cancer. It found that 34% of patients had an objective response to nivolumab and 62% had disease control. Responses were seen across patient groups regardless of number and type of prior therapies.
*Based on retrospective analysis of 2018 patients from the First BEAT trial
Okines A, et al. Br J Cancer. 2009;101:1033-1038.
*Clinical practice refers to outcomes seen in a large clinical trial, not necessarily guidelines.
Treating the Patient With Newly Diagnosed Metastatic Colorectal Cancer
clinicaloptions.com/oncology
Recommended Treatment Plan
FOLFOXIRI + bevacizumab for 6 months as neoadjuvant
therapy
Re-evaluate for resection after 3 months of therapy
If resection possible after 6 months, proceed with
resection
Evolving recommendations in prostate cancer screeningsummer elmorshidy
Prostate cancer screening recommendations have evolved as more evidence has emerged. Early approaches recommended annual PSA screening for all men over 50, but two large trials had conflicting results. One found no mortality benefit, while the other found a 21% reduction in men aged 55-69. However, significant overdiagnosis and harms were recognized, including false positives in 75% of biopsied men. Current guidelines recommend shared decision making for screening in men 55-69 and against screening for other age groups. Improved tests are still needed to better distinguish indolent from aggressive cancers.
This document discusses genetics implications for survivorship programs. It highlights identifying patients who were previously missed for genetic testing and may benefit from re-testing given advances in panel testing. It also reviews managing hereditary cancer risks and addressing the psychosocial issues patients face, such as making difficult medical decisions, informing relatives, and dealing with feelings of guilt. Survivorship programs can help such patients navigate these medical and familial implications.
This document discusses novel biomarkers for the diagnosis of ovarian carcinoma. It begins by describing commonly used biomarkers like CA125, which is elevated in 80-85% of advanced ovarian cancer cases but only 50% of stage I cases. The document then explores potential gene-based biomarkers like mutations in BRCA1, BRCA2, and DNA mismatch repair genes. It also discusses epigenetic changes and gene expression profiles. Turning to protein-based biomarkers, the document outlines approaches like proteomic pattern diagnostics and the OVA1 panel of biomarkers. Overall, the document reviews a variety of emerging genetic, epigenetic and protein-based biomarkers for ovarian cancer diagnosis but notes that no single novel biomarker has yet proven clinically useful
This document discusses high grade serous ovarian cancer (HGSOC), the most common and aggressive form of ovarian cancer. It provides details on:
- HGSOC is driven primarily by DNA copy number changes rather than recurrent mutations.
- Opportunities for targeted therapies exist for genomic aberrations impacting p53, homologous recombination repair, and other commonly mutated genes.
- Improving rates of complete tumor resection (R0) through a personalized surgical approach can significantly improve patient outcomes.
- Several clinical trials are exploring targeted agents and immunotherapy approaches, along with developing patient-derived xenograft models to advance precision medicine for HGSOC.
This document summarizes recent trends in colorectal cancer incidence among young adults in the United States. It finds that rates of colorectal cancer among those under 50 have been rising about 2-3% annually since the early 1990s. This is concerning as colorectal cancer typically affects older adults. Risk factors like obesity, lack of physical activity, and unhealthy diets may be contributing to earlier onset of the disease. More research is still needed to understand the full causes of the increasing trends in young adults. The document recommends awareness of family history to guide early screening when appropriate.
Genetic Syndromes and Thyroid Cancer by Pamela Brock, MS, LGCOSUCCC - James
This document discusses genetic syndromes associated with non-medullary thyroid cancer. It begins by outlining the objectives of reviewing established genetic conditions, discussing new candidate genes, and exploring genetic testing options. It then provides details on several known genetic syndromes and their associated thyroid cancer risks, including Cowden syndrome, Familial adenomatous polyposis, Carney complex, and Werner syndrome. It also discusses emerging candidate genes like CHEK2, DICER1, and MUTYH and their potential links to thyroid cancer. The document concludes by noting the low yield of genetic testing in familial non-medullary thyroid cancer cases but provides strategies to identify higher risk families.
HTAi 2015 - Cost-effectiveness analysis of bevacizumab and cetuximab in advan...REBRATSoficial
This document summarizes a cost-effectiveness analysis of treatment strategies for metastatic colorectal cancer in Brazil. It finds that adding monoclonal antibodies like bevacizumab and cetuximab to chemotherapy improves survival but that the strategies are not cost-effective in Brazil's public health system as the cost per life year gained is over the hypothetical threshold of 3 times GDP per capita. The analysis uses a Markov model to compare costs and outcomes of 3 treatment sequences over a lifetime, finding that chemotherapy alone without antibodies has the best cost-effectiveness profile.
Chair and Presenter, Prof Eric Van Cutsem, MD, PhD, and Scott Kopetz, MD, PhD, prepared useful Practice Aids pertaining to colorectal cancer for this CME/MOC/NCPD activity titled “Putting a Personalized Colorectal Cancer Treatment Algorithm Into Practice: Navigating Practicalities in the Era of Molecularly Defined Care.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD information, and to apply for credit, please visit us at https://bit.ly/3aSSAtm. CME/MOC/NCPD credit will be available until November 13, 2022.
The document discusses a prostate cancer test called the Prostate Core Mitomic Test (PCMT) that detects large-scale mitochondrial DNA deletions to help determine if a negative prostate biopsy result represents a true negative or false negative. It provides examples of two patients (Patient A and B) where PCMT identified one as low risk for undiagnosed cancer after a negative biopsy (true negative) while identifying the other as high risk (false negative). The document promotes PCMT as helping physicians confidently stratify patients, avoid unnecessary repeat biopsies, and better manage patient care through early cancer detection.
Update on Systemic Therapy for Metastatic Pancreas AdenocarcinomaOSUCCC - James
The document discusses treatment options for metastatic pancreatic cancer. For first-line therapy, FOLFIRINOX is an option but is reserved for younger, healthier patients due to toxicity. Gemcitabine plus nab-paclitaxel is a preferred first-line option. For second-line therapy after progression on gemcitabine, nanoliposomal irinotecan plus 5-FU/LV has shown a survival benefit compared to 5-FU/LV alone. Molecular profiling of pancreatic tumors has identified subtypes that could help guide targeted therapies, and immune-based approaches also offer promise. The James Cancer Hospital is conducting clinical trials evaluating novel combinations for both first-line and second-line metastatic pancreatic cancer
This document summarizes information on biomarkers for ovarian cancer, including CA-125, HE4, and risk algorithms like ROMA and OVA1. It discusses several studies on the diagnostic performance of these biomarkers alone and in combination for detecting ovarian cancer, especially early-stage disease. The document also reviews recommendations and guidelines for the use of CA-125 testing in different clinical contexts. Finally, it presents findings from a study showing that hormone receptor expression levels have prognostic value for survival in certain ovarian cancer histological subtypes.
