Colon and rectal cancer lecture for fourth year medical students

1. Ajdabya University – Medical
College
General Surgery Department
Dr. Abdulgadir M. Abdulrahman,
MD
Colorectal Cancer

2. A 30 year-old –Female patient presented with
history of:
1-Left iliac fossa pain ,2- Anorexia , 3-weight
loss , All for one month , Vomiting for one
week , The patient denied any change in her
bowel habits or Rectal bleeding.
Past history : Insignificant, Social history : single
Examination : The patient is very sick ,
distressed , Cachexic , pale
Vital signs : Pulse rate : 110/min. Temperature :
38, BP: 120/60 mmHg , RR: 24
No lymphadenopathy No jaundice

3. Abdominal Examination: No scars No hernias ,
Significant fullness and distention & guarding
at Left iliac fossa about 7x 6 cms palpable
,tender mass at LIF , No hepatomegaly or
splenomegaly , BS =present
Rectal Examination : No masses Normal colored
stool
Chest/CVS/CNS = Unremarkable

4. Objectives :
• What we’ll be talking about
• How common is colorectal cancer? What is
colorectal cancer? What causes it? What are
the risk factors? Can colorectal cancer be
prevented? Tests to find colorectal cancer
early What you can do More information 

5. Lab data : WBC: 12.000 /mm3, Hb: 11gm/dl
/Plts: Normal
RFT: normal , LFT : Normal
CT-SCAN ABDOMEN & PELVIS WITH ORAL & IV-
CONTRAST:
1-Three irregular iso-hypodense soft tissue
lesions at both lobes of the liver (?
Metastases(,
2-Sigmoid( Cancer ) mass with Micro
perforation & mesenteric stranding and
enlarged adjacent LNs and Para-iliac LNs.

7. Management:
Trial for conservative management done for 72
hours , patient kept NPO, NGT ,IV-fluids, IV-
Antibiotics ,but the patient did not improve
and developed generalized peritonitis
,became very sick and toxic,
Emergency Laparotomy performed through
midline incision,

8. The operative findings were:
1-Three , hard liver lesions( ? Liver Metastases(
,
2-Hard perforated sigmoid mass which is
very adherent to pelvis and Retro peritoneum
and attached to omentum and small bowel
with pus collection.
Procedure : Peritoneal Lavage and Resection of
sigmoid colon with closure of the proximal
Rectum and End colostomy ( Hartmann's
procedure(

12. LYMPHATIC DRAINAGE OF COLON &
RECTUM

13. LYMPHATIC DRAINAGE OF RECTUM &
ANAL CANAL
Upper two-third of rectum : Sup Rectal nodes - Inferior mesenteric nodes
Lower one-third of rectum : Sup Rectal nodes- Inferior mesenteric nodes
AND Internal iliac nodes (along middle rectal vessels)
Anal canal above dentate line : Sup rectal nodes- Inferior mesenteric nodes
AND Internal iliac nodes laterally
Anal canal below dentate line : Inguinal nodes primarily
(can go to internal iliac or superior rectal nodes)

14. Epidemiology of Colorectal Cancer
Is a common cancer
• Countries of the Western world have a higher incidence
• Lifetime probability for colorectal cancer
– men : 1 in 17
– women : 1 in 19
• African Americans
– higher incidence than Caucasians
• ratio of 1.2 ((men))
• ratio of 1.3 ((women))
– higher mortality than Caucasians - ratio of 1.4 for both sex
• Incidence and mortality rate of CRC is decreasing
All statistics from Cancer Facts & Figures 2007, American Cancer Society

15. Epidemiology of Colorectal
Cancer
• Sporadic : 70-80%
• Family h/o CRC :
15-20%
• HNPCC : 4-7%
• FAP : 1%
• IBD & others : 1%

16. COLORECTAL TUMORIGENESIS
Molecular and genetic pathways are involved in
the genesis of colorectal cancer
• Tumor suppressor genes, DNA mismatch
repair genes, and proto-oncogene all
contribute to colorectal neoplasia, both in the
sporadic and inherited forms
• Adenoma-carcinoma sequence, i.e.
adenomatous polyp progresses to cancer

