Transcript CCSP 101 - University of Colorado Denver

Colorectal Cancer
Screening 101
Patient Education
December 2014
Colon Anatomy, Polys,
Colorectal Cancer (CRC)
&
Colorectal Cancer
Screening Exams
What is the colon?
• Also called the large
intestine or large bowel
• Part of the digestive
system
• About five (5) feet long
• Absorbs water and
nutrients from food you
eat
• Removes waste (feces)
from your body
http://www.aboutcancer.com/colon_and_rectal_anatomy.htm
Colon Anatomy
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Anus
Rectum
Sigmoid
Descending
Transverse
Ascending
Cecum
Cecum
http://en.wikipedia.org/wiki/Large_intestine
Colon Polyps
• Noncancerous or cancerous growths in the lining of
the colon
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Vary in size
May have a stalk or may be flat
Common in adults
Unknown what causes them
 Lifestyle factors: High-fat, low-fiber diet, obesity, sedentary lifestyle,
etc.
 Genetic factors
• Polyps must be removed to determine if the polyp is
cancerous or noncancerous
• Biggest risk of developing polyps
is being over 50 years
http://www.colon-cleanse-information.com/colon-polyps.html
Common Terms re: Polyps
• Hyperplastic
o Common, abnormal noncancerous growths
o Do not cause any symptoms
• Adenomatous
o Pre-cancerous polyps
o May cause symptoms
• Sessile
o Polyps that grow in a flat, broad-based structure
• Serrated
o Polyps that have a saw tooth like appearance
• Dysplasia
o Describes how much the polyp looks like cancer
• Low-grade: mild or moderate; does not look much like cancer
• High-grade: severe; has characteristics of cancer
Adenomatous Polyps
• Have various growth patterns that help decide
when you will need your next colonoscopy
o Tubular – small, lower risk of cancer developing
o Tubulovillous – some tubular and some villous qualities
o Villous – large, higher risk of cancer developing
• Dysplasia
o How much your polyp looks like cancer
o All adenomas are dysplastic
o High-grade dysplasia, higher risk of cancer developing
Normal Colon
http://www.kolumbus.fi/hans/gastrolab/feb17.jpg
Adenoma
Colon Cancer
http://www.gastrolab.fi/iamp4/105/002.jpg
http://www.kolumbus.fi/hans/hires/hi0060.jpg
What is Colorectal Cancer (CRC)?
• Second leading cause of death because of cancer
in the U.S.
• Third most common cancer diagnosed in men and
women in the U.S.
• It is expected that over 50,000 people will die from
colorectal cancer in the U.S. in 2014
• The risk of developing colorectal cancer in your
lifetime is about 1 in every 20 people
American Cancer Society. Colon/Rectum Cancer: Detailed Guide. 2013 (revised 1/31/2014).
http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/index
CRC in Colorado
• About 1,720 people will get colorectal cancer in
Colorado in 2014
o About 44 out of 100,000 men will get CRC
o About 34 out of 100,000 women will get CRC
• About 670 people will die from colorectal cancer in
Colorado in 2014
o About 17 men out of 100,000 will die
from CRC
o About 12 women out of 100,000 will die
from CRC
American Cancer Society, Cancer Facts & Figures 2014
http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf
CRC Risk Factors
• Risks you cannot change
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Age
Family history
Personal history
Race
Genetics
• Risks you can change
o Diet high in red meat/processed
meat consumption
o Sedentary lifestyle
o Obesity
o Cigarette smoking
o Alcohol consumption
American Cancer Society. Colon/Rectum Cancer: Detailed Guide. 2013 (revised 1/31/2014).
http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/index
Can you prevent CRC?
• Screening is the best way to prevent colorectal
cancer
• Screening looks for cancer or pre-cancerous polyps
in people who do not have symptoms
• If polyps are found they can be removed before
they turn into cancer, preventing colorectal cancer
altogether
American Cancer Society. Colon/Rectum Cancer: Detailed Guide. 2013 (revised 1/31/2014).
http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/index
Choosing the Right
CRC Screening Test for You
Colonoscopy
Stool Testing
PillCam
Flex Sig
Virtual
Colonoscopy
CRC Screening Methods
• Detect Polyps and Cancer
o Flexible Sigmoidoscopy
o Colonoscopy
o Computed Tomographic Colonography (virtual colonoscopy)
• Detect Polyps/Abnormalities
o Video capsule (PillCam)
• Detect Cancer
o High sensitivity FOBT/FIT
o Stool/Fecal DNA test
Bowel Preparation
• Many CRC screening methods require bowel
preparation
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Flexible Sigmoidoscopy
Colonoscopy
Computed Tomographic Colonography
Video Capsule
• Necessary in order to be able to see the colon and
find abnormalities and/or polyps
• Requires diet and/or fluid restrictions but will vary
according to your doctor’s instructions
What is a flexible
sigmoidoscopy (FSG)?
• An internal exam of the lower portion of the colon, from
the rectum to the sigmoid colon (sometimes through the
descending colon noted by the green line) using an
instrument called a sigmoidoscope
• Sedation may or may not be used. Ask your doctor.
