Screening For Colorectal Carcinoma

SCREENING FOR COLORECTAL CANCER IN MALAYSIA
CONSENSUS/CLINICAL PRACTICE GUIDELINES

Malaysian Society of Gastroenterology & Hepatology,
College of Surgeons of Malaysia,
Academy of Medicine, Malaysia

Committee Members:

Prof Mohamed Akhtar Qureshi IMU, Seremban (Convenor)
Assoc Prof. Mahendra Raj USM, Kota Baru
Assoc Prof Ong Kee Thiam UH, Kuala Lumpur
Dr Jayaram Menon Hospital Kota Kinabalu
Dr Tan Yan Mei UH, Kuala Lumpur
Dr Tan Soon Seng SJMC, Selangor
Dr Sebastian Tong DSS, Selangor
Dr Samuel Tay SJMC, Selangor
Dr Dominic Lopez Hospital Melaka

Contents
Page

Introduction
Target population
Definition of risk groups
Surveillance
How to screen
Investigation of subjects found to be positive on the screening test
Role of CEA in screening and management of colorectal cancer
Summary of recommendations
References

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Introduction

Colorectal cancer is the third commonest cause of cancer deaths in Malaysia. Data from the Ministry of Health of Malaysia confirms an increase in colorectal cancer admission rates from 8.1% in 1987 to 11.9% in 1995 (MOH 1995). Genetics, experimental, and epidemiological data suggest that colorectal cancer develops from complex interactions between inherited susceptibility and environmental factors. The current hypothesis is that adenomatous polyps are the precursors of the vast majority of colorectal cancers. Thus measures that can detect and reduce the prevalence of these adenomatous polyps can reduce the risk of colorectal cancer.

While new and exciting data is emerging with the use of chemo-radiotherapy to cure colorectal cancer without surgical intervention, at present surgical resection continues to be the best hope of cure for patients with colorectal cancer. However, by the time the patient presents to the physician with symptoms, the cancer is frequently advanced with little hope of cure. The prognosis of survival

References: Briggman J; Genduso R; Camara C; et al. Anticancer Res, 1999 Jul, 19:4A, 2411-4 Carriquiry LA; Piñeyro A Dis Colon Rectum, 1999 Jul, 42:7, 921-9 Fletcher RH. Carcinoembryonic antigen. Ann Intern Med. 1986; 104:66-73 Hardcastle JD, Chamberlain JO, Robinson MHE, Moss SM, Amar SS, Balfour TW et al Haseman JH et al Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals. Gastrointest Endosc. 1997; 45:451-5 Jasiah Z McPherson A, Payne JE. Importance of total colonoscopy in the diagnosis of colonic disorders Med J Aust. 1983; 19:170-2 Miller BJ et al Diagnostic failure in colonoscopies for malignant disease Macdonald JS. Semin Oncol, 1999 Oct, 26:5, 556-60 Muller AD, Sonnenberg A Rex DK Colonoscopic withdrawal technique is associated with adenoma miss rates. Gastrointest Endosc. 2000; 51; 33-6 Rex DK et al Relative sensitivity of colonoscopy and barium enema for detection of colorectal cancer in clinical practice Steine S et al Double contrast barium enema versus colonoscopy in the diagnosis of neoplastic disorders: aspects of decision-making in general practice. Fam. Pract. 1993; 10:288-91 Staab HJ, Anderer FA, Hornburg A, et al