FIRE 3 Trail FOLFIRI+Cetuximab Vs FOLFIRI+BevacizumabAhmed Allam
This randomized, open-label, phase 3 trial compared FOLFIRI plus cetuximab (C+F) versus FOLFIRI plus bevacizumab (B+F) as first-line treatment for KRAS wild-type metastatic colorectal cancer. The trial found that C+F resulted in improved progression-free survival and overall survival compared to B+F. C+F was associated with increased rates of acneiform rash, paronychia, and hypomagnesemia but similar rates of other adverse events compared to B+F. The trial demonstrated that for patients with KRAS wild-type mCRC, first-line treatment with C+F provided superior
New Trends in the Management of Metastatic Prostate Cancerflasco_org
This document discusses new trends in the management of metastatic prostate cancer. It begins with an overview of the clinical states of prostate cancer progression. It then presents a case study of an 85-year-old man with extensive bone metastases from prostate cancer who experienced a significant response to docetaxel chemotherapy. The document reviews several major clinical trials that established the role of docetaxel chemotherapy for newly diagnosed metastatic prostate cancer. It discusses factors like disease volume and age that influence decisions about chemotherapy. The role of androgen-targeted therapies like abiraterone and enzalutamide both before and after chemotherapy is examined. Limitations in the effectiveness of these therapies are presented. The potential for biomarkers like AR-V7 to
1. The document summarizes results from the EURO-E.W.I.N.G. 99 clinical trial for patients with high-risk localized or pulmonary metastatic Ewing sarcoma.
2. For patients with high-risk localized disease, consolidation with busulfan and melphalan was associated with improved event-free and overall survival compared to chemotherapy alone.
3. For patients with pulmonary metastases, consolidation with busulfan and melphalan did not improve outcomes over chemotherapy with vincristine, doxorubicin, ifosfamide, etoposide, and lung irradiation.
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
Screening, Surveillance And Diagnosis Of Colorectal Cancerensteve
Screening and surveillance for colorectal cancer involves assessing risk based on family history and personal medical history to determine appropriate screening methods and schedules. The National Bowel Cancer Screening Program in Australia uses fecal immunochemical testing every 2 years for average risk individuals aged 50-74, with colonoscopy for positive tests. Participation rates are around 40-50% and cancer detection rates are around 5% for those undergoing colonoscopy. Ongoing evaluation aims to improve participation and outcomes.
This document provides updates to guidelines for several types of cancer screening, including breast, colorectal, cervical, prostate, lung, and ovarian cancer. For each cancer, it discusses what screening tests are recommended, for which populations and age groups, and how frequently screening should occur. It also notes some controversial issues and new recommendations from groups like the US Preventive Services Task Force.
*Based on retrospective analysis of 2018 patients from the First BEAT trial
Okines A, et al. Br J Cancer. 2009;101:1033-1038.
*Clinical practice refers to outcomes seen in a large clinical trial, not necessarily guidelines.
Treating the Patient With Newly Diagnosed Metastatic Colorectal Cancer
clinicaloptions.com/oncology
Recommended Treatment Plan
FOLFOXIRI + bevacizumab for 6 months as neoadjuvant
therapy
Re-evaluate for resection after 3 months of therapy
If resection possible after 6 months, proceed with
resection
Evolving recommendations in prostate cancer screeningsummer elmorshidy
Prostate cancer screening recommendations have evolved as more evidence has emerged. Early approaches recommended annual PSA screening for all men over 50, but two large trials had conflicting results. One found no mortality benefit, while the other found a 21% reduction in men aged 55-69. However, significant overdiagnosis and harms were recognized, including false positives in 75% of biopsied men. Current guidelines recommend shared decision making for screening in men 55-69 and against screening for other age groups. Improved tests are still needed to better distinguish indolent from aggressive cancers.
This document discusses genetics implications for survivorship programs. It highlights identifying patients who were previously missed for genetic testing and may benefit from re-testing given advances in panel testing. It also reviews managing hereditary cancer risks and addressing the psychosocial issues patients face, such as making difficult medical decisions, informing relatives, and dealing with feelings of guilt. Survivorship programs can help such patients navigate these medical and familial implications.
This document discusses novel biomarkers for the diagnosis of ovarian carcinoma. It begins by describing commonly used biomarkers like CA125, which is elevated in 80-85% of advanced ovarian cancer cases but only 50% of stage I cases. The document then explores potential gene-based biomarkers like mutations in BRCA1, BRCA2, and DNA mismatch repair genes. It also discusses epigenetic changes and gene expression profiles. Turning to protein-based biomarkers, the document outlines approaches like proteomic pattern diagnostics and the OVA1 panel of biomarkers. Overall, the document reviews a variety of emerging genetic, epigenetic and protein-based biomarkers for ovarian cancer diagnosis but notes that no single novel biomarker has yet proven clinically useful
This document discusses high grade serous ovarian cancer (HGSOC), the most common and aggressive form of ovarian cancer. It provides details on:
- HGSOC is driven primarily by DNA copy number changes rather than recurrent mutations.
- Opportunities for targeted therapies exist for genomic aberrations impacting p53, homologous recombination repair, and other commonly mutated genes.
- Improving rates of complete tumor resection (R0) through a personalized surgical approach can significantly improve patient outcomes.
- Several clinical trials are exploring targeted agents and immunotherapy approaches, along with developing patient-derived xenograft models to advance precision medicine for HGSOC.
This document summarizes recent trends in colorectal cancer incidence among young adults in the United States. It finds that rates of colorectal cancer among those under 50 have been rising about 2-3% annually since the early 1990s. This is concerning as colorectal cancer typically affects older adults. Risk factors like obesity, lack of physical activity, and unhealthy diets may be contributing to earlier onset of the disease. More research is still needed to understand the full causes of the increasing trends in young adults. The document recommends awareness of family history to guide early screening when appropriate.
Genetic Syndromes and Thyroid Cancer by Pamela Brock, MS, LGCOSUCCC - James
This document discusses genetic syndromes associated with non-medullary thyroid cancer. It begins by outlining the objectives of reviewing established genetic conditions, discussing new candidate genes, and exploring genetic testing options. It then provides details on several known genetic syndromes and their associated thyroid cancer risks, including Cowden syndrome, Familial adenomatous polyposis, Carney complex, and Werner syndrome. It also discusses emerging candidate genes like CHEK2, DICER1, and MUTYH and their potential links to thyroid cancer. The document concludes by noting the low yield of genetic testing in familial non-medullary thyroid cancer cases but provides strategies to identify higher risk families.
HTAi 2015 - Cost-effectiveness analysis of bevacizumab and cetuximab in advan...REBRATSoficial
This document summarizes a cost-effectiveness analysis of treatment strategies for metastatic colorectal cancer in Brazil. It finds that adding monoclonal antibodies like bevacizumab and cetuximab to chemotherapy improves survival but that the strategies are not cost-effective in Brazil's public health system as the cost per life year gained is over the hypothetical threshold of 3 times GDP per capita. The analysis uses a Markov model to compare costs and outcomes of 3 treatment sequences over a lifetime, finding that chemotherapy alone without antibodies has the best cost-effectiveness profile.
Chair and Presenter, Prof Eric Van Cutsem, MD, PhD, and Scott Kopetz, MD, PhD, prepared useful Practice Aids pertaining to colorectal cancer for this CME/MOC/NCPD activity titled “Putting a Personalized Colorectal Cancer Treatment Algorithm Into Practice: Navigating Practicalities in the Era of Molecularly Defined Care.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD information, and to apply for credit, please visit us at https://bit.ly/3aSSAtm. CME/MOC/NCPD credit will be available until November 13, 2022.
The document discusses a prostate cancer test called the Prostate Core Mitomic Test (PCMT) that detects large-scale mitochondrial DNA deletions to help determine if a negative prostate biopsy result represents a true negative or false negative. It provides examples of two patients (Patient A and B) where PCMT identified one as low risk for undiagnosed cancer after a negative biopsy (true negative) while identifying the other as high risk (false negative). The document promotes PCMT as helping physicians confidently stratify patients, avoid unnecessary repeat biopsies, and better manage patient care through early cancer detection.
