Bowel Cancer Screening

Question 1

Which patients fit into the category 1 (low risk) group for bowel cancer screening. How should they be managed?

Answer 1

• No personal or family history of bowel cancer OR
• One FDR/SDR > 55 with bowel cancer
• FOBT 2-yearly from 50
• Flexible sigmoidoscopy 5-yearly

Question 2

Which patients fit into the category 2 (medium risk) group for bowel cancer screening. How should they be managed?

Answer 2

• One FDR < 55 with bowel cancer
• Two FDR or an FDR + SDR with bowel cancer at any age
• Colonoscopy 5-yearly from 50 or 10 years earlier than familial diagnosis
  
  • Flexible sigmoidoscopy + barium enema/CT colonography if above contraindicated
• FOBT in intervening years

Question 3

Which patients fit into the category 3 (very high risk) group for bowel cancer screening? How should they be managed?

Answer 3

• Three or more FDRs or FDR/SDRs on the same side of the family with bowel cancer
• Two or more FDR/SDRs on the same side of the family with any:
  
  • Multiple bowel cancers in the one person
  • Bowel cancer before 50 y/o
  • HNPCC-related cancers - endometrial/ovarian/stomach/SI/renal/biliary/brain
• One FDR/SDR with multiple adenomas (?FAP)
• Genetic mutation with high susceptibility in family member
• Referral to genetic counsellor
• FAP
  
  • Flexible sigmoidoscopy yearly/2-yearly from 12-15 until polyposis, then prophylactic surgery
• HNPCC
  
  • Colonoscopy 2-yearly from 25 or 5y earlier than familial diagnosis