Colorectal cancer secondary prevention

Colorectal cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Colorectal cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Metastasis Treatment

Primary Prevention

Secondary Prevention

Follow-up

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Colorectal cancer secondary prevention On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Colorectal cancer secondary prevention

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Colorectal cancer secondary prevention

CDC on Colorectal cancer secondary prevention

Colorectal cancer secondary prevention in the news

Blogs on Colorectal cancer secondary prevention

Directions to Hospitals Treating Colorectal cancer

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[edit | edit source]

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[edit | edit source]

### Familial Colorectal Cancer Syndromes[edit | edit source]

* Surgical resection followed by yearly colonoscopy for most polyposis syndromes[1]
* The criteria for surveillance and categorizing them as polyposis patients include the following:

* 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]

### Sporadic Colorectal Cancer Syndromes[edit | edit source]

* 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[edit | edit source]

1. ↑ 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.
2. ↑ 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.CS1 maint: Multiple names: authors list (link)  Review in: Ann Intern Med. 2011 Mar 15;154(6):JC3-2 Review in: Evid Based Nurs. 2011 Jul;14(3):71
3. ↑ 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.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

Template:WikiDoc Sources