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Colorectal Cancer

Digestive tract cancer is gaining the leading position worldwide in comparison to cancers of the other organ systems.

Colorectal cancer (CRC) nowadays has the dominant position among digestive tract cancers. In 2002, colorectal cancer was the third most common neoplastic disease for men (746,000) and the second most common for women (614,000) and it causes 690,000 deaths annually worldwide. The occurrence of CRC increases with age and is more frequent in men than women.

Causes of Colorectal Cancer Formation

The incidence rate of colorectal cancer is significantly higher in developed countries than in developing countries. Most probably, it is caused by lifestyle, especially by eating habits. This has been proven by the observation of the descendants of people who have moved from an area with a low occurrence of colorectal cancer into an area with a higher occurrence of CRC and their incidence rate is equal to that of the native population.

In Slovakia, there are about 3,600 new cases every year and death from colorectal cancer is the second most frequent cause of death from neoplastic disease in men and the third most frequent in women. If the disease is detected early, the patient is highly likely to recover, however, more than a third of patients visit a doctor during the last stage of the disease when the chances of survival are very small.

The majority of carcinomas of the large intestine develop slowly after formation. The interval between the formation of the tumour and its growth to a size that can cause clinical symptoms takes several years. Therefore, colorectal cancer is frequently diagnosed at an advanced stage based on alarming symptoms. On the other hand, it is also possible to diagnose the disease in its asymptomatic (latent) stage either by a screening examination or a random diagnosis during the examination of other pathological states.

Diagnosis in Asymptomatic (Latent) Stage

Colorectal cancer forms in the epithelium, a superficial layer of the mucosa. In this area, the mucosa loses its physiological characteristics and it becomes vulnerable after it has been infiltrated by the carcinoma and it can bleed microscopically. Based on this there is a simple non-invasive examination, the so-called occult bleeding test (OB).

If a polyp is detected in good time, it can be removed endoscopically. If it is ignored, it can cause a malignant tumour which forms a carcinoma.

The screening (active searching) for colorectal carcinoma reduces mortality from CRC increasing the number of diseases that can be diagnosed in their early stages. Therefore, it is vital to attend routine check-ups that also include a test to detect faecal occult bleeding (FOB). Routine check-ups with CRC screening are performed every two years for patients over 50 (Všeobecná zdravotná poisťovňa covers the costs over the age of 40) or without an age limit for those patients with a family history of this disease.

If blood is detected in the stool screening by means of the FOB test, it is necessary to continue with further examination of the large intestine. A colonoscopy is the best option; it is also possible to carry out either proctoscopy and irrigoscopy or virtual colonoscopy.

The diagnosis of polyps and their systematic removal is part of the screening. Polyps are divided into inflammatory polyps, hyperplastic polyps and adenoma. Adenomas have the potential to be malignant; 80-90% of all colorectal tumours are formed in the sequence adenoma-dysplasia-carcinoma.

Current FOB tests can identify the presence of haemoglobin in stool. The older tests that use guaiac resin provide a lower sensitivity and specificity as they also detect animal blood as well as human blood and can interact with some other types of food (meat, some types of vegetables). The more recent immunochemical tests show a higher specificity and sensitivity; it is not necessary to follow a specific diet before their application and thus false positives are minimized. Haemoglobin is unstable in the environment outside an erythrocyte and degrades relatively rapidly during its transfer through the large intestine. Thus, the classic FOB tests based on the detection of haemoglobin may not detect bleeding from polyps, adenomas or carcinomas localized in a proximal part of colon and thus might give a false negative result.

Literatúra:

(1) BIOHIT ColonViewTechnicalProductDataSheet

(2) Vasilyev, S. et al.: A New GenerationFecalImmunochemical Test (FIT) isSuperior to Quaiac-based Test in DetectingColorectalNeoplasiaAmongColonoscopyReferralPatients. AnticancerResearch 35“ 2877-2880 (2015)

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