17. Pathology: Adenoma to Carcinoma
Colorectal cancer is an adenocarcinoma – i.e. it develops from
the mucosal lining of the colon. The adenoma will arise from
glandular cells of the mucosa. Adenoma is the benign form of
the disease.
It is thought that all carcinomas of the large bowel arise from
adenomas.
Polyps of less than 1cm diameter are rarely malignant,
however they still have the potential to become so. Polyps
over 2cm have a 5-10% chance of being malignant.
Usually, the lesion will be a polyp with a stalk, however
sometimes it can be a flat lesion – these are known as sessile
lesions.
There can be multiple polyps or perhaps just even one. In
genetic polyp causing conditions there can be hundreds if not
thousands of polyps.

19. COLORECTAL POLYPSpolyps can be:
– sporadic or hereditary
– neoplastic or non-neoplastic
• Hyperplastic polyp is the most common of all colorectal polyps
• Tubular adenoma :: 65--80%
– most common neoplastic polyp
– are most often pedunculated
– generally less atypia in tubular adenomas
• Tubulovillous :: 10--25%
• Villous adenomas :: 5--10%
– are more commonly sessile
– severe atypia or dysplasia (precancerous cellular change) is found
more
often in villous adenomas
• Bigger the polyp,, higher the incidence of invasive carcinoma
• More the villous component,, higher the incidence of carcinoma

20. Pathology: Adenoma to Carcinoma
Colon Carcinogenesis and the effects of chemopreventive agents

22. • Colorectal cancer has the most thoroughly understood
disease progression
• There are three recognized genetic defects that have to
occur:
• Onocgene activation (k-ras, c-myc)
• Loss / mutation of tumour suppressor genes
• Loss / suppression of genes involved with DNA repair path
ways.
• On average, an adenoma will take 8-10 years to turn into
carcinoma. Small adenomas are present in 1/3 people. A
primary colonic carcinoma is present in 1/30 people.
Metastatic colon cancer is present in 1/60 people.

25. Polyps in the Colon
Image Source: National Cancer Institute

26. COLORECTAL CANCER
RISK FACTORS
Age
– incidence increase significantly between the ages of 40 and
50
– 90% of cases occur after age 50
• Inflammatory bowel disease - UC > CD
• Personal history of colorectal cancers or adenomatous
polyps
– Metachronous CRC incidence is 0.33% per year
• Hereditary Colon Cancer Syndromes
– Familial adenomatous polyposis (FAP) syndrome
– Hereditary nonpolyposis colon cancer (HNPCC)
– Family history of sporadic cancers or adenomatous polyps

27. COLORECTAL CANCER
RISK FACTORS
Probably related
– Long--term consumption
of red meat or processed
meats
– High--fat and low--fiber
consumption
– Cigarette smoking
– Prior pelvic irradiation
– Obesity
Probably protective
– Intake of a diet high in
fruits and vegetables
– Regular physical activity
– Postmenopausal hormone
use
– Anti--oxidants,, vitamins,,
Calcium,, Magnesium
– Medications ::
NSAID/aspirin,, statins

28. • NOTE::
Only about one
half of cancers
are within the
reach of the
flexible
sigmoidscope..
Hence full
colonoscopy is
important..

29. HEREDITARY COLON CANCER
SYNDROMES
Family history of sporadic cancers
• RR of 2.25 if 1st degree relative has CRC
• Higher incidence if relative had CRC at a younger age
• Higher incidence if more relatives are involved
• Hereditary nonpolyposis colon cancer (HNPCC)
• autosomal dominant
• two subgroups - Lynch syndrome I & Lynch syndrome II
• 70%-80% lifetime risk of colorectal cancer
• nearly 70% of cancers arise in the right colon
• Lynch II has colonic & extra colonic cancers
• Familial adenomatous polyposis (FAP) syndrome

