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Latest & greatest articles for colorectal cancer
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on colorectal cancer or other clinical topics then use Trip today.
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, SMAD4, BMPR1A, MLH1, MSH2, MSH6, PMS2, STK11, GREM1, MUTYH, and EPCAM* [*deletions associated with epigenetic silencing of MSH2]. Generally for the gastrointestinal (GI) cancer predisposition genes, those testing positive require close surveillance with colonoscopy to detect the rapidly growing cancers which occur driven by, for example, the mutator phenotype (accumulating hundreds of mutations in the tumours) typically of Lynch Syndrome. Those who do develop colorectalcancer are usually advised (...) this rearrangement. 3. Summary of consideration and rationale for MSAC’s advice MSAC noted that the proposed purposes and populations are (a) diagnostic testing of patients with either (i) colorectal or endometrial carcinoma and features suggestive of a hereditary basis, or (ii) a colonic polyposis syndrome, plus (b) cascade testing of relatives of those individuals who are diagnosed with the relevant germline gene variants. The diagnostic genetic test is to characterise germline gene variants in three or more
Robotic Versus Conventional Laparoscopic Surgery for ColorectalCancer: A Systematic Review and Meta-Analysis with Trial Sequential Analysis Minimally invasive surgery has been considered as an alternative to open surgery by surgeons for colorectalcancer. However, the efficacy and safety profiles of robotic and conventional laparoscopic surgery for colorectalcancer remain unclear in the literature. The primary aim of this review was to determine whether robotic-assisted laparoscopic surgery (...) (RAS) has better clinical outcomes for colorectalcancer patients than conventional laparoscopic surgery (CLS).All randomized clinical trials (RCTs) and observational studies were systematically searched in the databases of CENTRAL, EMBASE and PubMed from their inception until January 2018. Case reports, case series and non-systematic reviews were excluded.Seventy-three studies (6 RCTs and 67 observational studies) were eligible (n = 169,236) for inclusion in the data synthesis. In comparison
Performance Characteristics of Fecal Immunochemical Tests for ColorectalCancer and Advanced Adenomatous Polyps: A Systematic Review and Meta-analysis. Studies report inconsistent performance of fecal immunochemical tests (FITs) for colorectalcancer (CRC) and advanced adenomas.To summarize performance characteristics of FITs for CRC and advanced adenomas in average-risk persons undergoing screening colonoscopy (reference standard) and to identify factors affecting these characteristics.Ovid
. Why was this study needed? Bowel (colorectal) cancer is the fourth most common cancer in the UK. An estimated 15,900 people died from bowelcancer in 2014. Bowelcancer costs the NHS around £1.1 billion a year. Early detection of bowelcancer is essential to give the best chance of survival. Adenomas are small growths on the inner lining of the largebowel that can become cancerous. People with adenomas can be categorised as being at low, intermediate or high risk of cancer depending on the size (...) follow-up examination. It may be possible to reduce the frequency of screening for these people. A study of more recent data will be necessary to validate this finding. Share your views on the research. Why was this study needed? Bowel (colorectal) cancer is the fourth most common cancer in the UK. An estimated 15,900 people died from bowelcancer in 2014. Bowelcancer costs the NHS around £1.1 billion a year. Early detection of bowelcancer is essential to give the best chance of survival. Adenomas
suffered from nerve damage as a side-effect. Three-quarters of people survived to three years without disease progression on either treatment. This international trial, part funded by the NIHR, included over 6,000 people with high-risk stage II or III bowelcancer that had spread through the bowel wall or to nearby lymph nodes. Standard treatment after surgery is usually six months of an oxaliplatin-containing regimen. This study evaluated a shorter course. Oxaliplatin is known to damage nerves (...) Fewer side-effects and similar benefits from shorter chemotherapy after bowelcancer surgery Fewer side-effects and similar benefits from shorter chemotherapy after bowelcancer surgery Discover Portal Discover Portal Fewer side-effects and similar benefits from shorter chemotherapy after bowelcancer surgery Published on 12 June 2018 doi: A three-month course of chemotherapy after surgery for bowelcancer seems no less effective than the standard six-month course, and half as many people
