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Final Colorectal Cancer 2
Final Colorectal Cancer 2
Cancer
Holistic Group:
Abeer Manea, Andrin Antony,
Annamma Varghese, Bency Abraham,
Jenitha Selvam, Neena Chacko
June 15, 2017
Outline
01 Description of colorectal cancer
02 Epidemiology
(Wilkes, 2011)
Epidemiology
Colorectal cancer is third leading cancer in Qatar, both men
and women, around 61 cases in year
In 2010, the incidence of CRC in Qatar- 9%.
Qatar In 2014, the incidence of CRC in Qatar- 10% (Cancer
Strategy, 2014).
In 2015, there were 79 cancer related deaths among
Qataries, accounting for 30% of all deaths, breast cancer
19%, lung cancer 16.46%, and colorectal cancer- 12.66%
among Qatar population.
International Colorectal cancer is the 3rd most common cancer in men and
2nd in women.
Risk factors
Risk factor of colorectal cancer can be broadly classified as
1. Environmental risk factors 03 04
Diet:
Total calories- Obesity and total calorie intake are independent risk factor for colorectal cancer.
Meat, fat, and protein:
Ingestion of red meat
Fried, barbecued, and processed meat.
High protein intake may augment carcinogenic
Fatty components of red meat may be tumour promoters
(Wilkes, 2011)
(Libutti, Saltz, & Tepper, 2008)
Life style
o Physical inactivity
o Sedentary life style
o Alcohol consumption
o Prolonged cigarette smoking
o Occupational exposure to asbestos, acrylonitrile, ethyl acrylate, synthesis fibers,
halogens, printing materials, and fuel oils.
Drugs:
Steroidal anti-inflammatory drugs: use of aspirin and anti-inflammatory drugs
(NSAIDS),incidence of both colorectal cancer and adenomas.
(Wilkes, 2011)
(Libutti, Saltz, & Tepper, 2008)
2. Genetic risk factors:
o related to inherited germ line mutations(such as familial adenomatous
polyposis (FAP) with mutation adenomatous polyposis coloni (APC) gene,or
hereditary non-polyposis colon cancer(HNPCC),related to mutation in the MMR
gene, or inherited risk by a first- degree relative having colon cancer.
3. Socioeconomic factors:
o Generally, cancer incidence and mortality rates have been higher in
economically advantaged countries due to consumption of a high fat and high
red meat diet, lack of physical activity with resulting obesity.
(Wilkes, 2011)
(Libutti, Saltz, & Tepper, 2008)
Age: Sporadic colorectal cancer increases dramatically above the age of 45 to 50 years.
There is further enhancement of risk affected prior to the age of 60.
Gender: Incidence rate less for women than men.
Race and Ethnic group: Although dietary and life style factors are of paramount
importance in low incident regions of the world, especially Asia and Africa, however there
are certain trends along racial and ethnic line. Inherited mutations in the DNA mismatch
repair genes may be more common among African Americans, in part accounting for
anatomic variation in colon cancer between races in the United States.
Obesity
Inflammatory bowel disease (IBD)
Micronutrient deficiency
Qatar- Risk factors for cancer among the Qatar populations are smoking, obesity, physical
inactivity, and unhealthy diet.(National cancer strategy in Qatar 2011)
(Wilkes, 2011)
(Libutti, Saltz, & Tepper, 2008)
Prevention
Two type of prevention: are recognized for colorectal cancer:
Minimizing external risk factors such as The identification and modification of risk
obesity factors following development of a colonic
polyp,
Improving areas that are likely to be Involves surgical removal of suspicious
protective such as, diet ,micronutrients, adenomatous or
exercise
Factors that may minimize polyp formation Malignant polyps to prevent the
such as aspirin ( if the benefit outweigh risk development of colon cancer.
of side effects).
80% of colon cancers can be prevented by
dietary changes.
(Wilkes, 2011)
Dietary fiber : To protect the colonic
and rectal carcinogens through
increasing the transit rate of fecal
material containing carcinogens.
Primary Daily dietary recommendations for fiber
intake are 20 to 30 gram per day or
Prevention more, especially wheat bran and eating
at least 5 fruits and vegetables each
day.
Vegetable and fruits: A protective effect
of vegetables and fruits against
colorectal cancer, with raw, green and
cruciferous vegetables.
(Wilkes, 2011))
Secondary Prevention and Screening
Removing premalignant polyps, there by evolution of colon cancer in most cases.
