Report in English with a Dutch summary (KCE reports 45A)

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174 Screening for Colorectal Cancer: Appendices KCE reports vol.45 9 Management of Colorectal Cancer - A national clinical guideline 49 . 10 Guidelines for colorectal cancer screening in high risk groups 190 . 11 Preventive health care, 2001 update: colorectal cancer screening 28 . Scottish Intercollegiate Guidelines Network (SIGN) British Society of Gastroenterology (BSG) Association of Coloproctology for Great Britain and Ireland (ACPGBI) Canadian Task Force on Preventive Health Care (CTFPHC) 2003 1 SDR or any TDR with CRC Average risk screening 50 y N/A High risk: 3 family members with CRC 2 with CRC and 1 with endometrial CA in at least 2 generations, 1 diagnosed at 50 y and 1 FDR of the other 2 Moderate risk: 1 FDR with CRC < 45 y. or 2 FDR with CRC, one < 55 y or 2 (one with CRC < 55 y) or 3 family members with CRC or endometrial CA , who are FDR of each other and one being a FDR of the consultant 1 FDR with CRC < 45 y 2 FDR with CRC, one < 55 y 2002 2 FDR with CRC 1 FDR < 45 y with CRC 2001 1 FDR with polyps or CRC but not meeting the criteria for HNPCC ( Colonoscopy ( Discuss gynaecological screening for endometrial or ovarian CA ( Oesophagoduodeoscopy (OGD) for gastric CA screening ( Consider screening for other cancers which may occur in specific families and are part of the HNPCC spectrum At first consultation or 5 y younger then the youngest affected relative Colonoscopy At first consultation or at 30-35 y, whichever is the later Colonoscopy At first consultation or at age 35-40 y whichever is the later Colonoscopy & OGD every 2 y from 30-70 y If first colonoscopy clear, repeat at 55 y If initial colonoscopy clear then repeat at 55 y Colonoscopy 40 y Not stated Grade C, Level III Grade D See Appendix 2 SIGN Grade B See Appendix 2 BSG & ACPGBI See Appendix 2 USPSTF/CTSPHC grading
KCE reports vol.45 Screening for Colorectal Cancer: Appendices 175 Table 4: Guidelines & recommendations on CRC surveillance in case of high personal risk (N = 12) Nr. Title Issued by Year Familial Adenomatous Polyposis (FAP) & related 1 Colorectal Cancer Screening 58. National Comprehensive Cancer Network (NCCN) 2006 1. Family history of FAP FS or colonoscopy beginning at age 10-15 y. Repeat every 12 m until age 24 y; every 2 y until age 34 y; every 3 y until age 44 y then every 3-5 y thereafter. Consider substituting colonoscopy every 5 y beginning at age 20 in addition to the FS. 2.In case of: Personal history of adenomatous polyposis (> 10 adenomas, or > 15 cumulative adenomas in 10 y) either consistent with recessive inheritance or with adenomatous polyposis with negative APC mutation testing; Family history of sibling with MYH polyposis and asymptomatic (counseling and testing for the familial mutations is recommended); Biallelic MYH mutation positive and small adenoma burden manageable by colonoscopy and polypectomy Begin colonoscopy at age 25-30 y and every 3-5 y if negative (consider shorter intervals with advancing age) Consider upper endoscopy and side viewing duodenoscopy at age 30-35 y and repeat every 3-5 y. 5. Patients with duodenal adenomas are treated as FAP. 6. Dense polyposis or large polyps not manageable by polypectomy needs counseling regarding surgical options Recommendations 2A Hereditary Non- Polyposis Colon Cancer (HNPCC) 1. Colonoscopy at age 20-25 y or 10 y younger than the youngest age at diagnosis in the family, whichever comes first. Repeat every 1-2 y. Consider periodic evaluation for associated intra-abdominal malignancies. 2. If adenom(s) found: endoscopic polypectomy with follow-up colonoscopy every 1-2 y depending on: location, character, surgical risk, patient preference. 3. For women: screening for endometrial cancer with transvaginal ultrasound and office endometrial sampling annually starting by age 30-35 y or 5-10 y earlier than the earliest age of first diagnosis of these cancers in the family, and screening for ovarian cancer with concurrent transvaginal ultrasound (preferrably day 1-10 of cycle for premenopausal women) + CA-125 every 6-12 m. Recommendations 2A Personal history of CRC resection Curative intent resected CRC colonoscopy in 1 y, within 3-6 m if there was no or incomplete preoperative colonoscopy. If adenoma found repeat colonoscopy in 1-3 y. If normal repeat colonoscopy in 2-3 y Recommendations 2A Personal history of colonpolyps 1. Low risk adenoma = 3 polyps, < 1 cm, tubular) repeat colonoscopy within 3-6 y, if normal repeat every 5 y. 2. Advanced or multiple adenomas = high-grade dysplasia/carcinoma in situ OR larger than 1 cm OR villous (> 25% villous) OR number > 3 and 10 repeat colonoscopy within 3 y, if normal repeat every 3- 5 y. 3. > 10 adenomas or > 15 cumulative adenomas in 10 y consider a polyposis syndrome 4. Incomplete polypectomy Repeat colonoscopy within 3-6 m (timing depending on endoscopic and pathologic findings). Recommendations 2A Inflammatory bowel disease (IBD) 1. Starting at 8-10 y after onset of symptoms, colonoscopy every 1-2 y. When clinically quiescent, 4 quadrant biopsies every 10 cm with > 30 total samples using large cup forceps (preferred). Additional extensive sampling of strictures and masses. Endoscopic polypectomy when appropriate with biopsies of surrounding mucosa for the assessment of dysplasia. 2. Information regarding the value of endoscopic surveillance of long-standing Crohn s disease is limited. Surveillance is at the discretion of the physician. Optimal management of Crohn s related dysplasia remains undefined. Patient and physician preference should be considered. Extent of resection for Crohn s-related dysplasia needs to be based upon the individual findings. Recommendations 2A Miscellaneous Personal history of ovarian or endometrial cancer at age < 60 y start colonoscopy at age 40 y or at age of diagnosis of ovarian/endometrial cancer. Repeat colonoscopy at 5 year intervals if normal. Recommendations 2A
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