Adjuvant Therapy For Colorectal Cancer
The American Society of Clinical Oncology recommends against the routine use of adjuvant chemotherapy for patients with stage II colon cancer who are at low risk of recurrence, including in younger patients. However, ASCO recommends offering adjuvant chemotherapy to patients with stage IIB colon cancer and stage IIC colon cancer , with a discussion of the potential benefits and risks of harm. In addition, ASCO suggests offering adjuvant therapy to patients with stage IIA colon cancer who have any of the following high-risk factors :
- Sampling of fewer than 12 lymph nodes in the surgical specimen
- Perineural or lymphovascular invasion
- Poorly differentiated or undifferentiated tumor grade
- Intestinal obstruction
- Tumor perforation
- Grade BD3 tumor budding
ASCO guidelines do not routinely recommend the addition of oxaliplatin to fluoropyrimidine-based adjuvant therapy, but consider that it may be offered as a result of shared decision making. ASCO recommends against routinely offering adjuvant therapy to patients with mismatch repair deficiency/microsatellite instability tumors, but recommends including oxaliplatin in the chemotherapy regimen if the combination of dMMR/MSI and high-risk factors results in a decision to offer adjuvant therapy. In patients who are candidates for adjuvant doublet chemotherapy, the duration of adjuvant oxaliplatin-containing chemotherapy may be 3 or 6 months.
- Capecitabine plus oxaliplatin for 3 months or
- FOLFOX for 36 months
Colorectal Cancer Screening Updates And Recommendations
Its important to have a conversation with your primary care doctor about your screening preferences and what will work for you, because you have options.
Colorectal cancer is the second leading cause of cancer death in the U.S. but is largely preventable with proper screening. What is proper screening? Dartmouth-Hitchcock Norris Cotton Cancer Center gastroenterologist Audrey H. Calderwood, MD, explains what you need to know about screening for this cancer.
In her presentation from Cancer Screening Recommendations & Updates 2021, Calderwood provides an overview of colorectal cancer, including how it forms in the colon and its symptoms, explains why screening is effective for prevention and clarifies what screening meanswho should be screened, how to be screened and how often. She also answers questions about lifestyle habits and factors related to colorectal cancer, as well as steps that can be taken to reduce risk.
The U.S. Preventative Services Task Force recently updated screening guidelines for colorectal cancer, which Calderwood highlights here. Notably, updates include lowering the age at which its recommended to begin regular colorectal cancer screening from 50 to 45 due to an increase in the prevalence of this cancer in this younger age group.
The Thriving Thursday Cancer Survivorship Program is a collaboration between Dartmouth-Hitchcock Norris Cotton Cancer Center and the American Cancer Society.
For People At Increased Or High Risk
People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests. This includes people with:
- A strong family history of colorectal cancer or certain types of polyps
- A personal history of colorectal cancer or certain types of polyps
- A personal history of inflammatory bowel disease
- A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis or Lynch syndrome
- A personal history of radiation to the abdomen or pelvic area to treat a prior cancer
The American Cancer Society does not have screening guidelines specifically for people at increased or high risk of colorectal cancer. However, some other professional medical organizations, such as the US Multi-Society Task Force on Colorectal Cancer , do put out such guidelines. These guidelines are complex and are best looked at along with your health care provider. In general, these guidelines put people into several groups .
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Questions And Answers About Quality In Colonoscopy
- What training in colonoscopy did the doctor receive?
Proper training in colonoscopy is necessary not only to increase the chance that the procedure can be completed and any necessary treatments applied, but also to be sure that abnormal results can be properly interpreted. The American Society for Gastrointestinal Endoscopy recommends that persons performing colonoscopy complete a fellowship program in gastroenterology or receive training in colonoscopy during a surgical residency.
- How many perforations has the doctor had?
