Transcript Colorectal cancer screening guidelines in primary care

By
Dr Nahla Madan
NCD Committee
April 2010
The working group on the
guideline
The working Group
Reviewing Group
 Dr. Ibtihal Al Reefy
 Dr. Badryia Yaser
 Dr. Fathyia Abdulla
 Dr. Mai Bubshait
 Dr. Basma Al Tajer
 Dr. A. Hussain AL Ajami
 Dr. Mariam Al-Jalahma
 Dr. Kadhim Jaffer Zaber
 Dr. Ali Mirza Salman
 Dr. Abeer Al Ghawi
Colorectal cancer
facts
 Majority of colorectal cancer develop from
precancerous changes (polyps)
 About 90% of patients are over the age of 50
 Early Colorectal cancers are usually
asymptomatic
 The average duration of symptoms (from onset
to diagnosis) is 14 weeks. There is no
association between overall duration of
symptoms and the stage of the tumor
Symptoms of Colorectal Cancer
May Includes:
 Constipation/Diarrhea
 Narrow Stools
 Abdominal Cramps
 Bloody Stools
 Unexplained Weight Loss/Loss of Appetite
 Sense of Fullness
 Nausea & Vomiting
 Gas & Bloating
 Lethargy (Fatigue)
Colorectal cancer
Risk factors
 Age >50
 Personal or family history of colorectal cancer or





adenomatous polyp
Familial syndromes as Familial Adenomatous Polyposis
(FAP) or Hereditary Non-polyposis Colorectal Cancer
(HNPCC)
H/o inflammatory bowel diseases
High animal fat diet
Tobacco
Physical inactivity
Colorectal screening guidelines in
PHC For average risk population
Screening starts at the age of 50-
90 or until there is a 30% chance
of living to the next screening
interval
Colorectal screening guidelines in
PHC For average risk population
Fecal Occult Blood Test (FOBT)
annually
and
Flexible Sigmoidoscopy every 5 years
or
Colonoscopy every 10 years
Colorectal screening guidelines in
PHC For High risk population
 Screening start at the age of 40 or 10 years
before the age of cancer in the first degree
relative
 First degree relative: Any relative who is one
meiosis away from a particular individual in a
family (i.e., parent, sibling, offspring)
Colorectal screening guidelines in
PHC For special risk population
 Patients with hereditary colorectal cancer
syndrome should undergo annual colonoscopy
 Patients with Ulcerative Colitis or Crohn’s
Colitis of 7-10 years duration should start
colonoscopy screening every 1-3 years
Colorectal Screening tests
 Colonoscopy is the most sensitive and specific
test of the all available screening tests of
colorectal cancer
 FOBT has the most direct evidence of reducing
colorectal cancer mortality
 The sensitivity of sigmoidoscopy as a screening
tests affected by type of the instrument
What is available in PHC
 A pilot screening campaign will be started using
HEXAGON OBTI to test stool for human blood in all
adult 50-90 years of age attending LHC
 The available test sample for the pilot campaign is
500, and will be distributed in the following HC:




Muharraq HC
Shaikh Sabah HC
A’ali HC
East Raffa HC
Pilot screening campaign for
colorectal cancer
 The pilot period will end by using all the test samples
 It is necessary to collect data about the tested
candidates for the future analysis and updating of the
guidelines
 Collecting data will be by a form filled by the referring
physician
 After the pilot campaign, guidelines of colorectal
cancer screening will be updating and a second
awareness session will follow
HEXAGON OBTI
Immunochromatographic rapid test
This rapid screening test
detects human blood in the
stool.
HEXAGON OBTI is a twopart test:
- Collection tube for the
blood sample
- Test bar
Directions
Unscrew the cap of the tube and collect the
sample with the applicator stick by taking
several postions at different sites (3-4) of the
faeces . Remove excess stool with a tissue.
Reinsert the applicator stick into the tube. This
sample collected is stable at room
temperature and must be tested within one
week after collection.
With the lid screwed back on, shake the
sample gently inside the transport medium to
assure proper mixing.
Directions
Hold the tube with the red
end upwards and break-off
the tip.
Dispense exactly 2 full
drops, drop by drop, into
the test in the sample well
(S) at the lower end of the
test.
Results
A positive sample is
typically detected within
2-3 minutes.
Negative results should be
confirmed after
10 minutes.
Interpretation of Results
 A single blue line
means the testing
liquid is working fine,
but no human blood
has been detected. It is
called a “control line“
 Two blue lines mean
the test has detected
human blood (even if
blue color is weak)
 No control line means
that the test should be
repeated
Negative
Positive
Invalid
Other features
 The test kit is stable up to
the given expiration date
when stored at 2 – 25 oC
 Dietary restrictions are
not necessary
Thank You
and hope you a good day