Bowel Cancer Alex Hill. Why screen for bowel cancer? Bowel cancer causes 16000 deaths per yr It...
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Transcript of Bowel Cancer Alex Hill. Why screen for bowel cancer? Bowel cancer causes 16000 deaths per yr It...
Bowel CancerAlex Hill
Why screen for bowel cancer?Bowel cancer causes 16000 deaths per yrIt may be detected at asymptomatic stage by simple, safe and validated screening test generally acceptable to populationEarly treatment leads to better outcomes
Bowel Cancer Screening
Who is screened? Men and women in their 60s are sent a FOB
testing kit every 2 yrs People over 70 can request a kit
Two samples are collected from three separate bowels motions and returned within 14 days of first sample
Bowel Cancer Screening
From 1 minute http://www.cancerscreening.nhs.uk/bowel/
publications/video/bowel-screening-kit-cartoon.html
Bowel Cancer Screening
Possible Results:Clearly normal – no sample positive FOBCleary abnormal – 5-6 samples positiveUnclear – 1-4 samples positive
Up to 2 further tests required Screening considered abnormal if 2
subsequent tests unclear or abnormal
Bowel Cancer Screening
Abnormal FOB result 10% bowel cancer 40% benign polyp
60% people with colorectal cancer will have abnormal FOB results
Proportion of people with negative FOB and bowel cancer (false negative) unknown
Bowel Cancer Screening
Offered colonoscopy or other imaging if not appropriate
Suspicious lesions biopsied Benign polyps usually removed
Low risk polyps; return to screening Medium risk polyps; colonoscopy every 3yrs
until 2 examinations negative High risk polyps; colonoscopy after 1yr then
every 3 yrs until 2 examinations negative
Bowel Cancer Screening
Complications colonoscopy Heavy bleeding 1/600 Bowel perforation 1/1200 Death 1/14,000
Inappropriate reassurance from negative result
Anxiety over false positive result
Bowel Cancer Screening
>40y/o rectal bleeding with change in bowel habit towards looser stools and/or increased stool frequency for >6wks
>60 y/o with either change in bowel habit as above >6wks OR rectal bleeding without anal symptoms
Urgent Referrals
RLQ mass consistent with involvement large bowel
Palpable rectal mass Men; unexplained iron deficiency anaemia
with Hb ≤ 11g/100ml Non menstruating women; unexplained iron
deficiency anaemia with Hb ≤10g/100ml
Urgent Referrals
Always do digital rectal examination Consider FBC in patients with equivocal
symptoms to assess urgency of further investigation or referral
Urgent referrals
High risk of developing colorectal cancer after 10 yrs with extensive colitis
Surveillance colonoscopy recommended for people who have had extensive colitis for 10 yrs
Frequency usually 1-5 yrs depending on severity of colitis, patient preference and additional risk factors eg family history
Ulcerative Colitis
Care of patients by MDT Surgery Stenting Chemotherapy
Adjuvant, palliative or combined with radiotherapy in rectal cancers
Radiotherapy Biological agents - Cetuximab only available on the NHS when:
bowel cancer has spread to the liver and cannot be surgically removed
surgery to remove the cancer in the colon or rectum has been carried out or is possible
a person is fit enough to undergo surgery to remove the cancer from the liver if this becomes possible after treatment with cetuximab
Treatment options
74 y/o man Positive faecal occult blood test as part of
bowel screening program Oct 2008 Colonoscopy showed ulcerated polpoid
growth – confirmed adenocarcinoma sigmoid colon
Nov 2008 Anterior resection and ileostomy and adjuvant chemotherapy
Case Presentation
Nov 2009 – CT showed lung metastasis Commenced on palliative chemotherapy
completed March 2010 – significant side effects
Jan 2012 admitted with bowel obstruction secondary to strangulated incisional hernia
Problems with wound infection post op – required debridement and VAC therapy
Further exploration of wound April 2012
Case Presentation
Progression of lung metastases and feeling tired
Further 3 cycles of chemotherapy – stopped early due to side effects
Currently feeling tired, weak Very reluctant to discuss situation with GP or
family – happier when having some treatment Wife struggling emotionally
Case Presentation
www.cancerscreening.nhs.uk www.cks.nhs.uk Referral guidelines for suspected cancer:
lower gastrointestinal cancer [NICE, 2005]. http://www.nhs.uk/Conditions/Cancer-of-the-
colon-rectum-or-bowel/Pages/treatment.aspx
References