Minimising the consequences of colorectal cancer treatment

Transcription

1 Minimising the consequences of colorectal cancer treatment Muti Abulafi Consultant Colorectal Surgeon Croydon University Hospital Chair, Colorectal Pathway Group London Cancer Alliance

2 In two words Early diagnosis Bowel cancer is perhaps the only cancer that is preventable and 100% curable if detected early!!!

3 Why is colorectal cancer preventable Adenoma - Carcinoma Sequence Most colorectal cancers start as benign polyps called adenoma polyps. So if adenoma polyps are removed during endoscopic examinations then a cancer is prevented

4 Why is Colorectal Cancer curable if detected early Let us look at the 5 year survival of the various stages Stage 0-100% Stage I - 93 % Stage II - 71 % Stage III - 41 % Stage IV - 7% Therefore diagnosing a cancer early will lead to cure McDermott et al, Br J.Surg.1981;

5 Look at the survival rate of the UK vs Europe in the 90s

6 ICBP: 1 year relative survival. Coleman et al, Lancet AUS CAN SWE NOR DEN UK AUS SWE CAN 80 NOR DEN 75 UK Colorectal Cancer 1yr RS

7 Total around 10,000 pa Breast ~ 2000 Myeloma 250 Colorectal ~ 1700 Endometrial 250 Lung ~ 1300 Leukaemia 240 Kidney/Bladder ~ 990 Brain 225 Oesophagogastric ~ 950 Melanoma 190 Ovary ~ 500 Cervix 180 NHL/HD 370 Oral/Larynx 170 Pancreas 75 [NB Prostate has been excluded as survival gap is likely to be due to differences in PSA testing rates.] Data derived from Abdel-Rahman et al, BJC Supplement December 2009

8 What can we do to diagnose cancers early - therefore minimise the consequences of treatment 1. Improve Public health Education Better Primary and Secondary Prevention 2. Reduce Late presentation by patients to their GP Improve awareness of symptoms Minimise the barriers to accessing primary care 3. Supporting primary care to encourage early investigation and referral by addressing: GPs not recognising a problem as possible cancer? GPs not wanting to worry a patient when the likelihood of cancer is small? GPs having poor access to diagnostics? GPs being under pressure to limit referrals? 4. Improve quality of treatment, by addressing the following issues: Variable access to cancer surgery and variable surgical outcomes Inadequate Screening and Surveillance

9 What can we do to diagnose cancers early - therefore minimise the consequences of treatment Improve Public health Education: Better Primary and Secondary Prevention Primary Prevention Regular exercise Healthy body weight Dietary factors Folate Calcium Selenium Vitamin E Aspirin/NSAIDS Secondary Prevention Endoscopic or Surgical Polypectomy 93% colorectal cancers prevented National polyp study (USA) Prophylactic colectomy

10 What can we do to diagnose cancers early - therefore minimise the consequences of treatment Screening of colorectal cancer Perhaps the most effective way to achieve early diagnosis It diagnoses the condition before symptoms develop The cancers diagnosed by screening are mainly early stage with better outcomes Any polyps found will prevent development of cancers in years to come Currently uptake rate of screening programme is well below the national target of 60% - efforts need to improve this the more people we screen, the more cancers we detect. Currently the technology used to detect occult blood in the stools is old and there are new and sensitive tests used by other western countries. Moving to this test is likely to help us pick more cancers The age groups screened in England and wales starts at 60 to 75 years whereas in other western nations including Scotland it starts at 50 years.

11 Comparison of Dukes stage in screening vs two weeks detected cancers Courtney et al, Colorectal Dis. 2013; 15:

12 Screen detected colorectal cancers show improved cancer specific survival when compared with cancers diagnosed via the 2 week suspected colorectal cancer referral guidelines

13 Take Home Points Early Diagnosis is the Key to minimizing the consequences of cancer treatments in colorectal cancer Improving uptake of screening is most cost effective tool of early diagnosis