is limited for other outcomes, such as how different protocols impact cost or quality of life; on-going trials may shed light on this. Nevertheless, bowelcancer follow-up is time consuming and uses scarce NHS resources such as colonoscopy. If less intensive follow-up offers similar survival outcomes as more intensive approaches this may offer opportunities for savings. Share your views on the research. Why was this study needed? Around 40,000 new cases of bowelcancer (colorectalcancer) are diagnosed (...) : Cancer Research UK; updated 2015. NHS Choices. . London: Department of Health; 2014. NICE. . CG131. London: National Institute for Health and Care Excellence; 2014. Public Health England. . London: Public Health England and NHS RightCare; 2017. Why was this study needed? Around 40,000 new cases of bowelcancer (colorectalcancer) are diagnosed each year in the UK. This means 1 in 20 people could develop it during their lifetime. Surgery is usually the main treatment and if caught early enough
scans of chest, abdomen and pelvis, and colonoscopy, as well as CEA testing, when monitoring people who have had cancer removed from the colon or rectum. Share your views on the research. Why was this study needed? Bowelcancer is the fourth most common cancer in the UK, and costs the UK £1.6bn per year in terms of premature death, lost employment, health costs and informal care. However, survival has doubled in the last 40 years, to 57% at ten years after initial diagnosis. After surgery to remove (...) cancers that originated in the gut such as coloncancer. Other common conditions can also have raised CEA levels, such as liver disease, inflammatory boweldisease, or other cancers. So the test is not very specific for coloncancer recurrence. Normal ranges for levels of CEA in the blood vary by exact test and laboratory, but are generally are less than 2.5 to 5μg per litre. The pattern of changing levels over time is useful for identifying potential risk of recurrence, for example a significant rise
Making Patients Fit for Surgery: Introducing a Four Pillar Multimodal Prehabilitation Program in ColorectalCancer. Considering the relation between preoperative functional capacity and postoperative complications, enhancing patients' functional capacity before surgery with a prehabilitation program may facilitate faster recovery and improve quality of life. However, time before surgery is short, mandating a multimodal and high-intensity training approach. This study investigated feasibility (...) for colorectalcancer patients is feasible, safe, and effective. A randomized controlled trial (NTR5947) was initiated to determine whether prehabilitation may lower morbidity and mortality rates in colorectal surgery.
Adjuvant Chemotherapy of Locally Advanced ColonCancer: Final Results of a Randomized Trial Comparing 5-Fluorouracil and Folinic Acid with Folfiri. There is still the need to optimize adjuvant treatment of coloncancer (CC). Standard adjuvant chemotherapy using 5-fluorouracil (FU) and folinic acid (FA) was compared with a combination including irinotecan (Folfiri). The aim of the present report was to analyze overall survival (OS) after long-term follow-up, to summarize final recurrence rates (...) in 17 (12.8%) patients treated with FUFA and in 50 (36.8%) patients treated with Folfiri. Recurrences occurred in 46 of 133 (34.6%) and in 47 of 136 (34.6%) patients who received FUFA and Folfiri, respectively. 5-year OS rates were 69.9% (95% confidence interval (CI): 61.2-77.1) for FUFA and 72.7% (95% CI: 63.9-79.8) for Folfiri. OS was associated with tumor grading (1 & 2 vs. 3), tumor sub-stage (II vs. IIIa vs. IIIb vs. IIIc), and tumor location (left vs. right colon).Folfiri cannot be generally