Update on Systemic Therapy for Metastatic Pancreas AdenocarcinomaOSUCCC - James
The document discusses treatment options for metastatic pancreatic cancer. For first-line therapy, FOLFIRINOX is an option but is reserved for younger, healthier patients due to toxicity. Gemcitabine plus nab-paclitaxel is a preferred first-line option. For second-line therapy after progression on gemcitabine, nanoliposomal irinotecan plus 5-FU/LV has shown a survival benefit compared to 5-FU/LV alone. Molecular profiling of pancreatic tumors has identified subtypes that could help guide targeted therapies, and immune-based approaches also offer promise. The James Cancer Hospital is conducting clinical trials evaluating novel combinations for both first-line and second-line metastatic pancreatic cancer
This document summarizes information on biomarkers for ovarian cancer, including CA-125, HE4, and risk algorithms like ROMA and OVA1. It discusses several studies on the diagnostic performance of these biomarkers alone and in combination for detecting ovarian cancer, especially early-stage disease. The document also reviews recommendations and guidelines for the use of CA-125 testing in different clinical contexts. Finally, it presents findings from a study showing that hormone receptor expression levels have prognostic value for survival in certain ovarian cancer histological subtypes.
FIRE 3 Trail FOLFIRI+Cetuximab Vs FOLFIRI+BevacizumabAhmed Allam
This randomized, open-label, phase 3 trial compared FOLFIRI plus cetuximab (C+F) versus FOLFIRI plus bevacizumab (B+F) as first-line treatment for KRAS wild-type metastatic colorectal cancer. The trial found that C+F resulted in improved progression-free survival and overall survival compared to B+F. C+F was associated with increased rates of acneiform rash, paronychia, and hypomagnesemia but similar rates of other adverse events compared to B+F. The trial demonstrated that for patients with KRAS wild-type mCRC, first-line treatment with C+F provided superior
New Trends in the Management of Metastatic Prostate Cancerflasco_org
This document discusses new trends in the management of metastatic prostate cancer. It begins with an overview of the clinical states of prostate cancer progression. It then presents a case study of an 85-year-old man with extensive bone metastases from prostate cancer who experienced a significant response to docetaxel chemotherapy. The document reviews several major clinical trials that established the role of docetaxel chemotherapy for newly diagnosed metastatic prostate cancer. It discusses factors like disease volume and age that influence decisions about chemotherapy. The role of androgen-targeted therapies like abiraterone and enzalutamide both before and after chemotherapy is examined. Limitations in the effectiveness of these therapies are presented. The potential for biomarkers like AR-V7 to
1. The document summarizes results from the EURO-E.W.I.N.G. 99 clinical trial for patients with high-risk localized or pulmonary metastatic Ewing sarcoma.
2. For patients with high-risk localized disease, consolidation with busulfan and melphalan was associated with improved event-free and overall survival compared to chemotherapy alone.
3. For patients with pulmonary metastases, consolidation with busulfan and melphalan did not improve outcomes over chemotherapy with vincristine, doxorubicin, ifosfamide, etoposide, and lung irradiation.
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
Screening, Surveillance And Diagnosis Of Colorectal Cancerensteve
Screening and surveillance for colorectal cancer involves assessing risk based on family history and personal medical history to determine appropriate screening methods and schedules. The National Bowel Cancer Screening Program in Australia uses fecal immunochemical testing every 2 years for average risk individuals aged 50-74, with colonoscopy for positive tests. Participation rates are around 40-50% and cancer detection rates are around 5% for those undergoing colonoscopy. Ongoing evaluation aims to improve participation and outcomes.
This document provides updates to guidelines for several types of cancer screening, including breast, colorectal, cervical, prostate, lung, and ovarian cancer. For each cancer, it discusses what screening tests are recommended, for which populations and age groups, and how frequently screening should occur. It also notes some controversial issues and new recommendations from groups like the US Preventive Services Task Force.
Use of MicroRNAs to Screen for Colon CancerMostafa Gouda
This document discusses using microRNAs (miRNAs) to screen for colon cancer. It notes that current screening methods like fecal occult blood tests (FOBT) and colonoscopy have limitations. FOBT lacks sensitivity and requires dietary restrictions, while colonoscopy is invasive, costly, and can lead to complications. The document proposes that a screening approach using stable miRNAs extracted from stool or blood through commercial kits could provide a more preferable noninvasive option compared to other screening methods. Such a miRNA-based test could potentially make a significant impact on preventing colon cancer if further developed and validated.
This document provides an overview of colorectal cancer screening. It discusses the rationale for screening, including identifying precancerous polyps and cancer at early stages to improve outcomes. Risk factors like family history and medical conditions are assessed to determine screening frequency. Guidelines recommend starting screening at age 45-50 and discontinuing it between ages 75-86 depending on risk level and life expectancy. Screening tests include stool tests done yearly and structural exams of the colon done every 5-10 years. Follow up is needed if initial screening tests abnormal results. The document highlights ensuring equitable access to screening and a need to increase screening rates in resource-limited settings.
This document discusses various types of cancer screening. It begins by explaining the purpose and benefits of screening, as well as some limitations. It then outlines recommendations for breast, cervical, colorectal, genetic, lung, and prostate cancer screening. For each type of cancer, it provides details on screening modalities, intervals, and considerations for increased risk populations. The goal of screening is to detect cancer early before symptoms appear, but it must be weighed against potential harms.
This document discusses cancer screening guidelines for several common cancers. It recommends screening for breast cancer with annual mammograms and clinical exams starting at age 40, and beginning earlier or including MRI for those at high risk. Cervical cancer screening should begin at age 21 with Pap tests every 3 years or co-testing with HPV every 5 years. Colorectal cancer screening options include colonoscopy every 10 years, sigmoidoscopy every 5 years, or annual fecal tests. Genetic screening is recommended for those with a family history suggesting inherited cancer risk. Lung cancer screening with low-dose CT is advised for high-risk smokers aged 55-74. Prostate cancer screening involves PSA testing and DRE for men aged 50-69
This document discusses guidelines for cancer screening and the National Cancer Control Programme in India. It provides screening guidelines for several common cancers, including breast, cervical, colorectal, lung and prostate cancer. Screening aims to detect cancer before symptoms appear using tests such as blood tests, medical imaging or stool tests. Early detection can improve health outcomes. The National Cancer Control Programme also aims to increase awareness and improve access to screening and treatment services across India.
This document discusses colorectal cancer screening. It notes that colorectal cancer is the third most common cancer in the US and screening and polyp removal have led to declines in incidence and mortality. Screening allows detection of cancers earlier when they are more treatable. The document reviews various screening test options and recommendations, including colonoscopy, flexible sigmoidoscopy, fecal occult blood tests, and stool DNA tests. It emphasizes the importance of using high sensitivity fecal occult blood tests and making screening recommendations to improve low screening rates.
Petruzziello L. La Colonscopia di qualità e le Procedure operative. ASMaD 2016Gianfranco Tammaro
1) Colorectal cancer screening through colonoscopy has been shown to reduce CRC incidence and mortality by detecting and removing precancerous polyps.
2) Quality indicators like adequate bowel preparation, adenoma detection rates, and cecal intubation rates are important for colonoscopy effectiveness.
3) New technologies like HD imaging, water jets, and wide-angle endoscopes aim to improve polyp detection rates and make the procedure more comfortable and effective.
