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Screening & Surveillance for Colorectal Cancer

WHAT IS THE RISK OF COLORECTAL CANCER?

Colorectal cancer is the fourth most common cancer in the United Kingdom.  The average risk of a person developing bowel cancer in their lifetime is about 1 in 20.  This risk is increased if there is a family history of colorectal polyps or cancer.  

People with a history of extensive inflammatory bowel disease, such as ulcerative or Crohn's colitis over a prolonged period are also at increased risk.

WHAT IS SCREENING AND SURVEILLANCE?

Cancer of the large bowel and polyps (which can grow to become a cancer) often do not cause symptoms until they become large. Screening involves one or more tests performed to determine whether a person with no symptoms has a bowel tumour or bowel polyps.

The purpose of screening is to detect these problems in the early stages and therefore either prevent a future cancer developing or catch the cancer at an earlier stage. This then improves the chances of curing the disease.

Surveillance involves testing people who have previously had colorectal cancer or polyps.  These patients are at increased risk of developing further polyps which have potential to change into a cancer.  Therefore repeated testing is beneficial for these patients to keep a check on the bowel lining. Surveillance usually is done with colonoscopy.

WHY SHOULD TESTING BE UNDERTAKEN?

Like many other cancers bowel cancer can be described as a "silent" disease, because many people do not develop symptoms, such as bleeding or abdominal pain until the cancer is large and difficult to cure.  At present the possibility of curing patients after symptoms develop is only about 50%

On the other hand, if colorectal cancer is found and treated at an early stage, before symptoms develop, the opportunity to cure is 80% or better.  Most colon cancers start as non cancerous growths called polyps.  If the polyps are removed, then the cancer may be prevented.  Major surgery can usually be avoided.

WHAT SCREENING TESTS ARE DONE?

The simplest screening test for colon and rectal cancer is testing of the stool to detect tiny invisible amounts of blood in patients stool or poo.  This is called faecal occult blood testing. This test has been available for many years, is inexpensive and very simple. Unfortunately, it only detects cancer or polyps which are bleeding at the time of the test.Only about 50% of cancers and 10% of polyps bleed enough to be detected by this test. Therefore, further screening is necessary for accurate detection of cancers and polyps.

Colonoscopy is used to diagnose colon and rectal problems and to perform biopsies and remove colon polyps.  Most colonoscopies are done on an outpatient basis with minimal inconvenience and discomfort.

An alternative test to colonoscopy is a barium enema or x-ray of the colon is almost as good as colonoscopy in detecting large tumours, but it is not as accurate for small tumours or polyps.

WHO GETS SCREENING AND WHEN AND HOW OFTEN ARE TESTS DONE?

At present the bowel cancer screening program for patients in the UK started in 2007. The plan is to offer all men and women aged 60 to 69 screening tests. This is called the NHS Bowel Cancer Screening programme.

Patients outside these ages may still be offered screening or surveillance testing if they are in a high risk group.  The decisions to perform such tests are made by consultation with GPs or consultant colorectal surgeons or gastroenterologists.

High Risk groups:

1. People who have had any pre-cancerous polyps found and removed should have colonoscopy one to five years after the first examination.

2. People with a close relative, such as sibling, parent or child who has had colorectal cancer or a pre-cancerous polyp should have the same screening as people of average risk, but it should begin at age 40 or five to ten years before the age at which the youngest was diagnosed.

3. People with a family history of colorectal cancer in several close relatives and several generations, especially cancers occurring at a young age, should receive genetic counselling and consider genetic testing for a condition called hereditary non polyposis colorectal cancer. People with this family medical history should have an examination of the entire colon preferably colonoscopy every two years starting between the age of 20 and 30, and every year after age 40. These things are always organised after consultation with a consultant colorectal surgeon or gastroenterologist.

4. People with a family history of an inherited disease called familial adenomatous polyposis (FAP) should receive counselling and consider genetic testing to see if they are carriers for the gene that causes the disease.

5. People with a personal history of colorectal cancer should have a complete examination of the colon within one year after the cancer is initially detected and surgically removed.If this exam is normal, they should have a follow-up exam within three years.

6. People with a history of extensive inflammatory bowel disease for eight or more years should consider having a colonoscopy examination of their colon conducted every one to two years.

WHO DOES THE SCREENING AND SURVEILLANCE?

The simpler tests such as digital rectal examination, faecal occult blood testing may be performed by your GP or your surgeon. Your GP can also arrange for colonoscopy to be performed by a gastroenterologist or a colorectal surgeon. If you feel you require screening see your GP or arrange an appointment for a consultation.

If you wish to arrange an appointment with Dr. Rob Church at Al Zahra Hospital Dubai

Contact Al Zahra Call Center on +971 4-378-6666