Transcript Colon Cancer - WordPress.com

Intervention for Prevention
Marigo Werner
 Define
colon cancer
 Discuss pathophysiology of colon cancer
 Discuss morbidity and mortality statistics
 Discuss detailed plan for intervention
 Discuss evaluation methods
 Discuss implementation of intervention plan
*A tumor is abnormal tissue and can be benign
(not cancer) or malignant (cancer).
*A polyp is a benign (non-cancerous) tumor.
*Adenomatous polyps (adenomas) are polyps that can change into cancer.
*Hyperplastic polyps and inflammatory polyps, in general are not precancerous.
*Dysplasia is an area in the lining of the colon or rectum where the cells
look abnormal (but not like true cancer cells) when viewed under the
microscope.
(American Cancer Society, 2012).
 Adenocarcinomas
are a type of colorectal
cancer. They make up 95% of colon cancers.
 Carcinoid tumors start from specialized
hormone producing cells in the intestine.
 Gastrointestinal stromal tumors start from
interstitial cells of cajal.
(American Cancer Society, 2012)
 Lymphomas
are cancers of the immune
system cells that typically start in lymph
nodes.
 Sarcomas start in blood vessels as well as in
muscle and connective tissue in the wall of
the colon and rectum. Sarcomas of colon
and rectum are rare.
(American Cancer Society, 2012).
 Tumors
of the right (ascending) and left
(descending) colon include pain, a palpable
mass in the lower right quadrant, anemia,
and dark red or mahogany-colored blood
mixed with the stool.
(Huether, 2010, p. 1501)
 Manifestations
of tumors of the left, or
descending colon include progressive
abdominal distention, pain, vomiting,
constipation, need for laxatives, cramps and
bright red blood on the surface of the stool
(Huether, 2010, p.1051).
 Approximately
150,000 new cases of
colorectal cancer are diagnosed each year
and nearly 50,000 people die from this
disease each year. Colorectal cancer
accounts for 10% of all cancer deaths in the
U.S.
 Colon cancer is a significant health problem
in Kentucky-it is the second leading cause of
cancer death in Kentucky (“Kentucky Colon”,
2012).
SEER Incidence
From 2005-2009, the median age at diagnosis for cancer of the colon and rectum was 69 years of age 3.
Approximately 0.1% were diagnosed under age 20; 1.1% between 20 and 34; 4.0% between 35 and 44; 13.4%
between 45 and 54; 20.4% between 55 and 64; 24.0% between 65 and 74; 25.0% between 75 and 84; and
12.0% 85+ years of age.
The age-adjusted incidence rate was 46.3 per 100,000 men and women per year. These rates are based on
cases diagnosed in 2005-2009 from 18 SEER geographic areas.
Incidence Rates by Race
Race/Ethnicity
Male
Female
All Races
54.0 per 100,000 men
40.2 per 100,000 women
White
53.1 per 100,000 men
39.2 per 100,000 women
Black
66.9 per 100,000 men
50.3 per 100,000 women
Asian/Pacific Islander
44.9 per 100,000 men
34.2 per 100,000 women
American Indian/Alaska Native a
45.2 per 100,000 men
38.0 per 100,000 women
Hispanic b
45.2 per 100,000 men
31.5 per 100,000 women
(National Cancer Institute, 2012)
United States Cancer Statistics (USCS)
Cancers By State and Region
2008 Cancer Types Grouped by State and Region
Colon and Rectum. Age-Adjusted Invasive Cancer Incidence Rates and 95% Confidence Intervals by U.S. Census Region and Division, State
and Metropolitan Area, and Race and Ethnicity, United States (Table 2.4.1.1M) *†‡
Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population (19 age groups - Census P25-1130).
Geographic Area
United States
Hispanic
All Races
White
Black
51.6
50.2
63.5
45.9
51.9
50.0
64.1
48.2
East South
Central
60.3
57.9
73.0
39.6
Kentucky
64.0
63.9
67.4
–
South
§||
(Table 2.4.1.1M) Colon and Rectum. Age-Adjusted Invasive Cancer Incidence Rates and 95% Confidence Intervals by U.S. Census Region and
Division, State and Metropolitan Area, and Race and Ethnicity, United States *†‡
Footnotes
* Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25–1130).
