Screening colorectal cancer

Question 1

General

Answer 1

Screening for colorectal cancer and adenomatous polyps is performed in asymptomatic men and women ≥ 50 years of age.

Question 2

Low risk

Answer 2

• Complete colonoscopy (gold standard): Repeat every 10 years if no polyps or carcinomas are detected.
• Annual fecal occult blood test (FOBT): screening for occult bleeding, which may indicate colorectal cancer (This test has poor sensitivity for detecting polyps. )
• Sigmoidoscopy every 5 years and FOBT every 3 years
• Annual fecal immunochemical testing (FIT)
• CT colonography every 5 years

Question 3

High risk (Positive family history of colorectal cancer, hereditary syndromes, personal history of adenomatous polyps or colorectal cancer)

Answer 3

• Complete colonoscopy 10 years earlier than the index patient’s age at diagnosis or no later than 40 years of age
• In case of genetic predisposition: individual screening (see FAP and HNPCC for details)

Question 4

Surveillance following polypectomy

Answer 4

1. Hyperplastic polyp < 10 mm in size in the rectum or sigmoid : colonoscopia dopo 10 anni (il polipo iperplastico, a differenza di quello infiammatorio può avere una trasformazione maligna)
2. Low risk adenoma: 1–2 tubular polyps < 10 mm in size and without intraepithelial neoplasia (IEN): colonoscopia a 5 anni
3. High risk adenoma : colonoscopia a 3 anni
   - 3–10 tubular polyps
   - 1 polyp ≥ 10 mm
   - 1 villous or tubulovillous polyp
   - 1 tubular polyp with high-grade dysplasia

More than 10 adenomas : < 3 years; depends on the case (i.e., family history)

Question 5

Surveillance following CRC resection

Answer 5

-colonoscopy at 1 year
-3 year if no CRC
-5 year if no CRC
(è tutto sequenziale, cioè se dopo un anno non trovo crc, eseguo la colonoscopia dopo 3 anni e poi dopo 5 anni)