30. FAMILIAL ADENOMATOUS POLYPOSIS
autosomal dominant(AD)
• numerous colonic adenomas typically appear during childhood
• symptoms appear at an average age of approximately 16 years
• colon cancer develop in 100% of untreated individuals by age 45
• variants are Gardner's syndrome, Turcott's syndrome, and
attenuated adenomatous polyposis coli

31. COLON & RECTAL CANCER
SPREADLymphatic
– most common mechanism for metastatic disease
– pericolic nodes, then to the nodes at the root of the main vessel
• Hematogenous
– Liver (most common), lung, brain, bone, etc…
• Transperitoneal /Implantation
– tumors with serosal involvement shed viable tumor cells
– spreads within the peritoneal cavity and implant on other organs
– examples are ovaries, omentum, peritoneal surface, nodules in the rectovesical
pouch or pouch of Douglous
– widespread peritoneal involvement is called carcinomatosis
• Direct extension
– to any nearby structures by direct infiltration
– this is T4 disease

32. CLINICAL MANIFESTATIONS OF CRC
.1-Abdominal pain
– initially vague, dull, poorly localized
– partial obstruction
– peritoneal dissemination
– intestinal perforation leading to generalized peritonitis
– locally advanced
 • 2-Change in bowel habits
– narrowed bowel lumen leads to thin caliber of stool, constipation
and/or diarrhea
 • 3-Bleeding (hematochezia or melena)
– Proximal cancers - melena
– Distal cancers - hematochezia
 •4- Asymptomatic

33. CLINICAL MANIFESTATIONS OF CRC
 * -5-Weakness -- 20 percent
• 6-Anemia without other gastrointestinal symptoms --
11%
• Usually right sided cancers
• May be stool guiac positive
• 7-Weight loss -- 6 percent
• 8-Intestinal Obstruction
• 9-Unusual presentation:
• fistulas (internal/external)
• abscess
• fever & pain (mimics diverticulitis)
• 10-Metastatic disease – liver metastasis , ascitis,
peritoneal nodules, Siistter Joseph’’s nodulle, etc.
Any patient over 50 with
Anemia (man or
woman) – RULE OUT
colorectal cancer

34. CLINICAL MANIFESTATIONS OF CRC
May have synchronous cancers
– two or more distinct primary tumors
separated by normal bowel and not due to
direct extension or metastasis
– occur in 3-5% of patients with colon/rectal
cancer
Always DO (A COMPLETE COLONOSCOPY BEFORE )
STARTING TREATMENT , unless obstructing or nearly obstructing
ALWAYS

35. CLINICAL MANIFESTATIONS OF CRC
Resected right colon with large benign
sessile polyp adjacent to an
ulcerated carcinoma
Note: This is unlikely to obstruct
Know the differences between
RIGHT
Right--sided cancers
– tend to be polypoid or
fungating or ulcerating
– unlikely to obstruct
– tends to present with
weakness & anemia
– may have melena or guiac positive
stool
– * advanced lesions can cause
change in bowel habits and
bowel obstruction

36. CLINICAL MANIFESTATIONS OF CRC
Left--sided cancers
– tend to be annular or
constricting lesions
– likely to obstruct
– produce an "apple-core"
or
"napkin-ring" appearance
on Ba enema
– tends to present with
change in bowel habits &
gross bleeding

37. CLINICAL MANIFESTATIONS OF CRC
• Carcinoma of right
colon can also
• give rise to apple-core
lesion

38. RECTAL CANCER
Most common symptom of rectal cancer is hematochezia
• Unfortunately, this is often attributed to hemorrhoids (by
patient & physician), hence correct diagnosis is consequently
delayed until the cancer has reached an advanced stage.
• Other symptoms include
– mucus discharge
– tenesmus
– change in bowel habit
– pain (usually with locally advanced rectal cancer)
Colorectal cancer can co-exist with hemorrhoids.
Hence, always look for a proximal source of bleed
Cancer
Piles

