Talk:Colorectal cancer

Small error, but I'm a wiki newbie, not sure where to put this input

In this article, FAP is said to have a 100% colon cancer association by age 40. I don’t think that is correct. Age 40 is significant in FAP because it is the mean age of cancer diagnosis, not the age by which they all have cancer. FAP has a near 100% progression to colon cancer, but the mean age is 39 (call it 40). I think that the sentence should read "FAP progresses to colon cancer in nearly 100% of all individuals, at a mean age of 39."

In fact, I am not aware of any specific age by which 100% have cancer, because I believe that 100% malignant progression is approached asymptotically with no specific associated age.

Here is the appropriate reference to clarify the issue- Bussey HJR. Familial polyposis coli. Baltimore: The Johns Hopkins University Press; 1975.

Here is a reference that discusses the median age of benign findings and some of the epidemiology of progression- Campbell WJ, Spence RAJ, Parks TG. Familial adenomatous polyposis. Br J Surg 1994;81:1722-33.

I hope that helps, I am new to this and not really sure whom to notify of an error. It isn't a big error, by any means.

Thanks.

CEA

Comment about: "Prognosis

Survival is directly related to detection and the type of cancer involved. Survival rates for early stage detection is about 5 times that of late stage cancers. CEA level is also directly related to the prognosis of disease, since its level correlates with the bulk of tumor tissue."

Whether CEA is truly of clinical use is still controversial, as far as I know.

Evidence based screening

According to the National Guideline Clearinghouse™ (NGC), a public resource for evidence-based clinical practice guidelines.

at

http://www.guideline.gov/summary/summary.aspx?doc_id=14345

Colorectal cancer screening clinical practice guideline

MAJOR RECOMMENDATIONS

Definitions of the levels of evidence (evidence-based A-D, I and consensus-based) are provided at the end of the "Major Recommendations" field.

Recommendation 1*: Factors Associated with an Increased Risk of Colorectal Cancer in the General Population

1. A significant family history is associated with an increased risk of colorectal cancer. (See Recommendation #5, below, for screening recommendations and specific definition of family history.) (Evidence-based: A) 2. Advancing age is associated with an increased risk of colorectal cancer.** (Evidence-based: B) 3. There is fair evidence that blacks are at increased risk for colorectal cancer compared with whites. (Evidence-based: C) 4. There is fair evidence that a family history of advanced adenomas (i.e., >10 mm, with villous features or high-grade dysplasia) presenting before age 60 is associated with an increased risk of colorectal cancer. (Evidence-based: C) 5. There is insufficient evidence for or against the association of gender with an increased risk of colorectal cancer. (Evidence-based: I)

• The Guideline Development Team (GDT) adopted a hazard ratio >2.0 as the cut-point to declare a risk factor as sufficient to warrant a screening recommendation different from that for people at average risk.

• • Indirect evidence from analyses using cancer registry, Medicare, and other surveillance data indicates that the risk of cancer and advanced colonic neoplasms increases with age.

Recommendation 2: Effectiveness of Colorectal Cancer Screening Tests

1. Colorectal cancer screening is strongly recommended for all asymptomatic, average-risk adults. (Evidence-based: A) 2. Any of the following tests are acceptable for colorectal cancer screening in asymptomatic, average-risk adults:*

• High-sensitivity fecal occult blood test (FOBT) (Consensus-based)
• Immunochemical fecal occult blood test (iFOBT/FIT)** (Consensus-based)
• Flexible sigmoidoscopy (Evidence-based: B)
• Colonoscopy** (Consensus-based)
• A combination of high-sensitivity guaiac FOBT test and flexible sigmoidoscopy (Consensus-based)

3. The following additional screening tests are either less-preferred options or not recommended for screening. However, an adult who has had one of these tests is considered screened. Follow-up screening using a preferred option is recommended.

• An annual standard guaiac FOBT is a less-preferred option.*** (Consensus-based)
• Air contrast barium enema is not recommended as a screening strategy for average-risk adults. (Evidence-based: I)
• Virtual colonoscopy is not recommended as a screening strategy for average-risk adults.* (Consensus-based)
• Fecal DNA is not recommended as a screening strategy for average-risk adults.****(Consensus-based)

Note: For fecal blood tests, inform patients of the potential risks associated with false-positive test and false-negative test results, as well as the need for prompt follow-up of a positive test result. For flexible sigmoidoscopy, inform patients that the test has a small risk of complications and is not a complete examination of the entire colon.

