Colorectal cancer secondary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
Secondary prevention of colorectal cancer, as opposed to primary prevention, indicates that a person has already had the disease and there are steps being taken to prevent cancer recurrence, usually as metachronous tumors. This involves annual surveillance with colonoscopy after surgical removal | Secondary prevention of colorectal cancer, as opposed to primary prevention, indicates that a person has already had the disease and there are steps being taken to prevent cancer recurrence, usually as metachronous tumors. This involves annual surveillance with colonoscopy after surgical removal and possibly an adjunct after the initial operation. The timing for secondary prevention is critical to prevent recurrent advanced disease<ref name="Carethers2010">{{cite journal|last1=Carethers|first1=John M.|title=Secondary Prevention of Colorectal Cancer: Is There an Optimal Follow-up for Patients with Colorectal Cancer?|journal=Current Colorectal Cancer Reports|volume=6|issue=1|year=2010|pages=24–29|issn=1556-3790|doi=10.1007/s11888-009-0038-1}}</ref>. | ||
==Colorectal Cancer Secondary Prevention== | ==Colorectal Cancer Secondary Prevention== | ||
===Familial Colorectal Cancer Syndromes=== | ===Familial Colorectal Cancer Syndromes=== | ||
*Surgical resection followed by a colonoscopy yearly for most polyposis syndromes<ref name="Carethers2010">{{cite journal|last1=Carethers|first1=John M.|title=Secondary Prevention of Colorectal Cancer: Is There an Optimal Follow-up for Patients with Colorectal Cancer?|journal=Current Colorectal Cancer Reports|volume=6|issue=1|year=2010|pages=24–29|issn=1556-3790|doi=10.1007/s11888-009-0038-1}}</ref> | *Surgical resection followed by a colonoscopy yearly for most [[polyposis]] syndromes<ref name="Carethers2010">{{cite journal|last1=Carethers|first1=John M.|title=Secondary Prevention of Colorectal Cancer: Is There an Optimal Follow-up for Patients with Colorectal Cancer?|journal=Current Colorectal Cancer Reports|volume=6|issue=1|year=2010|pages=24–29|issn=1556-3790|doi=10.1007/s11888-009-0038-1}}</ref> | ||
:*Criteria for surveilling patients and categorizing them as polyposis patients include the following<ref name="Carethers2010">{{cite journal|last1=Carethers|first1=John M.|title=Secondary Prevention of Colorectal Cancer: Is There an Optimal Follow-up for Patients with Colorectal Cancer?|journal=Current Colorectal Cancer Reports|volume=6|issue=1|year=2010|pages=24–29|issn=1556-3790|doi=10.1007/s11888-009-0038-1}}</ref>: | :*Criteria for surveilling patients and categorizing them as polyposis patients include the following<ref name="Carethers2010">{{cite journal|last1=Carethers|first1=John M.|title=Secondary Prevention of Colorectal Cancer: Is There an Optimal Follow-up for Patients with Colorectal Cancer?|journal=Current Colorectal Cancer Reports|volume=6|issue=1|year=2010|pages=24–29|issn=1556-3790|doi=10.1007/s11888-009-0038-1}}</ref>: | ||
::*The presence of multiple polyps in the colon | ::*The presence of multiple polyps in the colon | ||
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::*Evidence for a syndrome based on genetic testing | ::*Evidence for a syndrome based on genetic testing | ||
*Chemoprevention has been used as an adjunct to colonoscopy in some FAP patients, such as the following: | *Chemoprevention has been used as an adjunct to colonoscopy in some FAP patients, such as the following: | ||
:*Cyclooxygenase (COX) inhibitors<ref name="Carethers2010">{{cite journal|last1=Carethers|first1=John M.|title=Secondary Prevention of Colorectal Cancer: Is There an Optimal Follow-up for Patients with Colorectal Cancer?|journal=Current Colorectal Cancer Reports|volume=6|issue=1|year=2010|pages=24–29|issn=1556-3790|doi=10.1007/s11888-009-0038-1}}</ref> | :*[[Cyclooxygenase]] (COX) inhibitors<ref name="Carethers2010">{{cite journal|last1=Carethers|first1=John M.|title=Secondary Prevention of Colorectal Cancer: Is There an Optimal Follow-up for Patients with Colorectal Cancer?|journal=Current Colorectal Cancer Reports|volume=6|issue=1|year=2010|pages=24–29|issn=1556-3790|doi=10.1007/s11888-009-0038-1}}</ref> | ||
:*Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs)<ref name="pmid21144578">{{cite journal| author=Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW| title=Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. | journal=Lancet | year= 2011 | volume= 377 | issue= 9759 | pages= 31-41 | pmid=21144578 | doi=10.1016/S0140-6736(10)62110-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21144578 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21403065 Review in: Ann Intern Med. 2011 Mar 15;154(6):JC3-2] [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21555322 Review in: Evid Based Nurs. 2011 Jul;14(3):71] </ref> | :*[[Aspirin]] and other nonsteroidal antiinflammatory drugs (NSAIDs)<ref name="pmid21144578">{{cite journal| author=Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW| title=Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. | journal=Lancet | year= 2011 | volume= 377 | issue= 9759 | pages= 31-41 | pmid=21144578 | doi=10.1016/S0140-6736(10)62110-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21144578 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21403065 Review in: Ann Intern Med. 2011 Mar 15;154(6):JC3-2] [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21555322 Review in: Evid Based Nurs. 2011 Jul;14(3):71] </ref> | ||