(National Cancer Institute, 2012)
Rates of Getting Colorectal Cancer by
State
The number of people who get colorectal
cancer is called the colorectal cancer
incidence. In the United States, the risk
of getting colorectal cancer varies from
state to state.
Colorectal Cancer Incidence Rates,* by
State, 2008†
(National Cancer Institute, 2012)
(Kentucky Cancer Registry, 2012)
Deaths from Colorectal Cancer by State
Rates of dying from colorectal cancer also vary from state to state.
Colorectal Cancer Death Rates,* by State, 2008†
(National Cancer Institute, 2012)
 (Kentucky
Cancer
(Kentucky Cancer Registry, 2012)
 Age-more
than 9 out of 10 people diagnosed
with colon cancer are at least 50 years old.
 Personal history of colorectal polyps or
colorectal cancer.
 Colorectal cancer removed-more likely to
develop new cancers in other areas of the
colon and rectum (American Cancer Society,
2012).
 Personal
history of inflammatory bowel
disease. Inflammatory bowel disease
includes ulcerative colitis and Crohn’s
disease, which are conditions in which the
colon is inflamed over a long period of time.
People who have had IB for many years often
develop dysplasia.
 Family history of colorectal cancer . 1 in 5
people who develop colorectal cancer have
other family members who have been
affected by this disease(American Cancer
Society, 2012).
 Inherited
syndromes-about 5% to 10% of
people who develop colorectal cancer have
inherited gene defects (mutations) that
cause the disease.
 Two of the most common inherited
syndromes linked with colorectal cancer are
familial adenomatous polyposis (FAP) and
hereditary non-polyposis colorectal cancer
(HNPCC) (American Cancer Society, 2012).
 Diet
high in red meat (beef, lamb, or liver),
processed meat (hot dogs and some luncheon
meats).
 Cooking at high temperature (frying,
broiling, or grilling)
 Obesity
 Smoking (American Cancer Society, 2012).
 Colon
cancer prevention and early detection
should be the primary goal of CRC screening.
 Screening an average-risk individual can
reduce CRC mortality by detecting cancer at
an early curable stage and by detecting and
removing adenomas. It has also been shown
to be cost-effective compared to other
screening programs (NCCN guidelines, 2012).
 Colon
cancer screening for the average risk
person should begin at age 50.
 Colonoscopy every 10 years
 Flexible sigmoidoscopy every 5 years
 CT colonography every 5 years (NCCN
guidelines, 2012)
 Screening
modalities that primarily detect
cancer are stool-based screening.
 Guiac-based testing annually (requires 3
successive stool specimens).
 Immunochemical based testing annually
 Stool DNA test with high sensitivity (NCCN
guidelines, 2012).
 Intensive
surveillance program should be
initiated for high risk patients.
 Colonoscopy is recommended rather than
flexible sigmoidoscopy because of the
predominant proximal location of cancer. It
should be offered every one to two years,
beginning between the age of 20 to 25 years
 (American Cancer Society, 2012).
Raise awareness in the community about colon
cancer and the importance of colon cancer
screening. Screening an average-risk individual
can reduce CRC mortality (NCCN guidelines,
2012).
 Form a task for composed of members from the
local hospital, local cancer center, health
department, Kentucky Cancer Program,
American Cancer Society Representative, local
school board, civic organizations, churches,
representative from local medical society,
representative from local nurse practitioners,
and volunteers.

 Task
force will develop a publicity campaign.
 Educational spots will be played on the radio
 Ads will be placed in The Medical Leader
 Speakers will give presentations at local
churches and civic organizations
 Literature on colon cancer will be passed out
at local business such as Wal-Mart and Food
City
 Task
force will give presentation at local
medical society meeting to promote colon
cancer screening.
 Instruction sheet for FOBT will be developed
and provided for local family practice
physicians to give to patients who are doing
the FOBT.
 This
is a hyperlink that shows a sample
instruction sheet for collection of specimen
for FOBT.
Fecal Occult Blood Test Instructions.docx
A
comprehensive family history is one
important way to identify at-risk individuals.
Correctly recognizing Lynch Syndrome is
essential for the application of appropriate
screening and surveillance measures (Jang &
Chung, 2010, p. 151).
 This fact about family history will be
reviewed with the medical society to
encourage this practice.
