Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Review

Volume 13, Number 1, February 2020, pages 1-10


Colon Cancer: A Clinician’s Perspective in 2019

Tables

Table 1. CRC Screening Recommendations by MSTF in 2017
 
Average-risk individualsFamily history of CRC
CRC: colorectal cancer; MSTF: Multi-Society Task Force; FIT: fecal immunochemical test; CT: computed tomography.
First tier tests: colonoscopy every 10 years or annual FIT. Colonoscopy should be offered first. If colonoscopy is refused, annual FIT.Persons with one first-degree relative of CRC or documented advanced adenoma diagnosed < 60 years or two first-degree relatives with those findings at any age - screening colonoscopy every 5 years beginning 10 years before the age at diagnosis of youngest relative or age 40, whichever is earlier.
Second tier tests: CT colonography every 5 years or FIT-fecal DNA test every 3 years or flexible sigmoidoscopy every 5 to 10 years.Persons with a single first-degree relative diagnosed at ≥ 60 years with CRC or an advanced adenoma - average risk screening options at age 40 years.
Third tier test: capsule colonoscopy every 5 years.
Septin9 serum assay: not recommended for screening CRC.

 

Table 2. CRC Screening Recommendations by ACP in 2019
 
Average-risk individuals
CRC: colorectal cancer; ACP: American College of Physicians; FIT: fecal immunochemical test; gFOBT: guaiac-based fecal occult blood test.
FIT or gFOBT every 2 years.
Colonoscopy every 10 years.
Flexible sigmoidoscopy every 10 years plus FIT every 2 years.

 

Table 3. BBPS Scores
 
ScoreColon cleanliness
BBPS: Boston bowel preparation scale.
0Unprepared colon segment with mucosa not seen due to solid stool that cannot be cleared.
1Portion of mucosa of the colon segment seen, but other areas of the colon segment not well seen due to staining, residual stool and/or opaque liquid.
2Minor amount of residual staining, small fragments of stool and/or opaque liquid, but mucosa of colon segment seen well.
3Entire mucosa of colon segment seen well with no residual staining, small fragments of stool or opaque liquid.

 

Table 4. Screening for CRC in High-Risk Individuals
 
High-risk individuals for CRCRecommendations
CRC: colorectal cancer; FAP: familial adenomatous polyposis; HNPCC: hereditary non-polyposis colorectal cancer; SPS: serrated polyposis syndrome; IBD: inflammatory bowel disease.
1. Family history: single first-degree relative with CRC or advanced adenoma diagnosed below the age of 60 years or two first-degree relatives with CRC or advanced adenomas at any age.Screening colonoscopy every 5 years beginning at age 40 or 10 years earlier than the youngest index case in the family.
2. Classical FAPAnnual colonoscopy or flexible sigmoidoscopy starting at age 12 to 14 years until the time of colectomy.
3. Attenuated FAPColon cancer screening should start at age 20 to 25 and there is no upper limit of stopping the surveillance.
4. HNPCCAll the family members with positive genetic testing should get screening colonoscopy every 2 years starting age 20 to 25 until age 40, then annually.
5. SPSSurveillance colonoscopy annually.
6. IBDScreening colonoscopy is recommended 8 to 10 years after the diagnosis of pan-ulcerative colitis, extensive ulcerative colitis and left-sided ulcerative colitis as well as Crohn’s colitis involving at least one third of the colon.

 

Table 5. TNM Staging System and Dukes Class for CRC With 5-Year Survival
 
StageCode5-year survivalDukes class
Primary tumor (T): Tis - carcinoma in situ; T1 - tumor invades submucosa; T3 - tumor invades through muscularis propria into subserosal; T4 - tumor directly invades other organs or structures, and/or perforates visceral peritoneum. Regional lymph nodes (N): N0 - no regional lymph node metastasis; N1 - metastasis in one to three regional lymph nodes; N2 - metastasis in four or more regional lymph nodes. Distant metastasis (M): M0 - no metastasis; M1 - distant metastasis. CRC: colorectal cancer.
0TisN0M0100
IT1N0M0100A
T2N0M090B1
IIT3N0M075B2
T4N0M030
IIIAny TN1M060C
Any TN2M30
IVAny T, any N, M13D

 

Table 6. Treatment of Different Stages of CRC
 
Stages of CRCTreatment modalities
CRC: colorectal cancer.
Stage 1Endoscopic resection of pedunculated malignant polyp or surgical resection of tumor and local lymph nodes.
Stage 2Surgery alone. Adjuvant chemotherapy only in presence of high risk features.
Stage 3Surgery plus adjuvant chemotherapy.
Stage 4Chemotherapy, biologic targeted therapy, immunotherapy, palliative surgery, radiotherapy, radiofrequency ablation and colonic stenting.