39. DIAGNOSIS OF COLORECTAL CANCER
1-Colonoscopy
– single best diagnostic test in symptomatic
individuals
– can localize lesions throughout the large
bowel
– biopsy mass lesions
– detect synchronous neoplasms
– remove polyps

40. DIAGNOSIS OF COLORECTAL CANCER
2-Double contrast barium enema
– cannot biopsy the lesion
– done if unable to reach the tumor with
colonoscope for technical reasons

41. Staging Of Colorectal CANCER
*1-Assess the local and distant extent of disease
•2- Thorough History & Physical examination
•3- Lab tests - LFT, CEA
• 4-CT scan of abdomen & pelvis
– regional tumor extension
– regional lymphatic disease
– distant metastases
– tumor-related complications (e.g., obstruction, perforation, fistula
formation)
• 5-Chest X--ray (or CT chest) to rule out lung metastasis
• 6-Endorectal ultrasound for rectal tumors
• 7-PET scans
– do not add significant information to CT for preoperative staging of CRC
Endorectal ultrasound of T3N1 rectal cancer

42. STAGING OF COLORECTAL CANCER
CT scan of a sigmoid cancer
– an irregular narrowed lumen
– speculated outer border
– sharp demarcation from normal
bowel
CT scan of abdomen showing
multiple liver metastasis

43. STAGING OF COLORECTAL CANCER
Multiple hepatic metastases from a primary colon Adenocarcinoma

44. Staging Of Colorectal CANCER
• 1- Duke staging system
(ABCD)
• 2- TNM staging system
• 3- AJCC staging system
Dukes Staging
A :: confined to bowel wall
B :: penetrates bowel wall into serosa
or perirectal fat
C :: lymph node metastasis
D :: Distant metastasis

45. TNM Staging
Primary Tumor (T)
Tis : carcinoma in situ
T1 :: invades submucosa
T2 :: invades muscularis propria
T3 :: invades subserosa or perirectal tissue
T4 :: invades other organs
Regional lymph nodes (N)
N0: No Regional LN involved
N1 :: metastasis to 1--3 nodes
N2 :: metastasis to > 3 nodes
Distant metastasis (M)
M0 :: no distant metastasis
M1 :: Distant metastasis

46. AJCC Dukes TNM

47. AJCC Staging

49. Treatment of Colorectal Cancer(CRC)
• Options Available :
• 1- Radical Surgery
• 2-Chemotherapy
• 3-Radiotherapy
• 4-Immunotherapy

50. Colon cancer Surgery
• Colon Cancer :
• Stage I, II : Surgery
• – Stage IIB*, III : Surgery followed by
chemotherapy( Adjuvant Chemo Thx)
• – Stage IV : Any modality as indicated
• Rectal Cancer:
• – Stage I : Surgery
• – Stage II, III : Pre-op chemoradiation followed by
surgery( Neo-Adjuvant Chemo Thx)
• – Stage IV : Any modality as indicated
Poor prognostic factors – lymphovacular invasion, perineural invasion, poorly differentiated

51. Principles of Surgery for Colorectal
Cancer
*The objective of surgery for colorectal
Adenocarcinoma is:
1-removal of the primary cancer with adequate
margins
–2- regional lymphadenectomy
–3- restoration of the continuity of the
gastrointestinal tract by anastomosis, if indicated
*The extent of resection is determined by:
– A-the location of the cancer
– B-its blood supply and draining lymphatic system
– C-presence or absence of direct extension into
adjacent organs

52. Surgical Options for Colon cancer
1-Ca of cecum/ascending colon:
– Right Hemicolectomy
2- Ca of hepatic flexure/proximal transverse colon:
– Extended right Hemicolectomy
3-Ca of distal transverse colon:
– Extended right Hemicolectomy including Splenic
flexure OR left Hemicolectomy
4- Ca of left colon:
– Left Hemicolectomy
5-Ca of sigmoid colon:
– Sigmoidectomy OR left Hemicolectomy