The COLONPREV trial compared fecal immunochemical testing every 2 years to a one-time colonoscopy for colorectal cancer screening in asymptomatic adults ages 50-69. An interim analysis found that FIT was non-inferior to colonoscopy for detecting colon cancer, though colonoscopy identified more adenomas. The main criticism is that the study is not yet completed, with mortality data to be collected through 2021. A limitation of FIT is that it cannot identify adenomas like colonoscopy can.
CES202002 - 08 - Cáncer de colon y rectoMauricio Lema
This document provides information about colorectal cancer (colon and rectal cancer), including:
- Epidemiology statistics showing it is the second leading cause of cancer death worldwide and the third in Colombia. Survival rates are much lower in Colombia compared to the US.
- Risk factors including diet high in fat and calories, inflammatory bowel disease, family history, and certain hereditary syndromes.
- Screening recommendations in Colombia include annual fecal immunochemical testing for those at average risk starting at age 50.
- Presenting symptoms vary depending on tumor location but can include anemia, abdominal pain, changes in bowel habits.
- The TNM staging system is used to classify tumors based on
This document discusses screening and diagnosis of colorectal cancer. It covers risk factors like aging, hereditary factors, diet, and inflammatory bowel disease. Common presentations include changes in bowel habits, hematochezia, and obstructive symptoms. Screening tests aim to detect early-stage cancer and include colonoscopy every 10 years, annual fecal immunochemical testing, and computed tomography colonography every 5 years. For high-risk patients, more frequent screening is recommended. Diagnostic tests following positive screening include colonoscopy, stool DNA testing, and imaging. Genetic testing guides screening for familial cancer syndromes.
This document provides an overview of endoscopic eradication therapy for Barrett's esophagus. It begins with definitions of Barrett's esophagus and risk factors. It then discusses the progression of Barrett's to malignancy and guidelines for screening and diagnosis. Treatment options including endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) are reviewed. The document presents data on the efficacy, safety, and durability of EMR and RFA. It concludes with an overview of the author's experience treating Barrett's esophagus at Northwestern University.
This document summarizes new guidelines and current issues regarding colorectal cancer screening. It discusses efficacy versus effectiveness of screening strategies and quality indicators for colonoscopy, such as adenoma detection rates and withdrawal times. While withdrawal time alone may not predict future neoplasia, adenoma detection rates over 20% are associated with lower risk of interval cancer. Endoscopist specialty and volume have shown mixed results as predictors of colonoscopy quality outcomes. Overall, the document emphasizes the importance of quality standards and monitoring in colorectal cancer screening programs.
ROI of Colorectal Cancer Screening - Colorado Cancer Coalition - Colorado Bus...Ryan Kerr
The Colorado Cancer Coalition presented to the Colorado Business Group on Health.
The aim of the presentation was to inform Colorado Businesses of the clinical and financial improvement opportunity that exists within the Colorectal Cancer space.
This document discusses cancer screening for seniors and whether it makes sense. It notes that reasons not to screen everyone include costs, potential harms from false positives or procedures, and factors related to life expectancy and health status. It provides examples of famous people who died of pancreatic cancer and notes that screening for pancreatic cancer is not recommended. It asks questions about the most common cancers, typical cancer ages, beneficial screening tests, and best screening advice. It discusses stopping screening at age 75 but continuing for those expected to live 10 more years. It provides resources on cancer screening guidelines.
Global Medical Cures™ | COLORECTAL CANCER TESTS SAVE LIVES
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Dr. Murphy presents slides discussing general screening trends in the US, including how the US compares to other countries, different screening modalities, and differences in screening by:
-Age
-Gender
-Geography
-Race/Ethnicity
I need a response for the 2 peers belowMany disorders, eskarinorchard1
I need a response for the 2 peers below:
Many disorders, especially malignancies, are asymptomatic in their early stages. Consequently, it is imperative that health care providers provide routine screenings so that diseases can be detected early on and prevention and treatment can be implemented if necessary. Screening is in no way a cure for diseases, but it provides a means to detect diseases before symptoms start. Screenings include Pap smear to detect cervical cancer, mammograms to detect breast cancer, colonoscopy to detect colorectal cancer, and low dose CT scan to detect lung cancer (Centers for Disease Control and Prevention (CDC), 2020).
Enacted in 1984, the U. S. Preventive Task Force (USPTF) is an independent group of experts from several specialties, such as pediatrics, primary care, behavioral health, and nursing, that strive to provide knowledge and advice on various interventions and preventive services for diseases based on evidence-based research (D’Andrea, Ahnen, Sussman, & Najafzadeh, 2019). The USPTF helps shape medicine by assisting health care professionals and patients to prevent and treat diseases. Patients and clinicians collectively decide what treatment is best for the patient based on the recommendation of “best practice” disseminated by the USPTF (D’ Andrea et al., 2019). The ultimate goal of USPFT is to promote and improve the health of Americans by enacting clinical preventive measures based on scientific research.
Colorectal Cancer Screening Recommendation
The USPFT has several recommendations in place regarding screening for colorectal cancer, which is a collective group of cancers that affects the large intestine (the colon) and/or the rectum. This type of cancer usually starts in the colon, preliminary as polyps in many cases, and then metastasize as cancerous cells to proximal areas of the gastrointestinal system or reproductive organs (American Cancer Society, 2020). According to the American Cancer Society, the recommendation for individuals of average risk of colorectal cancer is screening starting at age 45, with either a stool-based test that detects cancer cells in the stool or an imaging exam that visualizes the structures of the colon and rectum.
The American Cancer Society (2020) recommends that individuals who are in “good health and a life expectancy of at least 10 years” should continue to be screened for colorectal cancer until they are 75 years of age. For individuals 76 to 85 years of age, the choice to continue to be screened should be based on the preference of the patient, their life expectancy, overall health status, and outcome of prior screenings (American Cancer Society, 2020). Screening is not recommended for individuals over the age of 85 due to their decreased life expectancy with or without the disease (American Cancer Society, 2020).
The American Cancer Society (2020) reports that testing for colorectal is separated by stool-based testing or visualization of images. The ...
Similar to What Their Poo Can Tell You: How FIT (iFOBT) Fits Your Colorectal Cancer Algorithm (20)
Holistic Management as an Adjunct in IBD: Encourage your patient to own the...Patricia Raymond
The document discusses the potential for holistic management approaches as adjunct treatments for inflammatory bowel disease (IBD). It provides information on several ways patients can self-monitor their disease activity through indices like CDAI, UCDAI, and P-SCCAI. It also reviews evidence on the role of vitamin D supplementation, dietary changes, cannabis use, and lifestyle factors like exercise and meditation in managing IBD symptoms. While some studies found improvements in outcomes from these approaches, the evidence has limitations and their long-term impact requires more research.
Hash It Out: The Role of Medical Marijuana in GIPatricia Raymond
Marijuana's side effect of Cannabinoid Hyperemesis Syndrome is well known to us, as is use of Marinol to enhance appetite in the chronically ill, but are there other high points in the use of medical marijuana? What about the possible use of CBD oil for chronic pancreatitis or intractable abdominal pain?
Studies have shown cannabis' effect on GI motility, inflammation and immunity, intestinal and gastric acid secretion, nociception and emesis pathways, and appetite. Let's weed through the available data on the medical use and side effects of medicinal cannabis in gastroenterology.
Celiac Disease: Beyond Bowes, Bone, & Blood Rev 2019Patricia Raymond
Celiac disease can cause iron deficiency anemia, osteoporosis, and malabsorption…but is that all? Nope. There are a huge number of other disease associations with celiac disease beyond just bowels, bone, and blood. Join us for this classic presentation of celiac comorbidities that may alert you to the presence of this woefully under-diagnosed condition.
