Article by Dr. Nguyen Ngoc Khanh – Head of Department of Digestive – Urology – Robotic Surgery – Pediatric Surgery, General Surgery Department – Share99 Times City International Hospital.
In Vietnam, according to statistics 2018 with a population of 96,491,142: The number of new cancer cases annually is 164,671 people, the incidence rate is 140/100,000 people-year, the death toll is 114,871 people / year. In which colorectal cancer is: 14,733 cases (8.9% of types of cancer).
1. Signs of colorectal cancer
Survival rate after treatment of colorectal cancer varies with the stage: USA: The overall survival rate after 5 years is 65%, of which if detected early in stage I is 95%, 60% in stage III, 10% in stage IV with metalyses.
Colorectal cancer (UTT) often go un un noticeable because of poor early symptoms and less attention to the p
erson. The following symptoms may be signs of colorectal cancer, but are often late signs of the disease:
- Change in the habit of foretime: alternating between constipation and diarrhea.
- Blood in the stool.
- Mucus in the feces.
- Cramping abdominal pain, bloating, squash = signs of intestinal obstruction due to large lumps clogging the colon.
- The feeling that not going out of stools, often there is a feeling of wanting to go out.
- Weight loss, anemia do not know the reason.
2. The role of colorectal cancer screening
Late UTT is a condition that can be prevented by early detection through widely applied screening programs.
The full implementation of proven colorectal cancer screening guidelines can reduce colorectal cancer mortality in the United States by about 50%; even more if applied in countries where screening tests are difficult. Newer and more comprehensive screening strategies are also essential.
In the U.S., colorectal screening guidelines have been issued by the following organizations:
- American Cancer Society (ACS), US Multi-Society Task Force on Colorectal Cancer, and American College of Radiology
- U.S. Preventive Services Task Force (USPSTF)
- American College of Physicians (ACP)
- American College of Gastroenterology (ACG)
- National Comprehensive Cancer Network (NCCN)
While all guidelines recommend routine screening for colorectal cancer and gland polyps in asymptotic adults starting at age 50, they differ in screening frequency and age of screening stop, as well as screening methods. For high-risk patients, the recommendations vary in the age at which screening begins, as well as the frequency and method of screening.
For simplicity, ease of application, and unmistakable, the article presents the American Cancer Society (ACS) Screening Guidelines.
3. American Cancer Society Colorectal Cancer Screening Guidelines
- Adults 45 years of age and older at medium risk of having UTT should be screened regularly with: 1. Stool test with high sensitivity or 2. Examination of the structural edic(endoscopy), depending on the patient's preferences and the availability of the means of testing.
- As part of the screening process, all positive results in non-endoscopic screening tests (stool tests) must be monitored by colonoscopy in a timely manner.
- Starting screening at the age of 45 is a sufficient recommendation.
- Screening 50 years of age or older is a strong recommendation.
- Adults at medium risk, in good health with an expected life expectancy of more than 10 years of UTT screening up to the age of 75, are a sufficient recommendation.
- Clinicians personalize UTT screening decisions for people aged 76 to 85 based on preferences, life expectancy, health status, and previous screening history – qualified recommendations
- Clinicians discourage people over the age of 85 from continuing to have qualified recommendations.
Uttt screening media options:
- Stool tests:
- Annual stool immuno-chemotherapy testing
- Annual high sensitivity red blood cells test
- Multi-target DNA testing every 3 years
- Examination of structural edic erm (endoscopy):
- Colonoscopy every 10 years
- Colonectomy every 5 years
- Sigma colonoscopy every 5 years
4. Other reference guides
Other guidelines for further reference include: National Comprehensive Cancer Network (NCCN). NCCN has issued separate guidelines for medium-risk and high-risk subjects. For ordinary people, the recommendations are almost the same with the American Cancer Society, US Multi-Society Task Force on Colorectal Cancer and the American College of Radiology.
The average risk criteria of NCCN are as follows:
- Age ≥50
- No history of gland polyps, stalkless polyps or colorectal cancer
- No history of inflammatory bowel disease (IBD)
- No family history with colorectal cancer or a history of advanced glandular polyps has been confirmed (i.e., high dysbism, ≥1 cm in size, papillary or papillary histomy) or progressive sessile serrated leg polyps (i.e., ≥1 cm, any dysbism)
The Increased Risk criteria of NCCN are subject to any of the following factors:
- Individual history of adenoma or serrated broad-bank leg polyps.
- Personal history of colorectal cancer
- Inflammatory bowel disease (ulcerative colitis, Crohn's disease)
- There's a family history.
The High Risk criteria of NCCN are subjects with the following factors:
- Lynch syndrome (non-heredative colorectal cancer)
- Classic familial adenomatous polyposis-FAP
- Weakened familial polyps (Attenuated familial adenomatous polyposis-AFAP)
- MUTHYH-related polyps (MAP)
- Peutz-Jeghers Syndrome (PJS)
- Juvenile Polyps Syndrome (JPS)
- Serrated Polyps Syndrome (SPS)
- Adenomatous colon polyps of unknown causes
- Cowden Syndrome/Hamartoma PTEN Tumor Syndrome
- Li-Fraumeni syndrome
Individuals with one or more of the following criteria will be further evaluated for polyps syndromes:
- People with more than 10 gland polyps detected from (FAP, AFAP, MAP and other rare genetic causes of polyp glandular disease)
- People with more than 2 hamartomatous polyps (hamartoma PJS, JPS and Cowden/PTEN tumor syndrome)
- People with more than 5 serrated shore polyps close to the sigma colon (SPS)
- Family members with high-risk syndrome are associated with colorectal cancer, with or without mutations.
- People with desmoid tumors, hepatic tumours, cribriformmorular variants of papillae thyroid tumors (FAP, AFAP, MAP)
5. Risk-based screening
The International Council of Experts has published guidelines for colorectal cancer screening based on the risk to adults as:
- Ages 50-79,
- No previous screening
- No symptoms of colorectal cancer and
- Additional life expectancy is estimated at least 15 years.
- For those at estimated risk of colorectal cancer of less than 15 years below 3%, the workshop recommended no screening (weak recommendation).
- For individuals with an estimated 15-year risk of more than 3%, the workshop recommends screening with one of the following options:
- FIT annually
- FIT every 2 years
- S sigma colonoscopy 1 time
- Colonoscopy 1 time
Colorectal cancer risk/15 years is done using the online QCancer tool. (Note that this tool was developed for the United Kingdom.)
Early detection of cancer increases the chances of successful treatment and reduces the risk of dying from cancer. Share99 International Health Hub implements a colon cancer screening and early detection package for customers at risk of cancer, especially customers with colon polyps, enteritis (Ulcerative bowel disease or Crohn's disease), families of people with colorectal cancer; suspected polyps glands are family-like, Lynch Syndrome. With a modern system of machines that allow colonoscopy tests to be performed, it is closely monitored by specialists. Especially, Share99 is a leading hospital in implementing colorectal cancer treatments with robotic laparoscopic surgery with many outstanding advantages.
For advice and to make an examination, you can contact HERE
- Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society
- Is colorectal cancer curable?
- Note post-polyp colonectomy
- Colorectal Cancer Treatments