53. Right Hemicolectomy
Extended right Hemicolectomy
Left Hemicolectomy
Sigmoid Colectomy
Total Colectomy

54. 1.. Resects the colon cancer and do primary anastomosis (1 surgery)
2.. Two stage procedure
-- Resect the colon cancer, staple off the distal end and bring the proximal
end as an end colostomy (Hartmann’s procedure) (1st surgery).
- After 6-8 weeks, take down the colostomy and do anastomosis (2nd
surgery)
3.. Three stage procedure
-- Do proximal loop colostomy (1st surgery)
- Prep the bowel and do colon resection and do anastomosis (2nd surgery)
- After 6-8 weeks, take down the colostomy (3rd surgery)
4.. Resect the cancer and the entire proximal colon and do
anastomosis of ileum to the distal end (1 surgery)
5.. Resect the colon cancer,, do an on--table colon wash--out and do
primary anastomosis (1 surgery)

55. Obstructing Colon Cancer
Surgical Approach
1- Obstructing right colon or transverse colon can be
managed with right Hemicolectomy or extended
right Hemicolectomy
• Staged procedure ::
– Is done for obstructing cancer in stages
– Currently, most surgeons do a 2-stage procedure or
a 1-stage procedure.
• Colonic stenting across the tumor can be done as a
palliative measure allows transient relief of obstruction
and do bowel prep prior to definitive surgery
• Do metastatic work up when the condition permits
• Rule out synchronous cancers when appropriate

57. Perforated Colon Cancer
Surgical Options
Present with peritonitis
• Goal of treatment:
– remove the diseased segment of colon
– prevent ongoing peritoneal contamination
• Surgical procedure is
– Resect the colon cancer, staple off the distal end
and bring the proximal end as an end colostomy
(Hartmann’s procedure)
– thorough peritoneal lavage
• Associated with high rate of local recurrence and
overall low survival

58. (Hartmann’s procedure)
Resect the colon cancer, staple off the distal end and bring the proximal end as an end colostomy

59. Risk Factors for Colon Cancer
• Different cancers have
different risk factors
• Having a risk factor(s) does
not mean you will get
cancer
• Certain risk factors
increase a person’s chance
of developing a polyp(s) or
colorectal cancer
Risk Factor:
Anything that affects your
chance of getting a disease
such as cancer.

60. Risk Factors for Colon Cancer:
Lifestyle Factors
• Diet
– High in red meats (beef, pork,
lamb, or liver) and processed
meats
– Cooking meats at high temperatures
(frying, broiling, or grilling)
• Physical inactivity
• Obesity (Being very overweight)
• Smoking
• Heavy alcohol use
Increases
Risk for
Colon
Cancer

61. Other Risk Factors for Colon
Cancer:
• Age (over 50)
• Personal history of colorectal cancer
or polyps
• Personal history of Inflammatory
Bowel Disease (IBD)
• Family history of colorectal
cancer or polyps
• Inherited syndromes
• Racial & Ethnic Backgrounds:
African-Americans & Jewish persons of
Eastern European descent
• Type 2 Diabetes
Increases
Risk for
Colon
Cancer

62. Signs & Symptoms
of Colon Cancer
•A change in bowel habits
•A feeling of needing a bowel
movement
•Rectal bleeding
•Blood in the stool which may
make it look dark
• Cramping or abdominal
(belly) pain
• Weakness & fatigue
• Unintended weight loss
Early colon cancer may have NO symptoms.
Schedule an appointment to talk to your health care provider if you
have any of these symptoms.
If symptoms are present, they may include:

63. Clinical Presentation of Colon cancer
• About 50% of cancers occur at the retrosigmoid junction or
in the rectum.
• There can sometimes be an ascites high in protein. This is
produced by local spread into the peritoneal cavity.
• Sister Mary Joseph Nodule – this is a lymph node that can
be felt at the umbilicus and is a sign of metastatic spread.
• Liver metastases are relatively common but probably
asymptomatic at first. Later they can cause slight pain and
hepatomegaly, and late on they may lead to jaundice.
• Lung metastasis can produce a persistent cough.
• You may also get spread to bone marrow, producing
leucoerythroblastic anaemia.