Sequential Versus Combination Therapy of Metastatic ColorectalCancer Using Fluoropyrimidines, Irinotecan, and Bevacizumab: A Randomized, Controlled Study-XELAVIRI (AIO KRK0110) The XELAVIRI trial investigated the optimal treatment strategy for patients with untreated metastatic colorectalcancer. We tested the noninferiority of initial treatment with a fluoropyrimidine plus bevacizumab, followed by the addition of irinotecan at first progression (arm A) versus upfront use of fluoropyrimidine (...) of 421 randomly assigned patients (arm A: n = 212; arm B: n = 209) formed the full analysis set. Median age was 71 and 69 years, respectively. Noninferiority of TFS was not shown (hazard ratio [HR], 0.86; 90% CI, 0.73 to 1.02). In detail, patients with RAS/BRAF wild-type tumors benefitted from combination chemotherapy (HR, 0.61; 90% CI, 0.46 to 0.82; P = .005), whereas patients with RAS mutant tumors (HR, 1.09; 90% CI, 0.81 to 1.46; P = .58) did not (Cox model for interaction of study arm and RAS
Mortality From Postscreening (Interval) ColorectalCancers Is Comparable to That From Cancer in Unscreened Patients-A Randomized Sigmoidoscopy Trial Endoscopic screening for colorectalcancer (CRC) is performed at longer time intervals than the fecal occult blood test or screenings for breast or prostate cancer. This causes concerns about interval cancers, which have been proposed to progress more rapidly. We compared outcomes of patients with interval CRCs after sigmoidoscopy screening vs (...) diagnosed with CRC 30 days or longer after screening (interval cancer group, n = 163) and individuals diagnosed with CRC in the nonscreened group (controls, n = 1740). All CRCs in the control group were identified when they developed symptoms (clinically detected CRCs). Analyses were stratified by cancer site. We used Cox regression to estimate hazard ratio (HRs), adjusted for age and sex.Over the follow-up period, 43 individuals in the interval cancer group died from CRC; among controls, 525 died from
Colon capsule endoscopy (CCE-2) for the detection of colorectal polyps and cancer in adults with signs or symptoms of colorectalcancer or at increased risk of colorectalcancer SHTG Advice Statement | 1 Advice Statement 014-18 November 2018 Advice Statement Colon capsule endoscopy (CCE-2) for the detection of colorectal polyps and cancer in adults with signs or symptoms of colorectalcancer or at increased risk of colorectalcancer Advice for NHSScotland Colon capsule endoscopy (CCE-2 (...) ) is not recommended for routine use in NHSScotland for the detection of colorectal polyps and cancer. The clinical effectiveness evidence is currently limited, no relevant published evidence on the cost effectiveness of the technology was identified, and its place in the patient care pathway has still to be established. CCE-2 may however be considered as an additional testing option in patients who are able to undergo the intensive bowel cleansing needed for CCE-2 and who have contraindications for optical
with papillary thyroid cancer that is the cribriform-morular variant, or hepatoblastoma Individuals with a diagnosis of CRC and>10 colorectal adenomas Individuals with a personal history of20 adenomas Individuals with multiple gastrointestinal hamartomatous polyps or serrated polyposis syndrome Individuals from a family with a known hereditary syndrome associated with CRC with or without a known mutation Individuals with a desmoid tumor, multifocal or bilateral CHRPE CHRPE, congenital hypertrophy of retinal (...) of CRC or advanced adenoma warrants more intense screening for CRC. Well-designed prospective studies are needed in order to make de?nitive evidence-based recommendations about the age to commence screening and appropriate interval between screening tests. Keywords: Adenoma; Cancer; Colonoscopy; Colorectal; FOBT; Neoplasms; Polyp; Screening. Executive Summary Colorectalcancer (CRC) is the second leading cause of cancer deaths in Canada and the United States. A positive family history (FH) signi
Strategies for Detecting ColorectalCancer in Patients with Inflammatory BowelDisease: A Cochrane Systematic Review and Meta-Analysis Patients with longstanding ulcerative colitis (UC) and colonic Crohn's disease (CD) have an increased risk of colorectalcancer (CRC). We assess the effectiveness of endoscopic surveillance in patients with inflammatory boweldisease (IBD) for diagnosing CRC and reducing CRC-related mortality.MEDLINE, EMBASE, and CENTRAL were searched from inception to 19 (...) on the degree of heterogeneity; pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method.Five observational studies evaluating 7199 IBD patients were included; no RCTs met criteria for inclusion. There are limited new studies evaluating this clinical question (last included study published 2014). There was a significantly higher rate of cancer detection in the non-surveillance group (3.2%, 135/4256) compared to the surveillance group (1.8%, 53/2895