• There is insufficient evidence to choose one screening test over another.

• • If a patient has had a normal colonoscopy within the last 10 years, there is insufficient evidence that supplemental FOBT adds any incremental benefit.

• • • Even though there is sufficient evidence in support of this screening modality, it is not a preferred option due to its low sensitivity and low compliance rates.

• • • • Please note that fecal DNA testing and virtual colonoscopy are not listed as "appropriate screening tests" in 2008 HEDIS (Health Plan Employer Data and Information Set) specifications for colorectal cancer screening, and therefore regions may choose to screen members with other appropriate tests.

Recommendation 3: Frequency of Colorectal Cancer Screening

1. The following intervals for colorectal cancer screening in asymptomatic, average-risk adults are recommended*:

• Flexible sigmoidoscopy: at least every 10 years (Consensus-based)
• High-sensitivity guaiac or immunochemical FOBT (iFOBT/FIT): every 1-2 years (Consensus-based)
• Colonoscopy: every 10 years (Consensus-based)
• Combined FOBT and flexible sigmoidoscopy: every 1-2 years for FOBT, at least every 10 years for flexible sigmoidoscopy (Consensus-based)

2. The following additional screening tests are either less-preferred options or not recommended for screening. However, if these tests are performed, then the recommended intervals are as indicated below. Follow-up screening using a preferred option is recommended.

• Standard guaiac FOBT: every 1-2 years (Consensus-based)
• Air contrast barium enema:** every 5 years (Consensus-based)
• Virtual colonoscopy:** every 10 years (Consensus-based)
• Fecal DNA:** every 5 years (Consensus-based)

• The GDT recognizes that these screening intervals differ from current HEDIS measures. Some regions may choose to offer screening at more frequent intervals. HEDIS intervals are as follows: FOBT (annual), flexible sigmoidoscopy (every 5 years), air contrast barium enema (every 5 years), colonoscopy (every 10 years).

• • These modalities are not recommended for screening average-risk adults (see Recommendation #2 above).

Recommendation 4: Age to Begin and End Colorectal Cancer Screening

In the absence of sufficient evidence, the following ages at which to begin and end colorectal cancer screening in asymptomatic average-risk adults are recommended:

1. Initiation of screening is recommended at age 50. (Consensus-based) 2. Discontinuation of screening is generally recommended at age 75, provided that there is a history of routine screening. For those with no history of routine screening, discontinuation is recommended at age 80. The decision to discontinue screening should be based on physician judgment, patient preference, the increased risk of complications in older adults, and existing comorbidities. (Consensus-based)

please fix the epidemelogy section edits I made

Hi,

I've added some info to this section but it's appearing oddly and I'm new to this please could somebody fix it and it would be really helpful if you could let me know what was happening. — Preceding unsigned comment added by Matt wickenden (talk • contribs) 12:27, 28 September 2011 (UTC)

Review of colorectal cancer from the Lancet

Cunningham, D; Atkin, W, Lenz, HJ, Lynch, HT, Minsky, B, Nordlinger, B, Starling, N (2010 Mar 20). "Colorectal cancer.". Lancet 375 (9719): 1030-47. PMID 20304247. http://pingpong.ki.se/public/pp/public_courses/course08879/published/0/resourceId/0/content/Colon%20cancer.pdf. Doc James (talk · contribs · email) 23:56, 17 December 2011 (UTC)

Targeted CC therapy

article,[1] Re:References The Kannagi paper is an extensive review of biomarkers moving toward a cheap quantitative peripheral blood determination for cimetidine coadjuvant treatments, suitable for the socialized medical program of Japan. He briefly shows the scope of this discussing cimetidine vis a vis Matsumoto (2002), which concerns high risk stage II and III CRC. High risk due to overexpressed VEGF and EGFR and/or lack of immune response to tumors, all of which cimetidine addresses in patients identified by tumor tissues stained with CA19-9 and CSLEX. Kannagi's carbohydrate biomarker work been published by the National Academy of Sciences in the US.--Stageivsupporter (talk) 05:23, 13 February 2012 (UTC)