65. Cecal and right sided carcinoma
presentation:
• Often asymptomatic but may present with iron deficiency
anaemia, and other vague symptoms such as weight loss
and malaise.
• Vague abdominal pain
• Faecal occult blood loss
• Palpable right iliac fossa mass
• Acute appendicitis – this may rarely occur due to caecal
tumour blocking off the entrance to the appendix
• Distal ileal obstruction (rare)- shows advanced disease –
the faecal matter entering the caecum is normally liquid –
and it takes a massive blockage to prevent liquid getting
through!

66. Left sided and sigmoid carcinoma
• By the time the stool reaches this region it is often hard as
most of the water has been absorbed. As a result,
obstruction may be a symptom in this form of the disease.
The diagnosis may be confused with diverticular disease or
IBS.
• Alteration of bowel habit – often alternating between
constipation and diarrhoea.
• There may or may not be any pain. If pain is present it is
often colicky.
• Desire to defecate (tenesmus) and distension
• Palpable mass in the left side of the abdomen.
• There may often be mucus visible in the stools, but visible
blood is rare (only about 10% of cases)

67. Rectal cancer• These often cause symptoms earlier on than other locations. They are also often
accessible by digital examination or rigid sigmoidoscopy. The symptoms can be
attributed to haemorrhoids or anal fissure and this may delay the diagnosis. This
could be linked to the fact there is a reluctance by both patients and doctors to
carry out a rectal examination and so colorectal cancer may be missed.
• Rectal bleeding – This is a particularly common finding. The blood may be dark and
mixed with the stool, but it can also be lighter coloured and completely separate
from the stool.
• Changes in bowel habit – could be more frequent and there may also be lots of
mucus and diarrhoea.
• Continuous urge to defecate – caused by the presence of a large tumour in the
bowel which gives a continuous feeling of fullness. This is known as tenesmus
• Anal and perineal pain. May at first be associated with the urge to defecate, but
can later become constant. This occurs with a low rectal cancer that invades the
anal sphincters.
• There may also be faecal incontinence caused by a cancer invading the anal
sphincter, and back pain caused by involvement of the sacral plexus.
• Infiltration of the urinary tract, leading to urinary tract infections, possible fistulas,
and even renal failure.

68. Spread
• pread normally occurs through the bowel wall. Often rectal
cancers will infiltrate pelvic viscera and side walls.
Lymphatic spread is common at presentation, and spread
can also reach the liver through systemic and portal venous
systems. Spread to the lungs is rare. Tumour staging at the
time of presentation is the most important factor in
determining prognosis. The site of the cancer can have an
effect on overall patient outcome. Rectal cancers often
have a better outcome than colonic ones because they are
detected earlier. However, there is a higher risk of
recurrence in rectal cancers due to the fact it is harder to
remove all the tissue you need to. Generally, right sided
tumours have a better prognosis then left sided ones, even
if they are both staged at the same level.

69. Importance of Screening
for Colon Cancer
• Colon cancer is PREVENTABLE!
• Early diagnosis means a better chance at
successful treatment.

70. Who should be screened?
People at
Average Risk
• ALL people ages
50-75 who are
“average risk”
• After age 75,
discuss with
your doctor if
screening needs
to be continued
• Includes men
and women
People at High Risk
• Have one or more risk factors
for developing colon cancer
• Must be screened more often &
regularly
• This includes persons with a
personal or family history of
polyps or colon/rectal cancer
The American College of Gastroenterology,
a professional medical organization,
recommends African-Americans begin
colon cancer screening at age 45.

71. Which Screening Test Should
You Get?
It depends on your RISK FACTORS. Be sure to talk with your
health care provider about your risk factors and the risks for
each colon cancer screening test.
Common Colon Cancer Screening Tests which are often covered by
Private Health Insurance, Medicare, & Medicaid
Fecal Immunochemical Test (FIT) or Guaiac Fecal Occult Blood Testing
(gFOBT)
Colonoscopy
Some insurance companies may also cover the fecal DNA test
(includes Cologuard-is covered by Medicare & Aetna) or other
screening tests for colon cancer. Be sure to talk to your
insurance company about which test(s) they cover for your
individual risk factors.