Diverticulitis: Popular Misconceptions & New Management rev 2019Patricia Raymond
As presented at RMSGNA 2019: Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
Evolving diets in GI Disease 2019 Raymond/GallagherPatricia Raymond
As presented 09/2019 at RMSGNA: In the 50's , doctors recommended smoking for your health. More recently gastroenterologists told patients with ulcers to drink milk and eat bread to heal.
Are you using new science based dietary information for your patients? It's time to update your timeworn dietary strategies and handouts. Join us and review the science on recent advances in dietary management for gastrointestinal disorders: Fatty liver, IBS, IBD, Gastroparesis, Post gastric bypass, Diverticulosis, Cirrhosis, and more!
Examine historical misinformation in dietary management of gastrointestinal disorders
Describe the emerging evidence supporting the primary role of dietary therapies in digestive disease including Irritable Bowel Syndrome, Inflammatory Bowel Disease, Small Intestinal Bacterial Overgrowth, Non-Alcoholic Fatty Liver Disease, Gastroparesis, Pancreatitis, Post-Gastric Bypass, and Diverticulitis.
Identify the role of the Registered Dietitian and the importance of a multi-disciplinary approach to the management of digestives diseases
Know GI Inside & Out? Recognizing Skin Lesions of GI DisordersPatricia Raymond
Skin lesions seen with disorders of the digestive tract are not rare; would you recognize and correctly correlate erythema nodosum, dermatitis herpetiformis, pyoderma gangrenosum? Those were easy-- how about pyoderma vegetans, pyostomatitis vegetans, sweet’s syndrome, xanthomas, tripe palms, palmoplantar keratoderma, or trichilemmomas? Stumped?
Join us and learn the art of GI diagnosis without resorting to our endoscopes.
Fun Functional Gallbladder Disorders: Update on Hypo and Hyperkinetic Gallbla...Patricia Raymond
Functional gallbladder disorder is biliary pain from motility disturbance in the absence of gallstones, sludge, or microcrystal disease. In patients with biliary-type pain and a normal US, the prevalence is 8% men and 21% women. We will review the clinical manifestations, diagnosis, and management of patients with suspected functional gallbladder disorder, and also address current evaluation and management of sphincter of Oddi dysfunction.
Cyst Assist: Pancreatic Cyst Evaluation & ManagementPatricia Raymond
This document provides an overview of pancreatic cyst evaluation and management. It discusses the prevalence of incidentally detected pancreatic cysts on imaging and categorizes cysts as benign, pseudocysts, or one of four subtypes of pancreatic cystic neoplasms (PCNs): serous cystic tumors, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and solid pseudopapillary neoplasms. For each PCN subtype, it describes characteristics such as patient demographics, location, risk of malignancy, and management guidelines. It also reviews guidelines for managing pseudocysts and outlines the endoscopic, percutaneous, and surgical drainage options with expected outcomes. In summary,
Kudos To You: Learning your Kudo Pit Patterns and Paris Polyp ClassificationsPatricia Raymond
We've told patients that we won't know about their polyps until after the pathology report is back; turns out that's not precisely true. Today's excellence in optics provides an accurate instantaneous assessment of the histology of colon polyps which may help in decision making during colonoscopy.
Did you know that if a polyp has a type 5 Kudo pit pattern, 50% were invasive cancers to the submucosal layer? What is it about that scary polyp that raises your hackles? Join us in this highly interactive session where we'll learn Kudo pit patterns as well as Paris polyp classifications to elevate your GI procedure reporting and your patient care.
Describe the emerging evidence supporting the primary role of Kudo Pit Patterns in visual inspection of in situ polyps, and demonstrate your ability to identify the patterns
Authentication of Kudo Pits
Pits and their risks
Images of Kudo pits
Quiz of Kudo Pits
Discuss the potential and shortcomings of the Paris Polyp Classification, and demonstrate an ability to classify the polyp shape
Polyp shapes and and their risks (pedunculated, elevated, depressed)
Images of polyps for Paris classification
Polyps and their risks
Quiz of polyp shapes
Concerns regarding interobserver variability
Familial Adenomatous Polyposis affects 1 in 10,000 to 30,000 Americans who experience 100% risk of colon cancer, and FAP doesn't end with a total colectomy for removal of their hundreds of polyps.
Follow this journey of two real FAP patients through pancreatitis from symptomatic ampulla polyps, surgical resection of giant small bowel polyps, bowel obstruction from abdominal desmoid tumors, and Wilm's tumor of the kidney. How do we diagnose, monitor and support our FAP patients? Can pharmacotherapy reduce risk of polyp growth in FAP? What are the extracolonic manifestations of the APC gene mutation? Our responsibility doesn't end when the colon does.
Bored with Barretts: Diagnosing Gastric Intestinal Metaplasia, Meckels, & Pa...Patricia Raymond
We all know what to do with the border disorder that is Barretts, but what about other mucosal heterotopia: intestinal mucosa in the stomach, stomach mucosa in the intestine, pancreas mucosa in the stomach...what's going on with all this meandering mucosa? Join us for a discussion about how to diagnose and manage various misplaced gastrointestinal mucosa.
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Epidemiology and risk factors
Complete and incomplete, types I-III based on mucin expression
Risk of progression to cancer
Proper surveillance and endoscopic mapping
Management
35 min
Meckels
Describe the presumed anatomical development of Meckel's Diverticulum, summarize the 'Rule Of Twos', formulate management of a Meckel's associated cryptic bleed
Who was Meckel
Epidemiology and risk factors
Rule of twos
Risk of bleed
Management
10 min
Pancreatic Rests
Discuss the natural history of Gastric Intestinal Metaplasia and construct proper endoscopic surveillance and mapping guidelines
Review the endoscopic appearance of the Pancreatic Rest, discuss rare symptoms attributable to the finding and current endoscopic evaluation and management
Endoscopic appearance
Anatomic development
Risks for pancreatitis, cancer, obstruction
Endoscopic and surgical management
10 min
The document discusses the visual examination of the belly and navel from anatomical, historical, social, and medical perspectives. Anatomically, the navel is located at the midpoint of the body and develops from the umbilical cord that nourishes the fetus. Historically, many religions and cultures have ascribed spiritual or theological significance to the navel. Medically, examination of the navel can provide clues to intra-abdominal diseases and conditions. Variations in navel appearance like outies can occur normally or indicate issues like hernias.
Do You Believe in Reflux: Idiopathic Pulmonary FibrosisPatricia Raymond
Recent studies suggest that if you have IPF (idiopathic pulmonary fibrosis), that you may not perceive the GERD (reflux) that you have, and that this acid reflux may cause the fibrosis to progress. Ask for proper testing and treatment to see if you are one of the almost 80% of IPF patients who have reflux, often silent reflux.
This document summarizes key points from a presentation on restoring hospitality to hospital care. It emphasizes treating the whole person, not just the disease, and using a patient-centered approach. This involves greeting patients with courtesy, making them feel comfortable, clearly explaining their treatment plan, and finding ways to bring joy to difficult situations. The goal is to win by treating the person, not just curing the disease.
Hospitals have become unfriendly places for patients to be in…rushed, harried staff simply doesn’t have the time to provide the personal touch anymore…or can we? Delighted patients refer their friends and return for repeat procedures.
