From the Guidelines
The UK guidelines for colorectal cancer recommend a follow-up schedule that includes a CT scan of the abdomen and pelvis every two years following completion of treatment of the primary disease, as well as colonoscopy repeated after five years, as stated in the guidelines for resection of colorectal cancer liver metastases 1.
Key Recommendations
- The primary screening method for colorectal cancer is the fecal immunochemical test (FIT) every two years, which detects hidden blood in stool.
- Those with positive FIT results should undergo colonoscopy for definitive diagnosis.
- High-risk individuals, including those with family history of colorectal cancer, inflammatory bowel disease, or genetic syndromes like Lynch syndrome, should begin screening earlier and may require more frequent surveillance.
- Symptoms warranting immediate medical attention include persistent changes in bowel habits, rectal bleeding, abdominal pain, unexplained weight loss, or anemia.
Follow-up Surveillance
- Post-colorectal cancer resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years, as recommended by the british society of gastroenterology/association of coloproctology of great britain and ireland/public health england post-polypectomy and post-colorectal cancer resection surveillance guidelines 1.
- Surveillance aims to detect and resect metachronous premalignant polyps and to detect lesions not identified on the initial examination, thereby preventing cancer and reducing CRC mortality.
Treatment
- Treatment typically involves surgery as the primary intervention, often combined with chemotherapy (using agents like FOLFOX, CAPOX, or 5-FU) and/or radiotherapy depending on cancer stage and location.
- The most recent guidelines prioritize a personalized approach to follow-up surveillance, taking into account the individual's risk of future colorectal cancer, as stated in the british society of gastroenterology/association of coloproctology of great britain and ireland/public health england post-polypectomy and post-colorectal cancer resection surveillance guidelines 1.
From the Research
Colorectal Cancer Screening Guidelines in the UK
There are no specific UK guidelines mentioned in the provided studies. However, the studies discuss the effectiveness of fecal occult blood tests (FOBT) and fecal immunochemical tests (FIT) in colorectal cancer screening.
Fecal Occult Blood Tests (FOBT)
- FOBT is a recommended test for colorectal cancer screening, as it has been shown to decrease mortality from CRC 2, 3.
- The test includes guaiac FOBT and fecal immunological tests, with the latter being more sensitive and specific 3, 4.
Fecal Immunochemical Tests (FIT)
- FIT is a more sensitive and specific test compared to traditional guaiac-based FOBT, with a higher diagnostic performance 4.
- FIT can detect proximal and distal advanced neoplasia with similar sensitivity, making it a useful tool for colorectal cancer screening 5.
- The use of FIT is growing rapidly, and it is considered a valuable tool for colorectal cancer screening programs 6.
Diagnostic Performance of FOBT and FIT
- A systematic review and meta-analysis found that new-generation immunochemical FOBTs (iFOBT) have a significantly higher diagnostic performance compared to traditional guaiac-based FOBTs (gFOBT) 4.
- The area under the curve (AUC) for iFOBT was 0.87, compared to 0.77 for gFOBT, indicating a higher diagnostic accuracy for iFOBT 4.