Many Gastroenterologists have performed many thousands of colonoscopies. A colonoscopist should know the rate at which their procedures have been associated with a perforation or making a hole in the colon. This rate should certainly be below 1 in 500 examinations and many experts have rates of perforation well below 1 in 1000.
- How often does your doctor complete the colonoscopy?
Experienced colonoscopists reach the very beginning of the large intestine in more than 90% of cases and in more than 95% of patients who are undergoing screening. Screening is the process of checking people who have no symptoms for colon polyps and cancer.
A Team Of Colorectal Cancer Experts
Our colorectal cancer surgeons, gastroenterologists, medical oncologists, radiation oncologists, and other specialists are known for providing leading medical, surgical, and supportive care for people with colon and rectal cancers. We will put together a team of healthcare professionals to provide the care you need. When planning your treatment, our physicians consider the type, location, and stage of your cancer, as well as your age and physical health. Your providers meet regularly to discuss your care and make sure you are receiving the most effective therapies. Our doctors are also on the digestive cancer care team at NewYork-Presbyterian/Weill Cornell Medical Center.
Our Approach to Care
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Colorectal Cancer Screening Guidelines
The American Cancer Society 2018 guideline for colorectal cancer screening recommends that average-risk adults aged 45 years and older undergo regular screening with either a high-sensitivity stool-based test or a structural exam, based on personal preferences and test availability. As a part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy.
What Do Colorectal Cancer Screening Guidelines Say About Who Should Have Colorectal Cancer Screening
Expert medical groups, including the US Preventive Services Task Force , strongly recommend screening for colorectal cancer. Although some details of the recommendations vary, most groups now generally recommend that people at average risk of colorectal cancer get screened at regular intervals beginning at age 45 or 50 .
The expert medical groups generally recommend that screening continue to age 75 for those aged 76 to 85 years, the decision to screen is based on the individuals life expectancy, health conditions, and prior screening results.
People who are at increased risk of colorectal cancer because of a family history of colorectal cancer or documented advanced polyps or because they have inflammatory bowel disease or certain inherited conditions may be advised to start screening earlier and/or have more frequent screening.
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What Is An Increased Risk Of Colorectal Cancer
Your doctor may recommend more frequent or earlier testing if you have an increased risk of developing colorectal cancer. You may have an increased risk if:
- You or a close relative had polyps or cancer previously
- You have ulcerative colitis or Crohnâs disease
- Your family has a history of a genetic syndrome like Lynch syndrome or familial adenomatous polyposis
- Youâve had cancer with radiation to the abdomen or pelvic area
Comprehensive Colorectal Cancer Screening & Treatment
At NewYork-Presbyterian Brooklyn Methodist Hospital Cancer Center, our approach to colorectal cancer care goes beyond simply treating cancer. We strive to maintain your quality of life and speed your recovery while aiming to achieve our ultimate goal: curing your cancer. Our colorectal cancer specialists treat people with all stages of colorectal cancer. We offer the full spectrum of care, from diagnosis through treatment and survival.
Colorectal cancer is the third most common type of cancer in the United States and also one of the most preventable. This is why early detection is so important. At our Cancer Center, we offer colonoscopy and other screening tests to find colorectal cancers early, when they are most curable, and to remove potential precancerous colon polyps. We also offer genetic counseling and testing for people with an increased risk of colorectal cancer due to their personal or family medical history.
Our team also participates in clinical trials evaluating novel treatments to advance the care of people with colorectal cancer, especially those whose disease does not respond well to standard therapies. You may have the opportunity to participate in a clinical trial of a promising treatment.
Services & Specialties
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People Known Or Suspected To Have Certain Genetic Syndromes
These people generally need to have colonoscopy . Screening is often recommended to begin at a young age, possibly as early as the teenage years for some syndromes and needs to be done much more frequently. Specifics depend on which genetic syndrome you have, and other factors.
If youre at increased or high risk of colorectal cancer , talk to your health care provider to learn more. Your provider can suggest the best screening option for you, as well as determine what type of screening schedule you should follow, based on your individual risk.