Descending colon
What to expect: FSG
• The procedure takes about 10 – 20 minutes
• You will lie on your side with knees drawn up toward
your chest
• The sigmoidoscope is inserted through the anus and
gently advanced
• Air will be inserted through the scope to provide a
better view of the colon
• Careful examination is done during the insertion
and withdrawal of the scope
FSG Procedure
• Tissue samples may be taken or polyps may be
removed during the procedure
• You may feel pressure and slight cramping during
the exam
• If you experience abdominal pain, fever and chills
or rectal bleeding following the exam contact your
navigator or doctor immediately
• FSG is not sufficient to detect polyps or cancer in
the remaining portion of the colon and you may be
advised to complete a colonoscopy
What is a colonoscopy?
• An internal exam of the entire length of the colon
using an instrument called a colonoscope
What to expect: Colonoscopy
• The procedure takes about 30 – 60 minutes
• You will lie on your side with knees drawn up toward
your chest
• Sedation is provided to the patient
• After being given the sedative, the colonoscope is
inserted through the anus and gently advanced
The Colonoscopy
• Air will be inserted through the scope to provide a
better view of the colon
• Suction may be used to remove any secretions in
the colon
• Better views are seen during withdrawal of the
colonoscope so a more careful examination is
done during withdrawal of the scope
• Tissue samples and/or polyps may be taken with tiny
forceps inserted through the scope
The Colonoscopy
• You must have someone bring you to the exam.
You will not be able to drive because sedation is
used
• Risk of complications is low but could include
o Tear in the colon/rectum wall (perforation)
o Bleeding from the site where a tissue sample or polyp was removed from
the colon/rectum wall
o Adverse event related to sedation (e.g. breathing problems)
What is a computed tomographic
(CT) colonography?
• Procedure that uses low dose radiation CT scanning
to get a view of the inside of the colon
• Also referred to as a virtual colonoscopy
Image from a CT colonography
http://www.massgeneral.org/imaging/services/procedure.aspx?id=2254
What to expect:
CT Colonograpy?
• The procedure takes about 15 minutes
• You will be positioned on the CT exam table lying
on your back
• A small tube will be inserted into the rectum to
allow air to be pumped into the colon to help
eliminate folds/wrinkles that may hide polyps
• The table will move through the scanner to
obtain the images
What to expect:
CT Colonograpy?
• You may experience a feeling of fullness or a
need to pass gas
• Pain and discomfort are uncommon
• Risk of complications is low but may include
o Inflation of the colon could injure or perforate the bowel
o Exposure to radiation
• You may be asked to follow up with a
colonoscopy
What is capsule endoscopy?
• A noninvasive procedure that uses a wireless
camera, small enough to fit inside a vitamin-sized
disposable capsule, that you swallow
• Allows physician to view the entire colon to detect
polyps without sedation or radiation
http://thefutureofthings.com/5306-the-pillcam-colon-video-capsule/
What to expect:
Capsule Endoscopy
• A belt with sensors and a data recorder will be
placed around your waist
o Allows the capsule to wirelessly transmit images of your colon
• You will swallow the capsule with a glass of
water
o You will drink about 2 cups of bowel prep solution shortly after
• You are free to go about your regularly
scheduled day
What to expect:
Capsule Endoscopy
• Approximately 10 hours later you will return the
belt to your doctor’s office
• The capsule usually naturally passes with a bowel
movement within 24 hours
o The capsule is disposable and does not need to be retrieved
• There should be no discomfort when swallowing
the capsule, it traveling through your colon or
eliminating it during a bowel movement
• You may be asked to follow up with a
colonoscopy
What are Stool-based
Screening Tests?
• Noninvasive, take home tests that look for signs of
colorectal cancer in stool (feces)
• You collect stool specimens in the comfort of
your home
• A positive result will require follow up with a
colonoscopy
http://www.mountainside-medical.com/hemoccult-sensa-single-slide-tests.html
http://fightcolorectalcancer.org/research-treatment/medicare-now-covers-stool-dna-screening-test-cologuard/
http://seekingalpha.com/article/1575652-exact-sciences-line-your-pockets-not-your-toilet-bowl-3-of-5
What to expect: Fecal Occult
Blood Test (FOBT)?
• Looks for hidden (occult) blood in the stool
o Cannot determine if blood is from the colon or other
parts of the digestive tract
o Not specific to human hemoglobin
• Must collect an actual stool sample
o Requires multiple samples from different bowel
movements
• Involves dietary restrictions
• Positive test requires a colonoscopy
• Must be done annually to provide adequate
screening
What to expect: Fecal
Immunochemical Test (FIT)?
• Looks for hemoglobin protein found in red blood
cells
o Specific for human hemoglobin
o Less likely to react to bleeding from upper digestive tract
• No dietary restrictions
• No actual stool collected
o Brush stool surface or, if loose stool, stir the water around the stool
o Requires multiple samples from different bowel movements
• Positive test requires a colonoscopy
• Must be completed annually to provide adequate
screening
What to expect: DNA Stool Test
• Looks for abnormal sections of DNA from cancer
or polyps
• Tests for blood in the stool
• Requires no dietary restrictions and one bowel
movement
• Must handle and collect stool sample according
to the manufacturer’s instructions
• Positive test requires a colonoscopy
• Interval testing is every 3 years
How Do You Pay For Screening?
• Preventive services, to include CRC screening, are
covered by Medicaid, Medicare and private insurance
• Check with your insurance to see if a co-payment is
required if:
o A polyp is removed during a colonoscopy
o You have a colonoscopy following a positive stool test
o You have a colonoscopy following a FSG, virtual colonoscopy
or PillCam
• CCSP will cover the cost of endoscopic screening (FSG
and colonoscopy) for individuals uninsured or
underinsured who meet further criteria through June 30,
2015.
Questions?