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Screening

7

memories of being at home. I’m one

of four, and we played a lot with a

local family who had kids our age –

we were very good friends.

Where isyour favourite

place intheworld?

There are so many places to choose

from! I’m torn between the Alps and

the Caribbean...The Alps win, just,

because they’re so beautiful in both

the summer and winter.

Whowouldyou liketo

playyou, if a moviewas

made aboutyour life?

Julia Roberts without a doubt,

because I love ‘PrettyWoman’! I’m

a bit of a romantic at heart.

Dr Alison Taylor is now offering the

Lister Fertility Clinic service at 31

Old Broad Street – London Bridge

Hospital’s outpatient and diagnostic

centre in the heart of the City. For

further information, or to organise

a consultation, please telephone:

Tel: +44 (0) 20 7234 2009

Colorectal Cancer

Screening

Introduction

Colorectal Cancer (CRC) is the second

most common cause of cancer deaths

in developed countries with 35,000 new

cases and 16,000 deaths from CRC in the

UK (2004, CRCUK). Although there have

been significant improvements in prognosis

recently (50% survive 5 years), the UK still

lags behind the USA and most of Western

Europe. One of the main reasons for this

is late presentation, as early-stage tumours

have an excellent prognosis with surgery

alone, but only a minority of cancers are

diagnosed early.

Tests available for bowel cancer

screening

Faecal occult blood test

The NHS started bowel cancer screening

for the general population in 2006 but

not all areas of the country are currently

covered.The NHS screening programme

uses the faecal occult blood test (FOBt).

After a positive test, the subject is

invited to undergo a colonoscopy.The

evidence for the efficiency of bowel

cancer screening using FOBt comes from

three large randomised controlled trials.

These demonstrated a 15-33% mortality

reduction from CRC because of increased

detection of early stage cancers.The best

result was from the American study, where

a higher proportion of subjects underwent

a colonoscopy.The main disadvantages of

the test, are that it is not very sensitive and

may miss over half of all cancers, especially

if they are not bleeding; it may also not

pick up polyps and may sometimes give a

positive result, even if no cancer is present.

Colonoscopy

Colonoscopy is regarded as the gold

standard for colonic examination, not

only because it allows complete and

reliable examination of the entire colon,

but also offers the option to remove

polyps or adenomas, thus dramatically

reducing the risk of CRC. It has been

shown to detect advanced polyps or

cancers in 10% of asymptomatic subjects,

aged 50-75. Colonoscopy is used as

a screening test in the USA and some

parts of Western Europe.

CT Colonography (CTC)

This method produces both two-

dimensional and three-dimensional images

or ‘virtual colonoscopy’. Advantages of

CTC include safety, patient tolerability and

the ability to ‘look behind’ mucosal folds.

Recent trials of CTC show similar sensitivity

to optical colonoscopy for detecting polyps.

The main disadvantage of CTC is the

inability to take biopsies or remove polyps,

in this instance an optical colonoscopy is

required. Up to 45% of patients in the NHS

screening programme have been shown

to have polyps or cancer. Also, full bowel

preparation is still required for CTC.

Screening in high risk groups

Some patients have an increased risk of

developing bowel cancer because of a

strong family history or conditions which

predispose them to bowel cancer.These

include those with a past personal or family

history of CRC, those with

inflammatory bowel or endocrine

conditions that are known risk

factors for CRC and those with known

or suspected inherited genetic disorders.

These patients should be offered

surveillance according to current guidelines.

Bowel cancer screening at London

Bridge Hospital

London Bridge Hospital offers bowel

cancer screening using colonoscopy.

London Bridge Hospital

Dr Guy Chung-Faye MRCP PhD

Clinical Lead, SE London Bowel Cancer Screening Centre

Dr John O’Donohue MD FRCP FRCP(I)

Clinical Director, SE London Bowel Cancer Screening Centre

Summary

• Colorectal or bowel cancer is the

second most common cause of cancer

deaths in the UK.

• It is preventable and the prognosis is

related to the stage at presentation.

• FOBt has been shown to reduce CRC

mortality.

• The NHS offers CRC screening with

FOBt for subjects aged 60-69.

• The FOBt may miss half of all cancers.

• Colonoscopy and CTC are more

accurate but are more expensive and

currently not used for population

screening.

• London Bridge Hospital can offer

bowel cancer screening using

colonoscopy by accredited specialists

from Bowel Cancer Screening Centres.

For further information,

or to book an appointment,

please contct the GP Liaison

Team on:

Tel: +44 (0) 20 7234 2009