Transcript specc - SWSCN

SPECC – Significant Polyp and
Early Colorectal Cancer
Sarah Crane
Pelican Cancer Foundation
On behalf of the SPECC Team
Pelican Cancer Foundation
• Bill Heald and Basingstoke
• 1993
• Funding from donations, industry,
fees and charitable grants
• Conferences and workshops
• Research
What is SPECC?
“SPECC is a national development programme,
focussed on the treatment of significant
polyps and small (T1) tumours”
• Multidisciplinary – surgeons,
gastroenterologists, radiologists, pathologists,
nurse specialists
• 6 free places for every MDT
Steering group
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Brendan Moran - Lead
Brian Saunders
Rob Glynn-Jones
Phil Quirke
Gina Brown
Chris Cunningham
John Stebbing
Wendy Atkin
Matt Rutter
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Rupert Pullan
Bob Steele
Graham Williams
Sunil Dolwani
Michael Machesney
Gerald Langman
Neil Borley
Nicky Richards
Sarah Crane
SPECC workshops
Started November 2015
SPECC workshops
• London Cancer
• Yorkshire & Humberside
• London Alliance
• West Midland
• East Midland
• Wessex
• Greater Manchester
• South East Coast
• Wales
• Northern England
• East of England
• Cheshire & Mersey
• South West Coast 17.12.17
• Eire
• Ulster
• Scotland
So far…..
• 6 SPECC workshops completed
• 424 clinicians attended from 73 trusts
• Feedback on changes to clinical practice:
– Take more time at endoscopy
– Develop patient information
– Offer alternatives e.g. brachytherapy
Aims
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Definition – are you confident what it is?
Recognition – who and when
Documentation – who needs what
Treatment - alternatives
Strategic planning – locally, regionally,
nationally
Guidelines
This is what a SPECC looks like
Introduction
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Incidence of colorectal polyps increasing
 Wider
public awareness
 Bowel Cancer Screening Programme
Basil Morson
Morson B. The Polyp-cancer sequence in the Large Bowel. Proceedings of the Royal Society of Medicine.
1974;67:451-7
Risk of LN involvement
2%
8%
23%
SPECC
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not suitable for routine colonoscopic excision
may occur anywhere in the colon or rectum
a large (>20mm) sessile lesion
morphologically aberrant & difficult to access
endoscopically
Malignancy spectrum- shades of grey
• non-involvement of lymph nodes
• not common – up to 5% polyps only 10%
malignant. Increasing with BCSP
Factors contributing to significance
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Size
Morphology
Site
Access
Patient factors – comorbidity
Questions to ask yourself:
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Have you fully assessed the lesion?
Are there high malignancy risk features?
How should this lesion be managed?
Is MDT discussion required?
How does patient fitness impact on options?
Has the patient been fully consented?
If endoscopic resection –How complex will it be? –En
bloc or piecemeal?
• When should it be removed?
Recognition - MRI
• Setup and planning are
critical to achieve
optimal images
• Structured reporting to
allow best MRI input to
decision making
CT Colonography well-tolerated test that find
early CRC & significant polyps
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CTC has been around a long time
Diagnostic performance seems good
95%+ sensitivity for cancer
90% sensitivity for 10mm+ polyps
80% sensitvitiy for 6mm+ polyps
For symptomatic patients, CTC is an excellent
alternative to colonoscopy in UK real-world practice
• Early cancers and polyps may present a particular
challenge
• Radiologist QA is developing
With thanks to Andrew Plumb at UCLH
Triple assessment
• Flexible Endoscopy
• Rigid Endoscopy
• TRUS
With thanks to Neil Borley
Documentation: MRI reporting
Documentation
What have you recorded?
• Picture
• Video
• Tattoo
• Report
Not just a polyp!
Treatment: EMR
• Hardly features in the workshops or early
patient information leaflet
• Assumptions
• Risk / benefit
– Piecemeal
– Time / available equipment & expertise
• Have a go……!
ESD
Endoscopic Submucosal Dissection
• Drive for single piece resection – especially in
uncertain lesions
Potential advantages of ESD
• En bloc resection
• Better interpretation of pathology
• Potentially better decision making
BUT
• Time & Effort intensive
• Training
• If more than sm1 – Is local resection alone…?
TEMS
• T1 disease
• Balancing risk
• Potential to extend with adjuvant therapy
Thanks to Chris Cunningham
Contact Brachytherapy ‘Papillon’
• NICE guidelines
• Patient selection
– Older patients
– Patients with high surgical risk
Key messages
• Think twice and cut once
• Maximise local expertise in diagnostic
assessment
• Developing local service / up skilling
• Work with virtual polyp / SPECC MDTs
• Regional and supra-regional referral networks
Thanks to James East
SPECC
• Coming to South West in December 2017
Next Pelican project is SMART
Synchronous Metastases,
Advanced and Recurrent colorectal
Tumours
4th International Workshop on
Complete Response to Neoadjuvant
Therapy for Rectal Cancer
Discussing the challenges in recognition and treatment of a clinical Complete Response
to neoadjuvant therapy for rectal cancer.
This meeting will seek consensus on the terminology of a complete response.
With an international faculty from across Europe, the USA and Brazil
22nd March 2016 | Basingstoke, UK
Convenors: Professor Bill Heald & Mr Brendan Moran
To find out more or book a place:
www.pelicancancer.org/our-courses | [email protected]