American Cancer Society Guidelines For The Early Detection Of Cancer
Screening tests are used to find cancer before a person has any symptoms. Here are the American Cancer Society’s recommendations to help guide you when you talk to your doctor about screening for certain cancers.
Health care facilities are providing cancer screening during the COVID-19 pandemic with many safety precautions in place. The American Cancer Society Get Screened campaign encourages people to start or restart their recommended cancer screenings. Regular screenings can help find and treat pre-cancers and cancers early, before they have a chance to spread. Visit Get Screened to learn about screening tests and what you can do to get on track with a cancer screening schedule thats right for you.
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Colorectal Cancer Screening Guidelines For 2022
Colorectal cancer, a name for cancers that start in the colon or rectum, is the second leading cause of cancer-related deaths in adults. This year, itâs estimated that nearly 150,000 men and women will be newly diagnosed.
The overall diagnosis rate has decreased since the 1980s, but the rates in younger patients have been steadily increasing. To improve the chances of finding colorectal cancer in earlier stages and in a younger population, the recommended screening age was recently lowered to 45.
National Comprehensive Cancer Network
The National Comprehensive Cancer Network has released separate guidelines for average-risk and high-risk individuals. For average individuals, the recommendations are nearly identical to those of the joint American Cancer Society , US Multi-Society Task Force on Colorectal Cancer, and American College of Radiology. However, in 2021 the NCCN lowered the age for starting screening in average-risk individuals from 50 years to 45 years.
The NCCN criteria for average risk are as follows
- No history of adenoma, sessile serrated polyp, or colorectal cancer
- No history of inflammatory bowel disease
- Negative family history for colorectal cancer or confirmed advanced adenoma or an advanced sessile serrated polyp
The NCCN guidelines provide screening recommendations for patients at increased risk due to any of the following :
- Personal history of adenoma or sessile serrated polyp
- Personal history of colorectal cancer
- Inflammatory bowel disease
- Positive family history
The guidelines also specify recommendations for patients with the following high-risk syndromes :
- Classic familial adenomatous polyposis
- Attenuated familial adenomatous polyposis
- MUTHYH-associated polyposis
- Colonic adenomatous polyposis of unknown etiology
- Cowden syndrome/PTEN hamartoma tumor syndrome
- Li-Fraumeni syndrome
Individuals meeting one or more of the following criteria should receive further evaluation for polyposis syndromes :
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What The New Colorectal Cancer Screening Guidelines Mean To You
Screening for colorectal cancer is now recommended for all people, beginning at age 45 rather than 50. The U.S. Preventive Services Task Force recently updated its guidelines to begin screening five years earlier, citing a comparative modeling study that found colorectal cancer screening demonstrates a benefit for people at age 45.
“What we’re seeing now is more people developing colorectal cancer under the age of 50. In fact, 10% of colorectal cancer cases now are going to occur in people who are under the age of 50,” says Dr. Lisa Boardman, a Mayo Clinic gastroenterologist.
Journalists: Broadcast-quality sound bites with Dr. Boardman are available in the downloads at the end of the post. Please courtesy: “Lisa Boardman, M.D./Gastroenterology/Mayo Clinic.”
“Colorectal cancer is the third leading cause of cancer death in the U.S. It affects men and women equally. And we expect about 50,000 people will die this year from colorectal cancer,” says Dr. Boardman.
Rates of colorectal cancer are higher in Black Americans American Indians Alaskan Native adults those with a family history of colorectal cancer and adults with other health factors, including diabetes. The U.S. Preventive Services Task Force says it recommends that all adults get screened, beginning at 45, even if these risk factors are absent.
Types of screening and recommended intervals include:
What Is Colorectal Cancer Screening
A screening test is used to look for a disease when a person doesnt have symptoms.