The ‘Spa Hospital’ addresses our patients’ needs with low or no cost techniques adapted from those used at spas. Attention will also be given to reception and departure from unit, patient privacy concerns, and their lasting impression with reviews of medical literature supporting these techniques.
Diverticulitis: Popular Misconceptions and New ManagementPatricia Raymond
Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
This document contains information from a gastroenterologist on various gastrointestinal conditions including secretory diarrhea, Giardia infection, celiac disease, lactose intolerance, protein-losing enteropathy, small bowel bacterial overgrowth, irritable bowel syndrome, mesenteric ischemia, and Whipple's disease. It includes diagnostic criteria, clinical features, diagnostic tests, treatment recommendations, and prevalence statistics for each condition.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
What Their Poo Can Tell You: How FIT (iFOBT) Fits Your Colorectal Cancer Algorithm
1. Patricia L. Raymond MD FACG
Assistant Professor of Clinical Internal Medicine,
Eastern Virginia Medical School
what their stool can tell you:
How FIT (iFOBT) Fits
Your Colorectal Cancer Algorithm
4. We will cover:
… and perhaps change the tools you use
to detect blood in stool & colorectal cancer.
Screening
verses
detection
gFOBT,
iFOBT,
& the future
iFOBT
compliance
& outcomes
6. -rationale for screening for colorectal cancer
-the polyp-cancer sequence
-American College of Gastroenterology
2008 guidelines
-screening (colonoscopy)
-detection (FIT test)
-American Cancer Society 2012 guidelines
7. We do a poor job preventing colorectal cancer.
142,820 dx in 2013
American Cancer Society estimates
8. Colon Cancer
Statistics
Second leading cause of cancer deaths in the US
142,820 diagnosed, 50,830 deaths estimated for
2013
Early detection = 5 year survival
>90% if local stage
69% if to regional lymph nodes
20% if to distant organs
We don’t detect it early enough
39% local
37% regional
20% distant organs
6% of average risk Americans
will get colon cancer
ACS 2012 Cancer Facts and Figures, Colorectal Cancer Facts & Figures 2011-2013
Image from http://www.danielwagner.com/how-the-guru-send-me-traffic/
9. Polyp-Cancer Sequence
8-12 years
estimated for
polyp to
become cancer
Already a cancer:
Stage 0 Carcinoma in situ
Stage 1 Mucosal
Stage 2 To muscularis
Stage 3 To lymph nodes
Stage 4 To distant organs
10. Stage= Survival
Early detection = 5 year survival
>90% if local stage
69% if to regional lymph nodes
20% if to distant organs
We don’t detect it early enough
39% local
37% regional
20% distant organs
11. ACG 2008 guidelines – it’s been five years, people!
Changes in 2008 guidelines from the 2000 ACG
recommendations for screening
1. Screening tests are divided into cancer prevention
and cancer detection tests. Cancer prevention tests are
preferred over detection tests.
2. Screening is recommended in African Americans
beginning at age 45 years.
3. CT colonography every 5 years replaces double
contrast barium enema as the radiographic screening
alternative, when patients decline colonoscopy.
4. FIT replaces older guaiac-based fecal occult blood
testing. FIT is the preferred cancer detection test.
5. Annual Hemoccult Sensa and fecal DNA testing every
3 years are alternative cancer detection tests.
6. A family history of only small tubular adenomas in
first-degree relatives is not considered to increase the
risk of CRC.
7. Individuals with a single first-degree relative with CRC
or advanced adenomas diagnosed at age ≥60 years can
be screened like average-risk persons.
12. ACG 2008 : Preferred CRC screening recommendations
• Cancer prevention tests should be
offered first. The preferred CRC
prevention test is colonoscopy every
10 years, beginning at
age 50. (Grade 1 B)
• Screening should begin at age 45
years in African Americans
(Grade 2 C)
• Cancer detection test should be
offered to patients who decline
colonoscopy or another cancer
prevention test. The preferred
cancer detection test is annual
FIT for blood (Grade 1 B)
13. Time to discard stool guaiac?
“ ACG supports the joint guideline recommendation that
older guaiac-based fecal occult blood testing be
abandoned as a method for CRC screening.”
14. I’ve got job security. Detection verses prevention.
FIT for those who
refuse colonoscopy.
15. ACS guidelines on colorectal cancer screening & surveillance
Starting at age 50 years, men and women should
undergo one of the following screening tests (average
risk):
US Pharmacist. 2012;37(12):22-26.
Colorectal Cancer Screening Guidelines Update M Steinberg.
• Flexible sigmoidoscopy every 5 y
• Colonoscopy every 10 y
• Double-contrast barium enema every 5 y
• CT colonography every 5 y
• FOBT annually (take-home, multiple-sample method)
• FIT annually (take-home, multiple-sample method)
16. American Cancer Society guidelines
Method DescriptionNotes
Flexible sigmoidoscopy
Flexible, lighted, tubelike video camera
inserted into rectum allows visualization of
entire rectum, but less than half of colon
Requires bowel preparation
Colonoscopy
Flexible, lighted, tubelike video camera
inserted into rectum allows visualization of
entire rectum and colon; has ability to
remove any identified polyps
Requires bowel preparation; use of sedation
requires patient to rely on another person to
drive him/her home after the procedure
Double-contrast barium enema
Barium sulfate suspension is injected with air
into rectum via flexible tube; x-ray images are
taken
Requires bowel preparation; colonoscopy
may be performed to evaluate/remove any
suspicious polyps
CT colonography
Patient lies within scanning machine, which
rotates around him/her taking cross-sectional
images that enable 2-or 3-dimensional
visualization of colon and rectum
Requires bowel preparation; may require
drinkable contrast solution, as well as
insertion of air into colon to improve
visualization; colonoscopy may be performed
to evaluate/remove any suspicious polyps
FOBT
Patient applies stool sample (usually 3
consecutive bowel movements) to test-kit
cards and returns/mails completed kit to
medical office/laboratory
Requires colonoscopy for positive test to
determine cause of bleeding; NSAIDs, aspirin,
vitamin C (>250 mg/day), or red meat ≤3 days
before testing interacts with accuracy; may
not detect nonbleeding tumors
FIT or iFOBT
Patient applies stool sample (usually 2–3
consecutive bowel movements) to test-kit
cards and returns/mails completed kit to
medical office/laboratory
Requires colonoscopy for positive test to
determine cause of bleeding; no dietary
limitations; may not detect nonbleeding
tumors
US Pharmacist. 2012;37(12):22-26.
Colorectal Cancer Screening Guidelines Update M Steinberg.
17. ACS guidelines on increased CRC risk
US Pharmacist. 2012;37(12):22-26.
Colorectal Cancer Screening Guidelines Update M Steinberg.
Increased Risk (due to FH of colorectal cancer)
Risk Category Age/Time to Begin Recommended Test
Colorectal cancer or
adenomatous polyps in any
1st-degree relative <60 y or
≥2 1st-degree relatives at
any age
Age 40 y, or 10 y before
youngest immediate-family
case
Colonoscopy every 5 y
Colorectal cancer or
adenomatous polyps in any
1st-degree relative ≥60 y or
≥2 2nd-degree relatives at
any age
Age 40 y Colonoscopy every 10 y
18. ACS guidelines on high CRC risk
US Pharmacist. 2012;37(12):22-26.
Colorectal Cancer Screening Guidelines Update M Steinberg.