:*Postmenopausal hormone therapy (both combined estrogen plus progestin and unopposed estrogen) - not recommended for chemoprevention of colon cancer in women because of the associated long-term risks of therapy<ref name="pmid21365647">{{cite journal| author=Lin KJ, Cheung WY, Lai JY, Giovannucci EL| title=The effect of estrogen vs. combined estrogen-progestogen therapy on the risk of colorectal cancer. | journal=Int J Cancer | year= 2012 | volume= 130 | issue= 2 | pages= 419-30 | pmid=21365647 | doi=10.1002/ijc.26026 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21365647 }} </ref> | :*[[Postmenopausal]] hormone therapy (both combined estrogen plus progestin and unopposed estrogen) - not recommended for chemoprevention of colon cancer in women because of the associated long-term risks of therapy<ref name="pmid21365647">{{cite journal| author=Lin KJ, Cheung WY, Lai JY, Giovannucci EL| title=The effect of estrogen vs. combined estrogen-progestogen therapy on the risk of colorectal cancer. | journal=Int J Cancer | year= 2012 | volume= 130 | issue= 2 | pages= 419-30 | pmid=21365647 | doi=10.1002/ijc.26026 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21365647 }} </ref> | ||
===Sporadic Colorectal Cancer Syndromes=== | ===Sporadic Colorectal Cancer Syndromes=== | ||
Revision as of 18:26, 15 July 2015
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To view the secondary prevention of familial adenomatous polyposis (FAP), click here
To view the secondary prevention of hereditary nonpolyposis colorectal cancer (HNPCC), click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.
Overview
Secondary prevention of colorectal cancer, as opposed to primary prevention, indicates that a person has already had the disease and there are steps being taken to prevent cancer recurrence, usually as metachronous tumors. This involves annual surveillance with colonoscopy after surgical removal and possibly an adjunct after the initial operation. The timing for secondary prevention is critical to prevent recurrent advanced disease[1].
Colorectal Cancer Secondary Prevention
Familial Colorectal Cancer Syndromes
- Criteria for surveilling patients and categorizing them as polyposis patients include the following[1]:
- The presence of multiple polyps in the colon
- Young age at onset of colorectal cancer, particularly age less than 50 years
- A strong family history suggesting a familial syndrome
- Evidence for a syndrome based on genetic testing
- Chemoprevention has been used as an adjunct to colonoscopy in some FAP patients, such as the following:
- Cyclooxygenase (COX) inhibitors[1]
- Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs)[2]
- Postmenopausal hormone therapy (both combined estrogen plus progestin and unopposed estrogen) - not recommended for chemoprevention of colon cancer in women because of the associated long-term risks of therapy[3]
Sporadic Colorectal Cancer Syndromes
- An individual may develop sporadic colorectal cancer for the following reasons[1]:
- The patient has an unrecognized familial syndrome
- The residual tumor may be present after resection
- The patient has strong risk factors
- The patient has genetic risk factors that do not fit into a familial syndrome
- After diagnosis, a colonoscopy should be performed to rule out synchronous tumors and polyps along with a primary tumor resection[1]
- Within 1 year after the primary tumor resection, another colonoscopy should take place[1]
- If this examination is negative for lesions, the next colonoscopy generally may be performed after 3 years
- If that colonoscopy is negative, then secondary prevention by colonoscopy may be extended to every 5 years
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Carethers, John M. (2010). "Secondary Prevention of Colorectal Cancer: Is There an Optimal Follow-up for Patients with Colorectal Cancer?". Current Colorectal Cancer Reports. 6 (1): 24–29. doi:10.1007/s11888-009-0038-1. ISSN 1556-3790.
- ↑ Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW (2011). "Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials". Lancet. 377 (9759): 31–41. doi:10.1016/S0140-6736(10)62110-1. PMID 21144578. Review in: Ann Intern Med. 2011 Mar 15;154(6):JC3-2 Review in: Evid Based Nurs. 2011 Jul;14(3):71
- ↑ Lin KJ, Cheung WY, Lai JY, Giovannucci EL (2012). "The effect of estrogen vs. combined estrogen-progestogen therapy on the risk of colorectal cancer". Int J Cancer. 130 (2): 419–30. doi:10.1002/ijc.26026. PMID 21365647.