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

36 Screening for Colorectal Cancer KCE reports vol.45
3.2.2 Personal history of colorectal cancer
Patients with resected colorectal cancer are at risk for recurrent cancer and
metachronous neoplasms in the colon 68-70. Patients with endoscopically resected
TNM Stage I colorectal cancer, surgically resected Stage II and III cancers, and
Stage IV cancer resected for cure (isolated hepatic or pulmonary metastasis) are
candidates for endoscopic follow-up.
3.2.3 Personal history of endometrial or ovarian cancer
Women with endometrial and ovarian cancer diagnosed prior to age 60 years
are at mildly elevated risk for colorectal cancer. Risk is highest for women with
the primary diagnosis prior to age 50 years 71. However, this observation is
based on data that did not exclude patients with Hereditary Nonpolyposis
Colorectal Cancer (HNPCC) who may account for some of the observed risk 72.
3.2.4 Personal history of long standing active inflammatory bowel disease
involving the colon
Also at increased risk are individuals with a personal history of long standing
active inflammatory bowel disease (IBD) involving the colon73-80, such as longstanding
(8 - 10 years) chronic ulcerative colitis74, 75 or Crohn s colitis81, 76, 78.
One cross-sectional study 82 examined the relationship between distal
diverticulosis and risk for colorectal neoplasia in 502 patients undergoing firsttime
colonoscopy for any indication. Patients with prior polypectomy, colonic
resection, or inflammatory bowel disease were excluded. Patients completed a
survey about risk factors for CRC prior to colonoscopy. Endoscopists, blinded
to study objective and survey results, recorded the size, extent (none, few, or
many), and location of diverticuli and polyps. Overall comparison of patients
with extensive distal diverticulosis (EDD) versus few or no diverticuli revealed
no differences in the risks of any neoplasia or advanced neoplasia, either distally
(26,0% vs. 25,4%; 12,9% vs. 8,8%, respectively) or proximally (25% vs. 18,4%;
6.0% vs. 4,9%). However, compared to women with few or no distal diverticuli,
women with EDD were more likely to have any neoplasia and advanced
neoplasia, both distally (34,6% vs. 16,3%; p = 0,03, and 23,1% vs. 5,7%; p =
0,003) and proximally (30,8% vs. 14,9%; p = 0,049, and 11,5% vs. 4,3%, p =
0,13). Adjustment for age did not affect results for advanced distal neoplasia
(OR = 3,2; CI: 1,18 - 13); however, adjustment for the presence of a distal
neoplasm eliminated the increased risk of proximal neoplasia associated with
EDD (OR = 1,31; CI: 0,43 - 4,02). Hence, distal diverticulosis appears not to be
independently associated with proximal neoplasia in men or women.
3.2.5 Acromegaly
Recently, it has become apparent that patients with acromegaly have an
increased prevalence of colorectal adenomas and cancer 83-90. That this increased
risk might be related to serum growth hormone and/or IGF-1 levels is
supported by recent observational epidemiological studies in the nonacromegalic
population that have demonstrated an association between serum
IGF-1 and the risk of colorectal cancer 91-98.
3.2.6 Ureterosigmoidostomy patients
Neoplasia at the anastomosis of the ureters and colon in patients with any
urinary diversion that mixes urine and stool (ureterosigmoidostomy and its