Colorectal cancer from community or preventive medicine point of view.

1. Colorectal
Cancer
Update
Prepared By Dr.Anees AlSaadi
Community Medicine Training Program- Qatar
May 2014 1

2. Colorectal
Cancer
• Outline:
–Introduction &
Definition.
–Burden.
–Risk factors
–Presentation
–Prevention.
2

3. Colorectal Cancer
Introduction and Definition:
3
• (1941-1993) Captain of the England team.
• Won the 1966 World Cup.
• The greatest player of all time.
• (1933-2009)11th President Philippines.
• 1st female president in Asia.
• "Icon of Philippine Democracy"
.
• ( 1900 -2002) wife of King George VI.
• Mother of Queen Elizabeth II .
Bobby
Moore
Corazon
Aquino
Queen
Elizabeth
The Queen
Mother

4. 4
What Do you
KNOW
about
Colorectal Cancer ….. ?

5. Colorectal Cancer
The most common type
of gastrointestinal cancer.
It is a multifactorial
disease process.
Etiology transcending genetic factors, environmental
exposures and inflammatory conditions of the digestive
tract.
5

6. Colorectal Cancer
Burden: Globally
10%
The Cancer
Incidence
Burden.
2nd
F(614 000)
3rd
M
(746000)
4th
mortality
cancer.
(694 000)
deaths.
6

7. 7
Which Country
With
Highest Incidence Rate
of
Colorectal Cancer ….. ?

8. Colorectal Cancer
Burden: Globally
65% of New Cases in
Countries With High
Human Development
50% of the New Cases
Occurred in Europe +
Americas.
Highest Incidence Rates in
Slovakia
Hungary
Czech Republic
8

9. Colorectal Cancer
Burden: Internationally
USA
9

10. Colorectal Cancer
Burden: Globally UK
10

11. Colorectal Cancer
Burden: Internationally India
11

12. Colorectal Cancer
Burden: Globally
Rates tend to be relatively
low in many African
countries.
As with
incidence, mortality rates
are lower in women than
in men, except in the
Caribbean.
12

13. 13
Which Country
With
High Mortality Rate
of
Colorectal Cancer ….. ?

14. Colorectal Cancer
Burden: Globally
14

15. Colorectal Cancer
Burden: Internationally
15
USA

16. Colorectal Cancer
Burden: Internationally UK
16

17. Colorectal Cancer
Burden: Internationally India
17

18. Colorectal Cancer
Burden:
The scale of the colorectal
cancer incidence burden is
key marker of human
development transitions.
Burden is increasing in
many countries
transitioning towards
higher levels of human
development.
Trends appear to be
stabilizing or declining in
countries that have
attained the highest levels
of human development.
18

19. Colorectal Cancer
Burden: EMR
19

20. 20

21. 21
228000 Cases
170000 Deaths
239000 Cases
153000 Deaths

22. 22
Which Arab Country
With
Highest Incidence Rate
of
Colorectal Cancer ….. ?

23. Colorectal Cancer
Burden: Regional
23

24. Colorectal Cancer
Burden: Regional
24

25. Colorectal Cancer
Burden: Regional
25

26. Colorectal Cancer
Burden: Regional
26

27. Colorectal Cancer
Burden: Regional
27

28. Colorectal Cancer
Burden: Regional
28

29. 0
20
40
60
80
100
120
140
160
1996 1998 2000 2002 2004 2006 2008 2010 2012
NumberofCases
Years
Breast
Cancer
Bone
marrow
Colorectal
Cancer
The trend of the most common cancer types in Qatar between 1998 till 2010.
Source Cancer Registry AlAmal Hospital. Qatar. 29
Colorectal Cancer
Burden: Locally

30. Colorectal Cancer
Burden: Locally
30
Colorectal cancer is 2nd
after breast cancer.
Age Standardized
Incidence 3.0-3.4
9% of total cancer cases
3rd most common cause of
mortality in Qatar is
Cancer

31. Colorectal Cancer: Etiology
Colorectal
Cancer
Genetic
Susceptibility
Environmental
Exposures
31

32. Colorectal Cancer:
Risk Factors
Non Modifiable
• Age
• Personal History
• Family History
• Race
Modifiable
• Diet
• Physical Activity
• Obesity
• Smoking
• Alcohol Use
32

33. Colorectal Cancer:
Non Modifiable Risk Factors: Age
Can young adults develop colorectal cancer?
After which age the chances to develop
colorectal cancer increase?
About 9 out of 10 people diagnosed with
colorectal cancer are at least 50 years old.
33

34. Colorectal Cancer:
Non Modifiable Risk Factors: Personal
History
History of
adenomatous
polyps
(adenomas).
First colorectal
cancer at
younger age.
History of
Inflammatory
bowel disease
(IBD).
34

35. Colorectal Cancer: Non Modifiable
Risk Factors: Family History
• Mostly without a family history of colorectal cancer.
• 1 in 5 patients have family history of colorectal cancer or
adenomatous polyps.
• 1st Degree relative diagnosed before age of 45.
• 1st Degree relative with premature death.
35

36. Colorectal Cancer: Non Modifiable
Risk Factors: Family History
Familial Adenomatous Polyposis (FAP)
Hereditary Non-Polyposis Colon Cancer
(HNPCC) Lynch Syndrome
Turcot Syndrome
Peutz-Jeghers syndrome
MUTYH-associated polyposis
36

37. Colorectal Cancer: Non Modifiable
Risk Factors: Race
• African Americans have
the highest incidence rate
in the United States.
• Jews of Eastern European
descent (Ashkenazi Jews)
– I1307K APC mutation, is
present in about 6% of
American Jews.
37