Risk Category Age to Begin Recommended Test(s)
FAP diagnosed by genetic
testing, or suspected
without genetic testing
Age 10–12 y
Yearly flexible
sigmoidoscopy; genetic
testing
HNPCC or FH of condition
Age 20–25 y or 10 y before
youngest immediate-family
case
Colonoscopy every 1–2 y;
genetic testing
Inflammatory bowel
disease
Unclear, but cancer risk begins ≤8 y after Colonoscopy
with biopsy pancolitis onset or 12–15 y after LC onset
every 1–2 y
22. More uninsured, so they get stool testing
at least, right?
http://www.examiner.com/article/free-health-care-101-where-to-find-chicago-s-low-and-no-cost-health-care
23.
24.
25. -causes of false-positives with guaiac-based
FOBT(gFOBT)
- how immunochemical FOBT (iFOBT
or FIT) works
-the future of & development of fecal
DNA testing
27. Standard Guaiac testing
Peroxidase reaction with hemoglobin
turns guaiac impregnated paper blue
Hemoccult sensa is more sensitive
than Hemoccult, Hemoccult-II or
Hemoccult-R
• hydrogen peroxide is dripped onto the
guaiac paper
• oxidizes the alpha-guaiaconic acid to a
blue colored quinone
• occurs very slowly when no blood (& no
peroxidases or catalases from vegetables)
are present
• Heme catalyzes this reaction, giving a
result in about two seconds
• positive test result is one where there is a
quick and intense blue color change of the
film.
Your Meemaw’s gFOBT
Image from http://digital-photography-school.com/forum/how-i-took/59938-chuck-norris-eyedrops.html
Kratochvil JF, et al. (1971). "Isolation and characterization of alpha-guaiaconic acid and the nature of guiacum blue". Phytochem 10: 2529.
28. Dietary restrictions– who actually follows them?
Restrictive diet advised
• high fiber diet x 2 days
• no red meat
• no vitamin C or citrus fruits
• false negatives due to anti-oxidant
properties inhibiting
the color reaction
• no gastric irritant medications
• includes iron
• no peroxidase containing
vegetables (cucumber, cauliflower,
horseradish)
• Reduced compliance with
screening
Biennial (every 2 years) screening
with non-rehydrated specimens
Beg M, et al. (2002). "Occult Gastrointestinal Bleeding: Detection, Interpretation, and Evaluation" JIACM 3 (2): 153–8.
29. Food peroxidases & guaiac testing
In vivo study, N = 61
Peroxidase challenge diet for three days
with 750 g of raw peroxidase-rich fruits
and vegetables daily
160–180 g of broccoli
160–180 g of cauliflower
40–50 g of red radish
110–120 g of turnip
250–280 g of cantaloupe
“… ingested plant peroxidases are capable
of surviving transit through the gut and
that, in the feces, they can cause positive
guaiac-based FOBT reactions… the ability
of plant peroxidases to cause false-positive
reactions decreases rapidly as the
time between fecal smearing and
development increases.”
Clinical Chemistry January 1999 vol. 45 no. 1 123-126. Interference of Plant Peroxidases with Guaiac-based Fecal Occult Blood Tests Is Avoidable
30. If it is human blood, where from?
• Mouth and dental
• Esophagus
• Stomach
• Small intestine
• Colon
• Anal
Image from http://www.uofmmedicalcenter.org/healthlibrary/Article/40233 and
http://1.bp.blogspot.com/-Nxq4Bx0WK3k/T1zdJcnEh0I/AAAAAAAABUg/WArnSc1PgCg/s1600/Funny+joke+picture+on+Apple+iPhone+Ambulance+bleeding+help+humor+image.jpg
31. CRC mortality reduced by 33% at 13
years (annual gFOBT)and 21 % at 18
years (biennial gFOBT)
2% Guaiac + patients had cancer =
50 colonoscopies to detect 1 cancer
• Single FOBT sensitivity for CRC 30%
• Program of repeated testing
sensitivity 80-92%
• High false positive rate
• ? Chance detection of cancers
verses specific effect of gFOBT
• Does not detect polyps which do
not bleed, many false positive
results
More on gFOBT
Image from http://www.sciencemuseum.org.uk/hommedia.ashx?id=91853&size=Inline
Mandel JS, Church TR, Ederer F, Bond JH. Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. J Natl Cancer Inst 1999; 91:434.
Allison JE, Sakoda LC, Levin TR, et al. Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics. J Natl Cancer Inst 2007; 99:1462.
Lang CA, Ransohoff DF. Fecal occult blood screening for colorectal cancer. Is mortality reduced by chance selection for screening colonoscopy? JAMA 1994; 271:1011.
Ederer F, Church TR, Mandel JS. Fecal occult blood screening in the Minnesota study: role of chance detection of lesions. J Natl Cancer Inst 1997; 89:1423.
32. Modern stool testing today: iFOBT (FIT)
More specific than guaiac testing
Respond only to human globin
• No false + for UGI bleed (globin
digested in transit)
• No false + for foods with
peroxidase activity
• Sensitivity does degrade in mailing
delay (degradation of hemoglobin)
• >5 days post sample verses no
delay with decrease in
adenoma detection (OR 0.6)
Qualitative and quantitative
testing available, with
adjustment of cut-off
Image from http://ncmuseumofhistory.org/exhibits/healthandhealing/topic/36/, http://dsc.discovery.com/tv-shows/curiosity/topics/modern-medicine-pictures.htm
van Rossum LG, van Rijn AF, van Oijen MG, et al. False negative fecal occult blood tests due to delayed sample return in colorectal cancer screening. Int J Cancer 2009; 125:746.
33. iFOBT (FIT) major advantages over traditional gFOBT
No diet or medication restrictions
Increased specificity with high
sensitivity
Specific to lower GI bleeding
-improved compliance (10-12%)
-DOUBLE detection advanced
lesions with little loss of PPV
Better patient return rate
Fewer false-positives for CRC
Ideal CRC screening product
Fewer false positives and needless colonoscopies
34. Using stool guaiac (gFOBT) is like using
Laennec’s stethoscope (1819)…
Image from http://www.homeopathyworldcommunity.com/forum/topics/rene-theophile-hyacinthe
35. Future fecal DNA testing (sDNA)
• CRC sheds DNA, mutations may be
tested
• Commercially available sDNA test off
market 2012, new panels under
development
• False negatives (unidentified
genetic abnormality), false + (upper
GI malignancy or premalignant
genetic abnormalities elsewhere in
GI tract)
Cost analysis 2010 pricing
• $350 per test
• sDNA every 3-5 years more costly
than other screening per year of
life saved.
• Could be cost effective at $40-60
Image from http://inside-the-brain.com/tag/future-of-medicine/
Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 2004; 351:2704.
36.
37. -logistics of iFOBT (FIT)
testing
-compliance
-outcomes in population-based
prevention studies
How does this work?
41. Positive: Occult blood is detected in the
stool sample. Please consult a doctor
Negative: No occult blood is detected in the
stool sample.
Invalid: This may be due to
inadequate/excessive sample
being collected or delay in sample
transportation to the clinic.
In your office
42. Compliance with FIT
• No diet change
• No multiple samples
• No chasing stool in toilet with
popsicle stick
Now you can make fun
craft projects!
