Colorectal Cancer

1
Colorectal Cancer

• JCMG GI
• Presented by
• D.J. Denby, M.D.
• September 2006

2
JCMG Gastroenterologists
D.J. Denby, M.D.
Charles Landsbaum, M.D.
Richard Jennett, M.D.
Joseph Wang, M.D.

• Board Certified in Gastroenterology
• JCMG Building
• 1241 West Stadium Boulevard
• Jefferson City, MO 65109
• 573-635-JCMG (5264)
• www.jcmg.org

3
Fast Facts

• Colorectal cancer (CRC) is common in both sexes.
• It can be lethal. It is the third most common
  cancer and the third leading cause of cancer
  death in both sexes. Up to one third of patients
  ultimately succumb to this disease.
• The prognosis improves the earlier the cancer is
  diagnosed.

4
Fast Facts

• It is commonly a preventable disease.
• It is infrequent before age 40.
• The incidence rises progressively after the age
  of 40 to 3.7/1000 per year by age 80.
  
• The lifetime incidence for patients at average
  risk is 5 percent.
  
• 90 percent of all cases occur after the age of 50.

5
Colorectal Cancer Screening

• The purpose of screening began to find the cancer
  at an earlier stage to improve survival.
  
• Once colonoscopy became readily available, it
  ultimately became the screening method of choice
  for several reasons.

6
To understand the benefit of colonoscopy, one
must understand the adenoma- carcinoma sequence.
7
The Adenoma Carcinoma Sequence

• The vast majority of colorectal cancers arise
  from adenomatous polyps.
  
• The polyps grow from small to larger polyps
  ultimately accumulating increasing dysplastic
  characteristics. Dysplasia means neoplastic
  (tumor like) changes.
• Current thought is that this progression probably
  takes at least 10 years in most people.

8
Adenoma Carcinoma Sequence

• Some cancers unfortunately also arise from flat
  adenomas (i.e. they are not polypoid).
  
• The two main types of colorectal polyps are
  either adenomas or hyperplastic polyps. These
  lesions cannot be distinguished reliably on gross
  appearance biopsy is required for diagnosis.
• Two-thirds of polyps are adenomas.

9
Adenoma Carcinoma Sequence

• The prevalence of adenomas is about 25 percent by
  age 50 and 50 percent by age 70.
  
• The larger the polyp, the more likely is
  progression to cancer.
  
• Hyperplastic polyps account for most of the
  remaining polyps and are mainly distal. They are
  generally thought not to progress to cancer,
  although some may.

10
Why is this important?

• If you remove the polyps when they are smaller,
  they cannot grow into cancer.
  
• Colonoscopy drastically decreases the risk of
  colorectal cancer (well over 90).
  

11
The Main Types of Screening Tests

• Fecal occult blood tests. This entails putting
  stool on a card to detect blood. This has helped
  identify those patients with large polyps and
  cancers.
• Flexible sigmoidoscopy.
• This test involves inspecting only the last third
  of the colon.
  
• This has largely been replaced by complete
  colonoscopy.
  
• Colonoscopy.

12
Why colonoscopy has become the screening test of
choice

• The goods
• It looks at the entire colon.
• If a polyp is found, it can be removed through
  the scope and sent to pathology to determine the
  type of polyp and to rule out cancer.
  
• Other abnormalities of the colon can be
  identified.
  
• When polyps are removed, they cannot grow into
  cancer.
  

13
Colonoscopy problems

• The bads
• The risks are small but present.
• Most procedures are virtually pain free under
  conscious sedation but some patients
  unfortunately are uncomfortable during the
  procedure.
• It entails a full colon preparation.
• It needs to be repeated every few years
  (depending on numerous factors). Usually the
  interval is 3-10 years.

14
Newer tests

• Virtual Colonoscopy (CT colography)
• This still requires (currently) a full colon
  prep
  
• Is similarly priced to colonoscopy
• Misses smaller polyps and flat polyps
• A colonoscopy needs to be performed if polyps are
  found.
  