Polyps commonly form in the colon or rectums an individual ages, with risk increasing beyond 50 years of age.
A primary screening goal is to identify polyps before they become malignant.
Digital rectal examinations are simple but can detect abnormalities only up to 7 cm from anal verge, and not useful for
colon cancer screening.
Often polyps bleed as they enlarge, bleeding can be identified by fecal occult blood test (FOBT).
FOBT-annually
Flexible Sigmoidoscopy-every 5 years
Colonoscopy every 10 years
Double contrast barium enema every 5 years
CT colonography ( virtual colonoscopy, CTC) every 5 years, or MRI
Fecal immune chemical test(FIT) annually or stool DNA test (s DNA) frequency unknown.
(Wilkes, 2011))
Secondary Prevention and Screening
Biopsy. colonoscopy is required for
Person with an inherited risk for FSIG,DCBE,OR CTC, if polyps are
colorectal cancer such as family less than 6 mm .
history of FAP should begin Laboratory test for gene mutation: to
screening by colonoscopy between screen individuals at increased risk
the age of 10 & 12. for developing colorectal cancer as a
Individual with 1 or more first- result of inherited mutations.
degree relatives who developed Genetic analysis of population at risk
colon cancer before the age of 55 and early identification of the
should have annual FOBT, and a colorectal malignancy.
colonoscopy or double contrast
barium enema every 5 years starting
10 years before the age of onset in
the relatives.
Person with lower level of risk
,should have standard screening at
the age 50.
If examination is positive, a
(Wilkes, 2011)
Signs and Symptoms Unique to the Colorectal
Cancer
Clinical manifestation in the colon vary Signs are Iron deficiency anaemia-
depending on location . Symptoms includes those of anaemia
Tumor in the cecum or ascending or right (such as fatigue , weakness , shortness
colon, occurs in 54% of patients. of breath and exercise intolerance )
(Wilkes, 2011)
Transverse colon Descending or sigmoid colon
Others
Is the site of water absorption About 36% of colon cancer Early signs symptoms
where the faecal material found in this area
may include vague
begins to become formed and A lesion may partially occlude
abdominal pain, flatulence
firm. the lumen, causing a change in
minor change in the bowel
Signs and symptom of a bowel habits as well as change
movement with or without
malignant lesion in the in calibre of stool , so the stool
rectal bleeding.
transverse colon include gas become pencil like or ribbon like
Late Signs and symptoms
A change in bowel habit. and narrow
of cancer include , severe
Abdominal cramping Partial obstruction of the bowel
pain anorexia , weight
Partial or complete obstruction lumen can cause, cramps,
loss , sacral or sciatic pain
Possible perforation of the flatulence , constipation ,
, jaundice , pruritis ,
bowel alternating with diarrhea.
ascites , hepatomegaly
And blood in the stool Abdominal pain, bright red blood
and renal impairment .
on stooling
A feeling of incomplete stooling
and obstructive symptoms such
as nausea , vomiting , melena
may occur if bowel perforation.
(Wilkes, 2011))
How Cancer is Diagnosed and Treated?
(Daher, 2012)
New Evidence for Screening
Cologuard
Is a new alternative test for colonoscopy, a stool test, which detect
cancerous and precancerous genetic marker.
o Cologuard analysis a stool specimen for DNA changes and evidence of
blood.
o Cologuard does not require any preparation, dietary or medication
restriction.
o Recommended for under the age of 50.
o An option for anyone who refuses colonoscopy and is at risk for
colonoscopy.
Vaccines
Researchers are studying several vaccines to
try to treat colorectal cancer or prevent it
coming after treatment.
Social Worker
Social Workers aim to help the patient, their family and careers to cope by
providing social care and support.
Dietician
Dieticians play an important role in managing dietary problems.
Physiotherapist
Physiotherapy aims to reduce some of the effects of cancer or its treatment.
Occupational Therapist
The occupational therapist aims to help you increase you independence and
quality of life.
1
Education and
Understanding Prevention
2 Early
3 Rapid and
Definitive
diagnosis
4 Treatment
5
Detection
6
Ongoing Care
Measuring
Performance
7 Workforce
8 Research
9 Treatment
5
Make Submission of
Awareness of Financial support recommendations
colorectal cancer to cancer patients projects on health
and provide the policy and a
and how to who are unable to necessary plans to
prevent it afford treatment comprehensive
fight all cancer national program to
types. fight cancer.
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