Image from http://www.mycafelove.com/2012/01/funny-face-made-from-vegetables-funny.html
43. Sealed with a iFOBT
Belgium 2009, N=19,542
Random mailings verses GP advice
42.1% overall participation (8229 fecal samples)
– 52.3% mail, 27.7% GP (p<0.001)
– 26.5% mail, 16.6% GP prior to
reminder letter and other
invitation strategy
Odds of participation almost 3 x
higher (OR= 2.96) for people invited
by mail than invited by their
physician
44. Sealed with a iFOBT (2)
• Women > Men (OR 1.22, p<0.001)
• Residential (OR=1.98) and rural
(OR=2.90) > urban
– 8229 sent sample
– 435 of 8229 (5.3%) positive iFOBT
– CRC in 18/317 scoped (5.7%)
Compliance for follow up colonoscopy
72.9%, did not differ in mail verses GP
groups
Van Roosbroek S, Hoeck S, Van Hal G. Population-based screening for colorectal cancer using an
immunochemical faecal occult blood test: a comparison of two invitation strategies. Cancer Epidemiol.
2012 Oct; 36(5):e317-24.
45. Population based studies
Belgium
Mail compliance vs. GP
Brazil
Population screening
Netherlands
Higher participation rate &
improved detection verses gFOBT
France
Better than gFOBT with lesions
that bleed less
Germany
Enhanced detection
despite/due to low dose aspirin use
FIT around the globe
(in developed
countries)
46. IMMUNOLOGICAL FECAL OCCULT BLOOD
TEST ON THE SCREENING FOR
COLORECTAL CANCER IN A BRAZILIAN
TOWN – PRELIMINARY RESULTS
Angelita HABR-GAMA, M.D.; Rodrigo Oliva PEREZ, M.D., Igor PROSCURSHIM,
M.D., Guilherme Pagin SÃO JULIÃO, M.D., Mauro PICOLO, M.D.,
Joaquim GAMA-RODRIGUES, M.D.,
Project carried out in
Santa Cruz das Palmeiras
municipality, São Paulo
state, Brazil, sponsored by
ABRAPRECI – Brazilian
Association for Colorectal
Cancer Prevention
4,567 FIT tests
54.8% of the local
population over 40 years
• 905 (19.8%) were not
returned
• 22 (0.5%) could not be
analyzed.
• 3,640 tests, 43.7% of
the target population,
were analyzed
• Results were positive
in 390 (10.7%) exams
47. FIT Brazilians
FIT positive in 390 (10.7%)
exams
Out of the 245 patients with
positive result and referred to
colonoscopy, 33 (13.5%)
refused to undergo the exam.
The results of the 212
performed colonoscopies
were:
• 53 patients with
diverticular disease,
• 59 with polyps
• 9 with adenocarcinoma
• 91 normal.
32% yield of polyps and cancer
Out of the patients with
adenocarcinoma, three were
treated endoscopically since
lesions were small and
detected at an early stage.
48. Participation rate FIT > gFOBT
In a randomized trial in
the Netherlands
comparing Hemoccult
II (guaiac-based), a
quantitative fecal
immunochemical test
(FIT), and flexible
sigmoidoscopy for
screening, the
participation rate was
higher for the FIT
compared to the
guaiac test (61.5%
versus 49.5%)
Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy.
Hol L, van Leerdam ME, van Ballegooijen M, van Vuuren AJ, van Dekken H, Reijerink JC, van der Togt AC, Habbema JD, Kuipers EJ
Gut. 2010;59(1):62. Image from http://www.123rf.com/photo_6011092_windmill-with-tulip-field-near-schermerhorn-netherlands.html
49. gFOBT + 2.8%
FIT + 4.8%
FFS + 10.2%.
Detection of
advanced neoplasia
was significantly
higher in the FIT
(2.4%; OR, 2.0; CI,
1.3 to 3.1) and the FS
arm (8.0%; OR, 7.0;
CI, 4.6 to 10.7) than
the gFOBT arm
(1.1%)
Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy.
Hol L, van Leerdam ME, van Ballegooijen M, van Vuuren AJ, van Dekken H, Reijerink JC, van der Togt AC, Habbema JD, Kuipers EJ
Gut. 2010;59(1):62. Image from http://www.123rf.com/photo_6011092_windmill-with-tulip-field-near-schermerhorn-netherlands.html
50. FIT: More sensitive with less bleeding lesions
N=20 322 , tested with gFOBT and
FIT
At least 1 positive test in 1615,
colonoscopy results were
available for 1277
43 invasive cancers and 270 high-risk
adenomas were detected.
The gain in sensitivity associated
with the I-FOBT was calculated
using the ratio of sensitivities
(RSN) according to type and
location of lesions, and amount of
bleeding.
The gain in sensitivity by using I-FOBT
increased from invasive
cancers (RSN=1.48 (1.16-4.59)) to
high-risk adenomas (RSN=3.32
(2.70-4.07)), and was inversely
related to the amount of
bleeding.
Comparison of a guaiac and an immunochemical faecal occult blood test for the detection of colonic lesions according to lesion type and location.
Guittet L, Bouvier V, Mariotte N, Vallee JP, Levillain R, Tichet J, Launoy G
Br J Cancer. 2009;100(8):1230.
51. “…use of low-dose aspirin compared with no
aspirin was associated with a markedly higher
sensitivity for detecting advanced colorectal
neoplasms, with only a slightly lower specificity.”
2 different FIT tests in
1979 patients (mean
age, 62.1 years):
• 233 regular users of
low-dose aspirin
• 1746 who never
used low-dose
aspirin
• Advanced
neoplasms were
found in 24 users
(10.3%) and 181
nonusers (10.4%) of
low-dose aspirin
Low-dose aspirin use and performance of immunochemical fecal occult blood tests.
Brenner H, Tao S, Haug JAMA. 2010;304(22):2513.
55. Learn more: Resources
» Guidelines for Colorectal Cancer Screening 2008 -
American College of Gastroenterology
» www.s3.gi.org/media/ACG2009CRCGuideline.pdf
» Review slides wherever you are
» Slideshare.net/PatriciaRaymond
56. Learn more: Selected Resources
» ACG & Cancer Detection Testing with FIT
Nakajima M , Saito H , Soma Y et al. Prevention of advanced colorectal
cancer by screening using the immunochemical faecal occult blood test: a
case-control study . Br J Cancer 2003 ; 89 : 23 – 8 .
Lee KJ , Inoue M , O tani T et al. C olorectal cancer screening using fecal
occult blood test and subsequent risk of colorectal cancer: a prospective
cohort study in Japan . Cancer Detect Prev 2007 ; 31 : 3 – 11 .
Zappa M , Csatiglione G , rGazzini G et al. E7 ect of faecal occult blood
testing on colorectal mortality: results of a population-based case-control
study in the district of Florence, Italy . Int J Cancer 1997 ; 73 : 208 – 10 .
van Rossum LG , van Rijn AF , Laheij RJ et al. Random comparison of guaiac
and immunochemical fecal occult blood tests for colorectal cancer in a
screening population . Gastroenterology 2008 ; 135 : 82 – 90 .
Hol L , van Leerdam ME , van Ballegooijen M et al. Attendance to
screening for colorectal cancer in the Netherlands; randomized controlled
trial comparing two different forms of faecal occult blood tests and
sigmoidoscopy . Gastroenterology 2008 ; 134 : A87 .
57. Patricia L. Raymond MD FACG
Assistant Professor of Clinical Internal Medicine,
Eastern Virginia Medical School
what their stool can tell you:
How FIT (iFOBT) Fits
Your Colorectal Cancer Algorithm
This presentation demonstrates the new capabilities of PowerPoint and it is best viewed in Slide Show. These slides are designed to give you great ideas for the presentations you’ll create in PowerPoint 2010!
For more sample templates, click the File tab, and then on the New tab, click Sample Templates.