 Life
size colon will be displayed at annual
Hillbilly Days Festival. This display allows
people to walk through the inside of a colon
and see polyps and tumors. This will be done
in conjunction with the Kentucky Cancer
Program.
 Volunteers will be present at the display to
answer questions and provide education
material (Kentucky Cancer Program, 2012).
 An
educational program will be developed
with the local hospital employee education
department that will be made available to
healthcare provider.
 A form letter will be developed and provided
for family practice physicians to send to
patients who have FOBT ordered .
 Community Preventive Services Task Force
recommends use client reminders to improve
compliance with FOBT (2012).
FOBT will be available through the local health
department.
 A free colon cancer screening will be provided by
the local cancer center in conjunction with local
general surgeons.
 According to the Community Preventive Service
Task force, the team found sufficient strong
evidence that interventions using one-on-one
education, client reminders, provider assessment
and feedback and reducing structural barriers
are effective in promoting colorectal cancer
screening with FOBT. (2012).

 Colon
Cancer education material will placed
in family practice physicians’ offices.
 Researchers concluded: “Low-cost education
materials have the potential to contribute to
public engagement with health promotion
and disease prevention” (“New Findings”,
2007).
 The
intervention plan will be evaluated by
having family practice physicians or
designated staff member keep a log of
patients who have FOBT ordered.
 This log will be collected monthly for six
months and reviewed by the task to
determine the amount of testing being done.
A
log of patients who undergo FOBT will also
be kept by the health department, which will
be collected and reviewed.
 A log will be kept at the free colon cancer
screening to determine the number of
participants.
 The
ultimate measure of success in a
screening program is a demonstrable
reduction in mortality in the screened
population. However, this needs large
numbers of individuals, and at least 10 years
of assessment for most cancers (Siakora,
2011).
 It
will take time to reveal the ultimate
effectiveness of the intervention plan
(Siakora, 2011).
 This campaign to increase community
awareness about colon cancer and encourage
participation in FOBT will be launched in
March which is National Colon Cancer
Awareness Month.
American Cancer Society. (2012). American
cancer society recommendations for
colorectal cancer early detection.
Retrieved from http://www.cancer.org/
cancer/colonandrectum
Colon cancer prevention; New findings from
university college in the area of colon
cancer prevention described. (2007, January).
Clinical Oncology Week, 28, 282. Retrieved from
http://proquest.umi.compqdlink?did=1188666061&Fmt
Community Preventive Services Task Force.
(2012). Task force recommendations and
findings. Retrieved from
http://www.thecommunityguide.org/cancer/screen
Department of Health and Human Services
Centers for Disease Control and
Prevention. (2012). Cancer data by state.
Retrieved from http://apps.nccd.gov/usc
Glittens, C. (2008, November). Limitations for
colon cancer screening. Oncology Nursing
News, 2(7), 24. Retrieved from
http://rx9vhehy4rserialssolutions.com
Huether, S. E., (2010). Pathophysiology the
biologic basis for disease in adults and
children. Alterations of digestive function
(pp. 1452-1515).
Jang, E., & Chung, D. C. (2010). Hereditary
colon cancer: Lynch syndrome. Gut and
Liver, 4(2), pp.151-160. doi: 10.5009/gnl.
2010.4.2.151
Kentucky Cancer Registry. (Cartographer).
(2012). Cancer Mortality Rates in
Kentucky [Demographic map]. Retrieved
from http://cancer_rates.info/common/new.html
Kentucky Cancer Registry. (Cartographer).
(2012). Cancer Incidence Rates in Kentucky
[Demographic map]. Retrieved from
http://cancer_rates.info/ky/index.php
National Cancer Institute. (Cartographer).
(2012). Surveillance epidemiology and
end results [Demographic chart]. Retrieved
from http://seer.cancer.gov/statistics
National Comprehensive Cancer Network
Version 2012. (2012). Colorectal cancer
screening. Retrieved from
http://www.nccn.org/professionals/physicians_gls/
Screening for Colorectal Cancer: U.S. Preventive
Services Task Force Recommendation
Statement. (2008, November). Annals of
Internal Medicine, 149(9), 627-637. Retrieved
from http://rx9vh3hy4r.search.serialssolutions.com
 Sikora,
K. (2011). Cancer screening.
Medicine,
40(1), pp. 24-28. Retrieved from
http://liberty.summon.serialssolutions.com.ez