• Stool genetic tests
• This is still unproven but promising.
• Unfortunately premalignant conditions may be
  missed
  
• Again, a colonscopy will be required to evaluate
  any positive tests.
  
• Is much more expensive than fecal occult blood
  tests.

15
In Summary

• Although colonoscopy has risks, can be
  embarrassing to the modest patient, and the
  preparation is unpleasant, it is the best test
  available at this time.
• Colonoscopy is the best test to detect polyps,
  remove them, and, ideally, prevent cancer.
  
• In other words, if you are 50 years old, and have
  not had your colonoscopy, get one!
  
• If someone you love is over 50 and has not had a
  colonoscopy, talk to them and convince them to
  get one.

16
Are YOU over the age of 50?

• Undergoing surgery for Colon Cancer
• Thousands of dollars, removal of some or part of
  the colon, and risk of placement of ostomy.
  
• Undergoing chemotherapy for Colon Cancer
• Thousands of dollars, risks of infection, and
  other organ toxicity.
  
• Undergoing radiation for Colon Cancer
• Thousands of dollars and radiation toxicity and
  effects.
  
• Early death because of the refusal to undergo
  colorectal cancer screening Tragic.
  
• Undergoing colonoscopy with removal of
  premalignant polyps before they transform to
  cancer PRICELESS.

17
Are YOU over the age of 50?

• The vast majority of cancers of the colorectum
  transform from benign polyps. If these polyps
  are removed, then they do not transform to
  cancer. Several factors are involved in colon
  cancer screening but
• If you are over the age of 50 and have not
  undergone colorectal cancer screening, GET ONE!
  
• COLONOSCOPIES ARE NOT A JOY BUT THEY ARE
  NECESSARY.
  
• GET OVER YOURSELF AND GET A COLONOSCOPY!
• JCMG Gastroenterologists
• 1241 W. Stadium Blvd.
• Jefferson City, MO 65109
• 573-635-JCMG (5264)
• WE WOULD LOVE TO SEE YOU SEE US, OR SOME OTHER
  GASTROENTEROLOGIST, BUT GET SCREENED.
  

18
JCMG Gastroenterologists
D.J. Denby, M.D.
Charles Landsbaum, M.D.
Richard Jennett, M.D.
Joseph Wang, M.D.

• Board Certified in Gastroenterology
• JCMG Building
• 1241 West Stadium Boulevard
• Jefferson City, MO 65109
• 573-635-JCMG (5264)
• www.jcmg.org

19
Welcome!
1241 W. Stadium Blvd.
20
JCMG GI Reception Desk
21
JCMG GI Clinic
22
JCMG GI Clinic
23
JCMG Outpatient Surgery Center
Use the entrance facing Stadium Blvd. on the day
of the colonoscopy.
24
JCMG Outpatient Surgery Center
25
The Outpatient Surgery Center
26
The Outpatient Surgery Center
27
The Outpatient Surgery Center
28
JCMG Outpatient Surgery Center
29
Post Procedure Recovery Staff
30
Post Procedure Recovery Staff
31
Outpatient Surgery Center
32
Outpatient Surgery Center
33
The Key

• If you have not undergone colorectal cancer
  screening, GET IT DONE.
  
• If you know someone over the age of 50 years old
  who has not had a colonoscopy, ask, beg, plead
  with them to get their colonoscopy.
  
• TOGETHER WE CAN WORK TO PREVENT COLORECTAL
  CANCER!

34
JCMG Gastroenterologists
D.J. Denby, M.D.
Charles Landsbaum, M.D.
Richard Jennett, M.D.
Joseph Wang, M.D.

• Board Certified in Gastroenterology
• JCMG Building
• 1241 West Stadium Boulevard
• Jefferson City, MO 65109
• 573-635-JCMG (5264)
• www.jcmg.org