72. Types of Colon Cancer
Screening Tests
Description of the Test Screening Schedule for
AVERAGE RISK PERSONS
Fecal/Stool blood tests
(FIT, FOBT, or gFOBT)
Samples of stool are
checked for blood
Every year
Stool DNA Test (Includes
Cologuard)
Samples of stool are
checked for blood as well
as DNA changes
Every 3 years
Colonoscopy A flexible, lighted tube is
used to look at the entire
colon & rectum
Every 10 years
Sigmoidoscopy A flexible, lighted tube is
used to look at the
rectum & lower colon
Every 5 years, with FIT or
FOBT testing every 3
years
Schedule an appointment to talk to your health care provider about which test is
right for you & how often you should be screened.

73. Preventing colorectal cancer
• Many colorectal cancers could be prevented with
regular screening.
• Screening is testing to find a disease in people who
have no symptoms.
• Why screen?:
• To find and remove polyps before they become
cancer
• To find CRC early – when it’s small and has not
spread, and when treatment can be more effective

74. How is CRC screening done?
• Types of tests for CRC screening: Tests that
can find both polyps and colorectal cancer
Tests that mainly find cancer

75. Tests that can find both polyps and
cancer
• 1-Flexible Sigmoidoscopy
• 2-Colonoscopy
• 3- Double contrast barium enema (DCBE)
• 4- CT colonography (“virtual colonoscopy”)
• These tests look inside the colon to find abnormal areas.
They are done with a lighted tube put in through the
rectum or with special x-ray tests. If polyps are found they
can be removed before they develop into cancer, so these
tests can help prevent cancer. These tests are preferred if
they are available and if a person is willing to have them.

76. Tests that mainly find cancer
• All of these test the stool for hidden blood or
other changes that may be signs of cancer.
• They are less invasive and easier to do.
• They are less likely to find polyps than the other
types of tests.
• Colonoscopy will be needed if results are
abnormal.

77. ACS Colorectal Cancer Screening
Guidelines
At age 50, both men and women should begin regular
screening and have one of the screening tests listed
here or on the next slide:
Tests that find both polyps and cancer :
 1-Flexible Sigmoidoscopy (FSIG) every 5 years*, or
 2-Colonoscopy every 10 years, or
 3-Double-contrast barium enema (DCBE) every 5
years*, or
4- CT colonography (virtual colonoscopy) every 5
years*
*Colonoscopy should be done if anything is found by these tests

78. ACS Colorectal Cancer Screening
Guidelines
• At age 50, both men and women who have an average
risk of CRC should begin regular screening and have
one of the screening tests listed here or on the
previous slide:
• Tests that find mainly cancer:
1-Guaiac-based fecal occult blood test (gFOBT) every
year*, or
2- Fecal immunochemical test (FIT) every year*, or
3- Stool DNA test (sDNA) every 3 years*
*Colonoscopy should be done if anything is found by these
tests

79. what can you do to prevent and beat colorectal cancer
(What you can do)
• 1-Stay at a healthy weight
• 2- Be active: At least 150 minutes of moderate or 75
minutes of vigorous intensity activity per week, or an
equivalent combination, preferably spread throughout the
week
• 3- Limit sedentary behavior
• 4-Eat right(Healthy food )
• 5-Limit alcohol
• 6- If you are age 50 or older, get tested for colorectal
cancer.(Talk with a doctor about which screening test is
best for you)
• 7-

81. Screening Summary
• Screening tests offer the best way to prevent
CRC or find it early. Finding cancer early gives
you a better chance for successful treatment.
Early CRC usually has no symptoms. Don’t wait
for symptoms to occur. Again —treatment is
most effective when CRC is found early.