Colorectal cancer screening

Abstract

Colorectal cancer (CRC) is the third most common cancer in the world, and mortality has remained the same for the past 50 years, despite advances in diagnosis and treatment. Because significant numbers of patients present with advanced or incurable stages, patients with pre-malignant lesions (adenomatous polyps) that occur as result of genetic inheritance or age should be screened, and patients with long-standing inflammatory bowel disease should undergo surveillance. There are different risk groups for CRC, as well as different screening strategies. It remains to be determined which screening protocol is the most cost-effective for each risk catagory. The objective of screening is to reduce morbidity and mortality in a target population. The purpose of this review is to analyze the results of the published CRC screening studies, with regard to the measured reduction of morbidity and mortality, due to CRC in the studied populations, following various screening procedures. The main screening techniques, used in combination or alone, include fecal occult blood tests, flexible sigmoidoscopy, and colonoscopy. Evidence from the published literature on screening methods for specific risk groups is scanty and frequently does not arise from controlled studies. Nevertheless, data from these studies, combined with recent advances in molecular genetics, certainly lead the way to greater efficacy and lower cost of CRC screening.

Fatores de mau prognóstico nas peças operatórias de pacientes submetidos ao tratamento cirúrgico do câncer colorretal

“…No que se refere ao estadiamento T, a distribuição encontrada nesse estudo foi percentualmente próxima àquela encontrada na maioria dos artigos revisados 4,8,13,33,37 , nos quais a maior parte dos pacientes encontravam-se em estádio T3; embora saiba-se que o cuidado com o exame histopatológico determina os resultados do T patológico. Em geral, para tumores gastrointestinais, o T patológico depende da profundidade de invasão 35 .…”

“…Recentes avanços em técnicas e tratamento adjuvante têm resultado em um impacto modesto ou inexistente em pacientes com doença avançada 4,5 .…”

Câncer ano-reto-cólico: aspectos atuais IV - câncer de cólon - fatores clínicos, epidemiológicos e preventivos

“…Nos termos das considerações sobre o comportamento do câncer de cólon e os sítios anatômicos de crescimento do tumor, o diagnóstico deve ser feito como conseqüência de programas populacionais de rastreamento, viabilizados por projetos bem delineados e acessíveis 25 , não cabendo, portanto o destaque para os sintomas e sinais da doença. Sob aspecto de busca por meio dos sinais e sintomas, por exemplo, dar-se-ia realce para a anemia de etiologia desconhecia, podendo ter como origem o ceco ou cólon ascendente, motivado pelo adenocarcinoma, às vezes, expressado, inclusive, pela massa que o paciente, de repente, sente ao passar a mão no abdômen, durante o banho.…”

Questionnaire assessment based on signs, symptoms and history in the prevention of colorectal cancer

“…However, it involves high cost and long time to perform it in the public health system in Brazil, as well as the inherent risks from the exam. Then, effective methods are required for CRC screening to reduce mortality and improve the cost-benefit ratio 11,12 .…”

“…Almost all CRC prevention programs are based on screenings performed with fecal occult blood test (FOBT) 6,11,12 . Studies conducted in Denmark showed that the follow-up of patients submitted to FOBT significantly reduced the risk of mortality caused by CRC 13,14 .…”