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 and possibly an adjunct after the initial operation. The timing for secondary prevention is critical to prevent recurrent advanced disease | 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. | ||
==Colorectal Cancer Secondary Prevention== | ==Colorectal Cancer Secondary Prevention== | ||
===Familial Colorectal Cancer Syndromes=== | ===Familial Colorectal Cancer Syndromes=== | ||
*Surgical resection followed by | *[[Surgical resection]] followed by yearly [[colonoscopy]] 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> | ||
*The criteria for | *The criteria for surveillance and categorizing them as [[polyposis]] patients include the following: | ||
:*The presence of multiple polyps in the colon | :*The presence of multiple [[polyps]] in the [[colon]] | ||
:*Young age at onset of colorectal cancer, particularly age less than 50 years | :*Young age at onset of colorectal cancer, particularly age less than 50 years | ||
:*A strong family history suggesting a familial syndrome | :*A strong family history suggesting a familial syndrome | ||
:*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> | ||
===Sporadic Colorectal Cancer Syndromes=== | ===Sporadic Colorectal Cancer Syndromes=== | ||
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:*The patient has strong risk factors | :*The patient has strong risk factors | ||
:*The patient has genetic risk factors that do not fit into a familial syndrome | :*The patient has genetic risk factors that do not fit into a familial syndrome | ||
*After the diagnosis, a [[colonoscopy]] should be performed to rule out synchronous tumors and polyps along with a primary tumor resection<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> | *After the diagnosis, a [[colonoscopy]] should be performed to rule out synchronous tumors and [[polyps]] along with a primary tumor resection<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 table below displays the guidelines for colonoscopy surveillance after the primary tumor resection<ref name="pmid22763141">{{cite journal| author=Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR et al.| title=Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. | journal=Gastroenterology | year= 2012 | volume= 143 | issue= 3 | pages= 844-57 | pmid=22763141 | doi=10.1053/j.gastro.2012.06.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22763141 }} </ref>. | The table below displays the guidelines for [[colonoscopy]] surveillance after the primary tumor resection<ref name="pmid22763141">{{cite journal| author=Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR et al.| title=Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. | journal=Gastroenterology | year= 2012 | volume= 143 | issue= 3 | pages= 844-57 | pmid=22763141 | doi=10.1053/j.gastro.2012.06.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22763141 }} </ref>. | ||
{| {{table}} | {| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" cellspacing="0" cellpadding="4" {{table}} | ||
| | | style="background:#f0f0f0;" align="center" |'''Colonoscopy Findings''' | ||
| | | style="background:#f0f0f0;" align="center" |'''Recommeded Surveillance Interval (years)''' | ||
|- | |- | ||
| No polyps||10 | | No [[polyps]]||10 | ||
|- | |- | ||
| Small (< 10 mm) hyperplastic polyps in rectum or sigmoid||10 | | Small (< 10 mm) [[Colonic polyps|hyperplastic polyps]] in [[rectum]] or [[sigmoid]]||10 | ||
|- | |- | ||
| 1-2 small (< 10 mm) tubular adenomas||5-10 | | 1-2 small (< 10 mm) [[tubular]] [[adenomas]]||5-10 | ||
|- | |- | ||
| 3-10 tubular adenomas||3 | | 3-10 [[tubular]] [[adenomas]]||3 | ||
|- | |- | ||
| >10 adenomas||< 3 | | >10 [[adenomas]]||< 3 | ||
|- | |- | ||
| One or more tubular adenomas ≥ 10 mm||3 | | One or more [[Colon polyps|tubular adenomas]] ≥ 10 mm||3 | ||
|- | |- | ||
| One or more villous adenomas||3 | | One or more [[Villous adenoma|villous adenomas]]||3 | ||
|- | |- | ||
| Adenoma with high grade dysplasia (HGD)||3 | | [[Adenoma]] with [[Dysplasia|high grade dysplasia]] (HGD)||3 | ||
|- | |- | ||
| Sessile serrated polyp(s) < 10 mm with no dysplasia||5 | | [[Sessile]] serrated polyp(s) < 10 mm with no [[dysplasia]]||5 | ||
|- | |- | ||
| Sessile serrated polyp(s) ≥ 10 mm ||3 | | [[Sessile]] serrated polyp(s) ≥ 10 mm ||3 | ||
|- | |- | ||
| Sessile serrated polyp with dysplasia||3 | | [[Sessile]] serrated polyp with [[dysplasia]]||3 | ||
|- | |- | ||
| Traditional serrated adenoma||3 | | Traditional serrated [[adenoma]]||3 | ||
|- | |- | ||
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Latest revision as of 15:15, 18 December 2017
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Risk calculators and risk factors for Colorectal cancer secondary prevention |
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.
Colorectal Cancer Secondary Prevention
Familial Colorectal Cancer Syndromes
- Surgical resection followed by yearly colonoscopy for most polyposis syndromes[1]
- The criteria for surveillance and categorizing them as polyposis patients include the following:
- 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]
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 the diagnosis, a colonoscopy should be performed to rule out synchronous tumors and polyps along with a primary tumor resection[1]
The table below displays the guidelines for colonoscopy surveillance after the primary tumor resection[3].
| Colonoscopy Findings | Recommeded Surveillance Interval (years) |
| No polyps | 10 |
| Small (< 10 mm) hyperplastic polyps in rectum or sigmoid | 10 |
| 1-2 small (< 10 mm) tubular adenomas | 5-10 |
| 3-10 tubular adenomas | 3 |
| >10 adenomas | < 3 |
| One or more tubular adenomas ≥ 10 mm | 3 |
| One or more villous adenomas | 3 |
| Adenoma with high grade dysplasia (HGD) | 3 |
| Sessile serrated polyp(s) < 10 mm with no dysplasia | 5 |
| Sessile serrated polyp(s) ≥ 10 mm | 3 |
| Sessile serrated polyp with dysplasia | 3 |
| Traditional serrated adenoma | 3 |
| Serrated polyposis syndrome (one of the following criteria according to WHO: (1) at least 5 serrated polyps proximal to sigmoid, with 2 or more ≥ 10 mm (2) any serrated polyps proximal to sigmoid with family history of serrated polyposis syndrome (3) > 20 serrated polyps of any size throughout the colon) | 1 |
References
- ↑ 1.0 1.1 1.2 1.3 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
- ↑ Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR; et al. (2012). "Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer". Gastroenterology. 143 (3): 844–57. doi:10.1053/j.gastro.2012.06.001. PMID 22763141.