Colorectal cancer almost always develops from precancerous polyps in the colon or rectum. Screening tests can find precancerous polyps, so that they can be removed before they turn into cancer. Screening tests can also find colorectal cancer early, when treatment works best.
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Colorectal Cancer Screening Adults
The AAFP recommends screening for colorectal cancer in all adults starting at age 50 years and continuing until age 75 years. The risks, benefits, and strength of supporting evidence of different screening methods vary. A recommendation
The AAFP recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Evidence indicates that the net benefit of screening all persons in this age group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the patient’s overall health, prior screening history, and preferences. C Recommendation
The AAFP concludes that the evidence is insufficient to assess the benefits and harms for screening for colorectal cancer in adults aged 45 to 49 years. I Statement
Clinical considerations from USPSTF:
The AAFP has reviewed the US Preventive Services Task Force recommendation for colorectal cancer screening in adults. The AAFP agrees with the USPSTF that screening should be recommended for adults aged 50-75 based on substantial net benefit for this age group.
These recommendations do not apply to individuals who are symptomatic or at increased risk for colorectal cancer .
1. Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017 67:177-193.
Crc Screening And Surveillance: Optimizing Quality
1.0 CME/CNE credits
This clinical anthology course has three related sections.
Douglas Corley, MD, PhD Kaiser Permanente, Northern California
This section covers
- Why CRC screening is important as a cancer prevention and control tool for PCPs.
- How PCPs can screen for CRC using stool-based and direct visualization screening options.
- How to determine the timing and frequency of CRC screening using factors such as personal history or family history of polyps or CRC, age, and comorbidities .
Michael P. Pignone, MD, MPH Dell Medical School, University of Texas, Austin, Texas
This section covers
- The pros and cons of current stool-based testing options.
- Seven essential steps to developing a high-quality home stool testing program.
- The need for a systematic approach for stool testing programs that includes regular testing and follow-up colonoscopy.
Jennifer Weiss, MD, MS University of Wisconsin, Madison, Wisconsin
This section covers
- Colonoscopy implementation challenges and how to address these challenges.
- Guidance for ensuring adequate bowel preparation for colonoscopy.
- Colonoscopy safety considerations.
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American College Of Gastroenterology
American College of Gastroenterology 2021 guidelines recommend colorectal cancer screening in average-risk individuals of age 50 to 75 years, and suggest screening in average-risk individuals of age 45 to 49 years. The ACG recommends colonoscopy and FIT as the primary modalities for colorectal cancer screening. Further ACG suggestions regarding colorectal cancer screening include the following:
When Should I Begin To Get Screened
Most people should begin screening for colorectal cancer soon after turning 45, then continue getting screened at regular intervals. However, you may need to be tested earlier than 45, or more often than other people, if you have
- Inflammatory bowel disease such as Crohns disease or ulcerative colitis.
- A personal or family history of colorectal cancer or colorectal polyps.
If you think you are at increased risk for colorectal cancer, speak with your doctor about
- When to begin screening.
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Accuracy Of Screening Tests
The USPSTF focused on reviewing evidence that reported accuracy of screening tests compared with colonoscopy as the reference standard. Colonoscopy accuracy is reported with a reference standard of either repeat colonoscopy or CT colonographyenhanced colonoscopy. The following accuracy results reflect accuracy after only a single application of the test rather than a program of repeated screenings.
Direct Visualization Tests
Colonoscopy was evaluated in 4 studies on accuracy, with 3 studies determining missed cases of colorectal cancer by follow-up CT colonographyenhanced colonoscopy or CT colonography and repeat colonoscopy for discrepant findings.9 In all 4 studies, sensitivity for detection of adenomas measuring 10 mm or larger ranged from 0.89 to 0.95 specificity was reported in a single study as 0.89 .9,10 Two of the studies on colonoscopy accuracy included patients younger than 50 years, although results in this age group were not reported separately.
The USPSTF did not identify any studies that reported on the accuracy of flexible sigmoidoscopy using colonoscopy as the reference standard.