Clues to colorectal cancer presentation (silent killer) Direct access colonoscopy. Mr Shafi Ahmed PhD, FRCS, FRCS(Gen.Surg) Consultant Laparoscopic Colorectal Surgeon Clinical and MDT Lead for Colorectal Cancer B arts Health NHS Trust Associate Dean and Honorary Senior Lecturer
Mr Shafi Ahmed PhD, FRCS, FRCS(Gen.Surg)
Consultant Laparoscopic Colorectal Surgeon
Clinical and MDT Lead for Colorectal Cancer
Barts Health NHS Trust
Associate Dean and Honorary Senior Lecturer
RCS Tutor and TPD Core surgery
Civilian Advisor to the Armed Forces
Academic Surgery Unit
Queen Mary University of London
Hypoxic biomarkers to predict response to therapy in rectal cancer.
Influence of telomerase length and hTERT expression in prognostication in CRC.
Tissue microarray in CRC.
MicroRNA’s in CRC prognostication.
Methylation markers in young age cancers in ethnic “Bangladeshi” population.
Clinical and molecular profiling of “Signet ring cell” lower GI cancers
Biomarkers of muscle damage in patients with parastomal hernia after bowel resection (cancer and non-cancer patients)Bowel Cancer Related Research Portfolio (Colorectal Cancer Team – Royal London Legacy Site)
HPV related methylation markers in patients with anal intra-epithelial neoplasia and anal squamous cell carcinoma
Clinical Research including clinical trials:
Randomised controlled trial comparing laser ablative therapy versus active observation to prevent development of anal squamous cell carcinoma in HIV positive MSM patients with high-grade AIN (LOPAC trial) – NIHR-HTA funded.
Development of a multi-modal therapy including exercise and cognitive interventions for improving quality of existence in cancer survivors (SURECAN) – NIHR programme development grant funded study.
Epidemiology of “anterior resection syndrome” and validation of “LARS” scoring system in UK population.
A clinical, molecular and functional study on discriminants of sphincter preserving restorative surgery in patients with low rectal cancer.
An International, longitudinal cohort study of safety and feasibility of “APPEAR” technique in ultra-low rectal resections.
RCT comparing SMART vs. conventional surgery for prevention of parastomal hernia
Pilot, feasibility study of functional outcomes after laser ablative therapy of high grade AIN in HIV positive patients
Development of a novel locomotion technology for active colon capsule endoscopy – proof of concept study (QM Innovation funded).
Evaluation of a novel combined laser and plethysmography probe to assess intra-operative bowel perfusion in patients undergoing restorative large bowel resection
Development of a humanoid arm/hybrid robotic system for laparoscopic and open pelvic/rectal surgery.
Fe deficiency anaemia
Change in bowel habit
Looser more frequent stools
TenesmusTraditional teaching of presentation of colorectal cancer 2 week wait referrals
22 referrals per year
Increasing every year
Peaks with health campaign
However only 10-15% of cancers diagnosed by 2wwTwo week wait referrals
25% of all patients presenting with colon cancer
Elective mortality <10%
Emergency mortality >30%
Incidental findingsLondon Cancer emergency audit
25% acute admission
Therefore approx 50% are through other routes
How to identify?The problem
2 week wait referrals
to reduce the burden of 2 week wait
Reduce the lead time for test and improve 31 and 62 day targetDirect access colonoscopy
To reduce the burden of OPD clinics
2 pilot clinicsQUIP - 2013
Assessment of suitability
Time dependent on CNS
Need support staff at RLHProblems faced
2week and 18 week wait referral
Current waiting times
8 weeks clinic appt
4- 6 weeks for colonoscopy
DNA rate 1%
50% reduction in pathway for 2ww
67% for 18 week
Shortlisted for BMJ prize for service innovationWhipps cross led by Ed Seward (Consultant Gastroenterologist)
Control and intervention group
incidence in the intervention group was reduced by 23%
mortality by 31%
South of Tyne (Queen Elizabeth & South Tyneside)
West Kent (West Kent & Medway)
St Marks (London)
Roll out in 2014Bowel Scope