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Colorectal Cancer Proposal of a Screening Program for Developing Countries with Emphasis on Costs

This proposal aims to create awareness about colorectal cancer in developing countries and suggest steps for implementing a screening program. It highlights relevant features of colorectal cancer and recommends articles and websites for further information.

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Colorectal Cancer Proposal of a Screening Program for Developing Countries with Emphasis on Costs

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  1. Colorectal CancerProposal of a Screening Program for Developing Countries with Emphasis on Costs

  2. Presentator: Alessandro L. Loiola, MD • Atendant of Coloproctology at the Specialties´ Regional Referral Center, Vitoria / ES - Brazil • Developer of Health Contents for Boasaude.com.br • E-mail: alpl@escelsanet.com.br

  3. Objectives • Create a consciousness of the problem for third-world countries • Access some relevant features in the diagnosis of Colorretal Cancer • Sugest steps for a screening program

  4. Recommended articles • BOND JH. Screning for colorectal cancer. Hosp Prac, Jan 15:59-74, 1997. • SELBY JV et alii. Effect of fecal occult blood testing on mortality from colorectal cancer. Am Col Phys, 118:1-6, 1993.

  5. Recommended websites: • Colorectal Cancer Homepage at http://home.swipnet.se/crc/ • Colorectal Forum at www.colorectal-forum.org/ • NCI CancerNet Database at www.meb.uni-bonn.de/cancernet/

  6. Creating a Consciouness for screening: did you know that . . . • Colorectal cancer kills more than AIDS and Diabetes ? • In some countries (Brazil included) colorectal cancer causes more deaths per year than ovarian, uterine, prostate or even lung cancer ?

  7. Relevant Features of Colorectal Cancer •  Special Risk Factors •  Decade of ocurrance •  Clinical manifestations •  Pathology

  8. Relevant Features of Colorectal Cancer:1 - Special risk factors • Diet habits • Inflamatory bowel diseases • Familial adenomatous polyposis syndrome • Strong incidence of cancer in the family

  9. Relevant Features of Colorectal Cancer: 2 - Decade of occurrance

  10. Relevant Features of Colorectal Cancer:3 - Clinical manifestations • Low intestinal bleeding • Altered bowel habits • Unexplained weight loss

  11. Relevant Features of Colorectal Cancer:4 - Pathology • 90% of Colorectal malignant tumors are Carcinomas • 60-70% of the lesions are located in the last 1/3 part of large bowel • 30% of all lesions can be reached by digital exam only

  12. Steps of the Colorectal Cancer Screening Program

  13. Colorectal Cancer Screening Program - Step 1 • Faecal-occult-blood test (FOBT) in people after age 50 and/or with known risk factors and/or physical evidences suggesting colorretal cancer

  14. Colorectal Cancer Screening Program - Step 1a • Patients with negative FOBT, without evidences at physical examination and/or without risk factors: • repeat FOBT every year

  15. Colorectal Cancer Screening Program - Step 1b • Patients with negative FOBT but with sustained clinical suspicion and/or with risk factors: go to Step 2

  16. Colorectal Cancer Screening Program - Step 1c • Patients with positive FOBT: go to Step 2 (sigmoidoscopy)

  17. Colorectal Cancer Screening Program - Step 2 • Sigmoidoscopy (flexible if possible)

  18. Colorectal Cancer Screening Program Step 2a - Negative Sigmoidoscopy • Patients without clinical suspicion and any risk factor: follow up with FOBT every year, one sigmoidoscopy each 3-5 years and one colonoscopy each 10 years.

  19. Colorectal Cancer Screening Program Step 2b - Negative Sigmoidoscopy • Patients with sustained clinical suspicion and/or any risk factor: consider Barium enema. One can choose promptly performing a Colonoscopy (Step 3) • If all negative: follow up as Step 2a.

  20. Colorectal Cancer Screening Program Step 2c - Positive Sigmoidoscopy • Go to Step 3 (Colonoscopy), after collecting samples.

  21. Colorectal Cancer Screening Program Step 3 - Colonoscopy • To further exam the extention of a particular lesion and to identify more lesions • Patients with negative colonoscopy: follow up as Step 2a.

  22. Colorectal Cancer Screening Program Hole of Barium Enema • Detect other lesions • Can be replace (with restrictions) colonoscopy where this exame is not obtainable

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