Screening for Colon Cancer in Older Adults: Risks, Benefits, and When to Stop

Nee, Judy; Chippendale, Ryan; Feuerstein, Joseph D.

doi:10.1016/j.mayocp.2019.02.021

Cited by 40 publications

(35 citation statements)

References 55 publications

(59 reference statements)

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“…If the patient is deemed eligible for screening, there are several approaches a physician can take including invasive techniques (colonoscopy, CT colonography, and sigmoidoscopy) as well as noninvasive tests (fecal immunochemical test, blood testing, and stool deoxyribonucleic acid (DNA) testing) [ 12 ]. While colonoscopy has traditionally been the standard investigation performed for colon cancer screening, there are no reports of randomized controlled trials that support its use in patients ≥ 50 years of age [ 7 ]. However, none of these investigations have been proven as superior to the rest as a first-line test, and the investigative approach is generally selected at the discretion of the treating physician [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is a challenging modality to use in older adults because it requires adequate insufflation. However, patients are not required to be sedated, and its results, if negative (absence of suspicious colonic lesions), can help reassure patients without exposing them to the risk of an invasive diagnostic procedure [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Negative results of noninvasive tests can be used to reassure patients, without subjecting them to any invasive procedures. However, in the event of a positive result (true/false positive), the patient will have to be investigated further using an invasive procedure, usually a colonoscopy [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Delayed Diagnosis of Colonic Adenocarcinoma in a 30-Year-Old Postpartum Woman Misdiagnosed with HELLP Syndrome

Maqueira

Rifai

Albury

et al. 2020

Case Reports in Surgery

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Colon cancer is a rare diagnosis in 30-year-old women, which may be further complicated by their concurrent gravid status. Several physiological changes that occur during an intrauterine pregnancy (IUP) can mask symptoms of early colon cancer. Our patient was a 30-year-old, Gravida 2, Para 0 woman with an uncomplicated pregnancy until the 35th week of gestation when she developed preeclampsia and symptoms suggestive of early hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. Following induction of labor and the subsequent, uncomplicated vaginal delivery, the patient developed symptoms of nausea, vomiting, and constipation with abdominal pain and bloating. Abdominal computed tomography (CT) revealed a large mass in the right colon along with the involvement of periaortic lymph nodes and the presence of liver metastases. Hepatic metastases were possibly responsible for the patient’s elevated liver enzyme levels, which were initially considered to have been caused by HELLP syndrome because the patient also had preeclampsia. The rarity of colon cancer in young, pregnant patients with no family history, such as in this case, results in poor prognosis owing to nonspecific symptoms of the developing malignancy being attributed to pregnancy, which further delays diagnosis and subsequent therapy. Of 29 cases of colon cancer in pregnant patients recorded till date, this is the first report of a stage 4 adenocarcinoma of the colon with hepatic metastasis, elevated liver enzyme levels, and increased blood pressure with associated preeclampsia, which was diagnosed in the postpartum period. It may be important to consider broader differential diagnoses in expectant patients presenting with unusual and persistent symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Delayed Diagnosis of Colonic Adenocarcinoma in a 30-Year-Old Postpartum Woman Misdiagnosed with HELLP Syndrome

Maqueira

Rifai

Albury

et al. 2020

Case Reports in Surgery

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“…After a positive result for FIT, colonoscopy is the gold standard diagnostic technique for CRC detection. However, it is an invasive method that needs bowel preparation and sedation, presenting certain risk of complications for the patients [ 156 ]. In this context, the use of epigenetic biomarkers such as DNA methylation in stool samples might provide a non-invasive and the most cost-effective approach in population-based screening for both CRC and precancerous lesions [ 157 ].…”