Survival differences with immediate versus delayed chemotherapy for asymptomatic incurable metastatic colorectalcancer. For patients with asymptomatic, incurable, metastatic colorectalcancer, palliative, systemic treatment can be started immediately, or can be delayed until disease-related symptoms occur. How the potential survival benefit of starting palliative, systemic treatment immediately after diagnosis weighs up against the potential side effects is currently under debate (...) August 2018. We did not apply limitations based on language or date of publication. We searched the reference lists of all included studies to identify trials that may not have been identified from the electronic searches.Randomised controlled trials evaluating immediate versus delayed chemotherapy in persons with asymptomatic, metastatic, incurable colorectal cancer.We applied standard methodological procedures, according to the recommendations of Cochrane and Cochrane ColorectalCancer. Two review
) in children and adults? Clinical Bottom Line Incidental findings on dental radiographs could serve as screening tools for systemic diseases and syndromes. The attention should be raised when gene mutation, congenitally diseases or familial colorectalcancer are reported by patients during the medical history questionnaire. For patients with risk of FAP, the Dental panoramic radiographic score (DPRS) is inexpensive, and reinforce the referral for the further clinical investigation, gene mapping (...) . Perspective: These studies emphasize the extra-intestinal manifestations of colorectalcancer. The dental anomalies, commonly considered incidental findings, appear around 10 years before the clinical evidence of the intestinal polyps and the dental professional should be aware of these correlations. Since the gene mutation affects families, it is important to early detect, refer and map genetically these patients reducing the morbidity. The colorectalcancer is considered a public health issue, FAP
Population health interventions to improve colorectalcancer screening by fecal immunochemical tests: A systematic review Despite clear evidence that colorectalcancer (CRC) screening reduces mortality, screening, including fecal immunochemical tests (FIT), is underutilized. We conducted a systematic review to determine the evidence of efficacy of interventions to improve FIT completion that could be scaled and utilized in population health management. We systematically searched publication
Evaluation of Interventions Intended to Increase ColorectalCancer Screening Rates in the United States: A Systematic Review and Meta-analysis Colorectalcancer screening (CRC) is recommended by all major US medical organizations but remains underused.To identify interventions associated with increasing CRC screening rates and their effect sizes.PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and ClinicalTrials.gov were searched from January 1, 1996 (...) , to August 31, 2017. Key search terms included colorectalcancer and screening.Randomized clinical trials of US-based interventions in clinical settings designed to improve CRC screening test completion in average-risk adults.At least 2 investigators independently extracted data and appraised each study's risk of bias. Where sufficient data were available, random-effects meta-analysis was used to obtain either a pooled risk ratio (RR) or risk difference (RD) for screening completion for each type
Risk Scores for Predicting Advanced ColorectalNeoplasia in the Average-risk Population: A Systematic Review and Meta-analysis A systematic review and meta-analysis was performed to summarize the available evidence on risk scores for predicting advanced colorectalneoplasia (advanced adenomas and cancer) in average-risk and asymptomatic populations undergoing screening colonoscopy.PubMed, EMBASE, and Web of Science databases were searched up to 28 March 2018. Studies that developed or validated (...) a risk score to predict the risk of advanced colorectalneoplasia were included. Two reviewers independently extracted study characteristics including diagnostic performance indicators and assessed risk of bias and applicability in the included studies. Meta-analyses were conducted to determine the overall discrimination of risk scores evaluated by more than 1 study.A total of 22 studies including 17 original risk scores were identified. Risk scores included a median number of 5 risk factors. Factors