38. Colorectal Cancer:
Risk Factors
Non Modifiable
• Age
• Personal History
• Family History
• Race
Modifiable
• Diet
• Physical Activity
• Obesity
• Smoking
• Alcohol Use
38

39. Colorectal Cancer: Modifiable
Risk Factors
39

40. Colorectal Cancer: Modifiable
Risk Factors:
Diet
Read Meat
Processed
Meat
Grilling
Cooking
Vegetables
and Fruits 40
What Is The Colon
Cancer Food
Connection?
http://www.youtube.com
/watch?v=twgBajFhHsI

41. Colorectal Cancer: Modifiable
Risk Factors:
Physical
Inactivity
High levels of physical activity
50%.
In both gender recreational &
occupational physical activity
decrease risk.
Active later in life may also
reduce their risk.
Moderate physical activities
lower risk of colon cancer.
41

42. Colorectal Cancer: Modifiable
Risk Factors:
Overweight or obese is
associated with a higher
risk of CRC
Observed in men than in
women
Abdominal obesity may
be a more important risk
factor.
42
Overweight &
Obesity

43. Colorectal Cancer: Modifiable
Risk Factors:
Smoking
• Sufficient evidence that
tobacco smoking causes
colorectal cancer.
• The association appears to
be stronger for rectal than
for colon cancer.
Alcohol
• Colorectal cancer has been
linked to even moderate
alcohol use.
• Lifetime average of 2 to 4
alcoholic drinks per day
have a 23% higher risk of
colorectal cancer.
43

44. Colorectal Cancer: Factors with
uncertain, controversial:
44
Previous
treatment for
certain cancers
e.g. Prostate
3 nights a month
for 15 years may
increase the risk
of colorectal
cancer in women
2X.
Diet Vitamin D
Deficincy
http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-risk-factors

45. 45
What are the most
INFLUENTIAL
Risk Factor
For
Colorectal Cancer ….. ?

46. 46

47. 47

48. Colorectal Cancer: Modifiable
Preventive Factors:
Reducing
CRC
Risk
Vegetables
Fruits
FibersCalcium
Drugs
48
Aspirin
NSAID
HRT

49. Colorectal Cancer: Signs and
symptoms
• Often detected during screening procedures.
49
Iron-deficiency anemia
Rectal bleeding
Abdominal pain
Change in bowel habits
Intestinal obstruction
or perforation
Early disease: Nonspecific
findings (fatigue, weight loss)
or none at all
Advanced disease:
Abdominal tenderness.
Macroscopic rectal bleeding.
Palpable abdominal mass.
Hepatomegaly and ascites.

50. Colorectal Cancer: Diagnosis
50

51. Colorectal Cancer: Preventive
Program
PRIMARY SECONDARY TERTIARY
Risk Factors
Targeting
Screening Management
Obesity
Diet
Physical Activity
Smoking
Medical
Surgical
Rehabilitation
51

52. 52
ACS:
Preventing colorectal cancer should be a major
reason for getting tested.
Tests finding both polyps and cancer are preferred
if these tests are available.
CRC Screening http://www.youtube.
com/watch?v=WWbe
QCUh418

53. Beginning at age 50, both men and
women at average risk:
Tests that find Polyps & Cancer
 Flexible Sigmoidoscopy every
5 years
 Colonoscopy every 10 years
 Double-contrast barium enema
every 5 years
 CT colonography (virtual
colonoscopy) every 5 years
Tests that mainly find cancer
 Fecal occult blood test (FOBT)
every year
 Fecal immunochemical test (FIT)
every year
53

54. People at
increased
risk
A personal
history of
CRC or AP
A personal
history of IBD
A strong
family history
of CRC or AP
A known family
history of a
hereditary CRC
syndrome such
as familial
adenomatous
polyposis (FAP))
54

55. 55
Which TEST is the most
Sensitive & Specific
For
Colorectal Cancer
Screening and Diagnosis.. ?

56. 56http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/cartzaubtab2.htm

57. Colorectal Cancer: Preventive
Program
PRIMARY SECONDARY TERTIARY
Risk Factors
Targeting
Screening Management
Obesity
Diet
Physical Activity
Smoking
Medical
Surgical
Rehabilitation
57

58. 58

59. 59
50%

60. 60

61. Health Promotion for Colorectal Cancer
61
http://www.youtube.com/watch?v=0MBaNe
Moobc

62. 62

63. Colorectal Cancer: Preventive
Program
PRIMARY SECONDARY TERTIARY
Risk Factors
Targeting
Screening Management
Obesity
Diet
Physical Activity
Smoking
Medical
Surgical
Rehabilitation
63

64. Prediction of Disease Free
64
http://nomograms.mskcc.org/Colorectal/index.a
spx

65. Future Perspectives
Development of regional and national
registries
Allocation of resources and personnel to
fight CRC.
Targeting of the common risk factors
even at primordial level.
Collaboration across individual
registries across the region and globally 65

66. Colorectal Cancer: Summary
•Colorectal cancer is one of the most common
cancers representing almost 10% of the global cancer
incidence.
•Dietary composition, obesity, and lack of physical
activity are established as contributing to risk of
colorectal cancer.
66

67. Colorectal Cancer: Summary
•Most colorectal carcinomas develop through an
adenoma–carcinoma sequence.
• Underpinning screening colonoscopy for
adenomatous polyp removal as a preventive
option.
67

68. 68