Section: Epigenetic Biomarkers In Colorectal Cancermentioning

confidence: 99%

Cancer Epigenetic Biomarkers in Liquid Biopsy for High Incidence Malignancies

Palanca-Ballester

Rodríguez‐Casanova

Torres

et al. 2021

Cancers

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Early alterations in cancer include the deregulation of epigenetic events such as changes in DNA methylation and abnormal levels of non-coding (nc)RNAs. Although these changes can be identified in tumors, alternative sources of samples may offer advantages over tissue biopsies. Because tumors shed DNA, RNA, and proteins, biological fluids containing these molecules can accurately reflect alterations found in cancer cells, not only coming from the primary tumor, but also from metastasis and from the tumor microenvironment (TME). Depending on the type of cancer, biological fluids encompass blood, urine, cerebrospinal fluid, and saliva, among others. Such samples are named with the general term “liquid biopsy” (LB). With the advent of ultrasensitive technologies during the last decade, the identification of actionable genetic alterations (i.e., mutations) in LB is a common practice to decide whether or not targeted therapy should be applied. Likewise, the analysis of global or specific epigenetic alterations may also be important as biomarkers for diagnosis, prognosis, and even for cancer drug response. Several commercial kits that assess the DNA promoter methylation of single genes or gene sets are available, with some of them being tested as biomarkers for diagnosis in clinical trials. From the tumors with highest incidence, we can stress the relevance of DNA methylation changes in the following genes found in LB: SHOX2 (for lung cancer); RASSF1A, RARB2, and GSTP1 (for lung, breast, genitourinary and colon cancers); and SEPT9 (for colon cancer). Moreover, multi-cancer high-throughput methylation-based tests are now commercially available. Increased levels of the microRNA miR21 and several miRNA- and long ncRNA-signatures can also be indicative biomarkers in LB. Therefore, epigenetic biomarkers are attractive and may have a clinical value in cancer. Nonetheless, validation, standardization, and demonstration of an added value over the common clinical practice are issues needed to be addressed in the transfer of this knowledge from “bench to bedside”.

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“…It is the most commonly utilised modality which, however, carries a risk of bowel perforation or bleeding. The multitarget stool DNA (mt-sDNA) test is not commonly used, although it is highly sensitive (comparable to colonoscopy, sigmoidoscopy and CT colonography) and non-invasive, which makes it a very good alternative to invasive tests [ 23 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Eotaxins and Their Receptor in Colorectal Cancer—A Literature Review

Zajkowska

Mroczko

2020

Cancers

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Colorectal cancer (CRC) is one of the most common malignancies in the world, with a global incidence of almost 2 million new cases every year. Despite the availability of many diagnostic tests, including laboratory tests and molecular diagnostics, an increasing number of new cases is observed. Thus, it is very important to search new markers that would show high diagnostic sensitivity and specificity in the detection of colorectal cancer in early stages of the disease. Eotaxins are proteins that belong to the cytokine group—small molecules with a variety of applications. Their main role is the activation of basophils and eosinophils involved in inflammatory processes. Therefore, we performed an extensive search of the literature pertaining to our investigation via the MEDLINE/PubMed database. On the basis of available literature, we can assume that eotaxins accumulate in cancer cells in the course of CRC. This leads to a decrease in the chemotaxis of eosinophils, which are effector immune cells with anti-tumor activity. This may explain a decrease in their number as a defense mechanism of cancer cells against their destruction and may be useful when attempting anti-tumor therapy with the use of chemokines.

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Screening for Colon Cancer in Older Adults: Risks, Benefits, and When to Stop

Cited by 40 publications

References 55 publications

Delayed Diagnosis of Colonic Adenocarcinoma in a 30-Year-Old Postpartum Woman Misdiagnosed with HELLP Syndrome

Delayed Diagnosis of Colonic Adenocarcinoma in a 30-Year-Old Postpartum Woman Misdiagnosed with HELLP Syndrome

Cancer Epigenetic Biomarkers in Liquid Biopsy for High Incidence Malignancies

Eotaxins and Their Receptor in Colorectal Cancer—A Literature Review

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