Colorectal Screening

Elwood Ml, Ali G, Schlup MT et al (1995) Flexible sigmoidoscopy or colonoscopy for colorectal screening a randomized trial of performance and acceptability. Cancer Detec... 

Winawer SJ, Stewart ET, Zauber AG et al (2000) A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. N Engl J Med 15 342 1766-1772 Winawer SJ, Fletcher RH, Rex D et al (2003) Colorectal screening and surveillance clinical guidelines rationale-update based on new evidence Gastroenterology 124 544-560... 

Several studies have shown that patients acceptance of CTC is greater than conventional colonoscopy or double contrast barium enema (Taylor et al. 2003). Development of minimal bowel prep or prep-less CTC through fecal tagging and electronic cleansing appears to be within reach, thus making a truly prep-less colorectal screening test an attractive possibility (Lefere et al. 2002). 

Virtual colonoscopy, now ten years old, has made substantial progress in the detection of adenomas and colorectal cancer. Recent studies report comparable sensitivities and specificities to conventional colonoscopy for polyps 10 mm or larger on a per polyp basis. CTC is currently approved by Medicare as a diagnostic study in patients with positive symptoms and after failed colonoscopy. Work continues to approve CTC as a colorectal cancer screening exam. Many experts believe CTC is also ready to be adopted into the colorectal screening algorithm. 

Effective colorectal cancer screening programs incorporate annual fecal occult blood testing in combination with regular examination of the entire colon starting at age 50 for average-risk individuals and should be recommended by all health care providers. 

Signs and symptoms of colorectal cancer can be extremely varied, subtle, and nonspecific. Patients with early-stage colorectal cancer are often asymptomatic, and lesions are usually detected by screening procedures. 

Baseline laboratory tests should include complete blood cell count, prothrombin time, activated partial thromboplastin time, liver and renal function tests, and serum carcinoembryonic antigen (CEA). Serum CEA can serve as a marker for monitoring colorectal cancer response to treatment, but it is too insensitive and nonspecific to be used as a screening test for early-stage colorectal cancer. 

Bialkowska A.B. Crisp M. Bannister T. He Y. Chowdhury S. Schurer S. Chase P. Spicer T. Madoux F. Tian C. Hodder P. Zaharevitz D. Yang, V.W. Identification of small-molecule inhibitors of the colorectal cancer oncogene Kriippel-like factor 5 expression by ultrahigh-throughput screening. Molecular Cancer Therapeutics, 2011, 10, 2043-2051. 

Irinotecan refractory EGFR-positive metastatic colorectal cancer 576 screened... 

Raedle, J., Brieger, A., Trojan, J., Hardt, T., Herrmann, G., and Zeuzem, S. 1999. Evaluation of rapid microsatellite analysis of paraffin embedded specimens in screening for hereditary nonpolyposis colorectal cancer. Mod. Pathol. 72 485-491. 

Seeff LC, RichardsTB, Shapiro J/, Nadel MR,Manninen DL, Given LS, Dong FB,Winges LD, McKenna MT. How many endoscopies are performed for colorectal cancer screening Results from the CDCs survey of endoscopic capacity. Gastroenterol 2004 127 1670-7. 

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