Podcast
Questions and Answers
What is the global incidence rate of colon and rectal cancer?
What is the global incidence rate of colon and rectal cancer?
Which of the following is considered a personal medical history risk factor for colon and rectal cancer?
Which of the following is considered a personal medical history risk factor for colon and rectal cancer?
Which hereditary syndrome is associated with a mutation in the tumor suppressor gene APC?
Which hereditary syndrome is associated with a mutation in the tumor suppressor gene APC?
How does sedentary lifestyle affect colon cancer risk?
How does sedentary lifestyle affect colon cancer risk?
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Which lifestyle change is NOT recommended to reduce the risk of developing colorectal cancer?
Which lifestyle change is NOT recommended to reduce the risk of developing colorectal cancer?
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What is a common ethnicity with a higher risk of developing colon and rectal cancer in Singapore?
What is a common ethnicity with a higher risk of developing colon and rectal cancer in Singapore?
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What is the daily limit for alcohol intake suggested for men to reduce cancer risk?
What is the daily limit for alcohol intake suggested for men to reduce cancer risk?
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What is the efficacy range of aspirin in reducing colonic adenomas and colorectal cancer risk in average risk individuals?
What is the efficacy range of aspirin in reducing colonic adenomas and colorectal cancer risk in average risk individuals?
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Which condition is associated with hyperinsulinemia and elevated IGF-1 levels that promote tumor cell proliferation?
Which condition is associated with hyperinsulinemia and elevated IGF-1 levels that promote tumor cell proliferation?
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Which of the following statements about colorectal cancer risk factors is false?
Which of the following statements about colorectal cancer risk factors is false?
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Which of the following is NOT a common side effect of chronic NSAID use in cancer prevention?
Which of the following is NOT a common side effect of chronic NSAID use in cancer prevention?
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What is the recommended low dose of aspirin for preventive measures in individuals with hereditary nonpolyposis colorectal cancer?
What is the recommended low dose of aspirin for preventive measures in individuals with hereditary nonpolyposis colorectal cancer?
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What percentage of new cases of colon and rectal cancer occurs in men in Singapore?
What percentage of new cases of colon and rectal cancer occurs in men in Singapore?
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Which lifestyle factor is indicated as a method to maintain a healthy weight?
Which lifestyle factor is indicated as a method to maintain a healthy weight?
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Why is high dosage of aspirin (600 mg/day) suggested for patients with hereditary conditions?
Why is high dosage of aspirin (600 mg/day) suggested for patients with hereditary conditions?
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What is the main purpose of secondary prevention strategies in cancer management?
What is the main purpose of secondary prevention strategies in cancer management?
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What is the primary reason screening strategies for colon and rectal cancer are important?
What is the primary reason screening strategies for colon and rectal cancer are important?
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At what age should average-risk individuals begin screening for colon cancer?
At what age should average-risk individuals begin screening for colon cancer?
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Which screening method is considered the gold standard for preventing colon cancer?
Which screening method is considered the gold standard for preventing colon cancer?
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For individuals aged over 75, what is the recommended approach to screening decisions?
For individuals aged over 75, what is the recommended approach to screening decisions?
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What screening option is recommended every 1 to 3 years?
What screening option is recommended every 1 to 3 years?
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Which of the following is a disadvantage of screening for colon cancer?
Which of the following is a disadvantage of screening for colon cancer?
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What is the recommended frequency for a colonoscopy in average-risk individuals?
What is the recommended frequency for a colonoscopy in average-risk individuals?
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Which group is considered high-risk for colorectal cancer screening?
Which group is considered high-risk for colorectal cancer screening?
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What does sensitivity measure in a screening test?
What does sensitivity measure in a screening test?
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Which screening method is highlighted as the most cost-effective for the population?
Which screening method is highlighted as the most cost-effective for the population?
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What is the specificity of the Faecal occult blood testing (FOBT)?
What is the specificity of the Faecal occult blood testing (FOBT)?
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What is considered the gold standard for complete large bowel evaluation?
What is considered the gold standard for complete large bowel evaluation?
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What is a significant advantage of screening tests according to the content?
What is a significant advantage of screening tests according to the content?
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Which of the following is NOT a cause for a positive result in faecal occult blood testing?
Which of the following is NOT a cause for a positive result in faecal occult blood testing?
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What is a limitation associated with the detection ability of the Faecal occult blood testing (FOBT)?
What is a limitation associated with the detection ability of the Faecal occult blood testing (FOBT)?
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In terms of cost-effectiveness, under what condition is colonoscopy considered more effective than FOBT?
In terms of cost-effectiveness, under what condition is colonoscopy considered more effective than FOBT?
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What is a significant disadvantage of the sigmoidoscopy procedure?
What is a significant disadvantage of the sigmoidoscopy procedure?
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Which of the following factors is NOT considered a risk for colorectal cancer (CRC)?
Which of the following factors is NOT considered a risk for colorectal cancer (CRC)?
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What might influence a person's decision to avoid CRC screening?
What might influence a person's decision to avoid CRC screening?
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What is one of the advantages of CT colonoscopy compared to traditional colonoscopy?
What is one of the advantages of CT colonoscopy compared to traditional colonoscopy?
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At what age should average risk patients begin regular colon examinations?
At what age should average risk patients begin regular colon examinations?
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Which of the following described the prep procedure for sigmoidoscopy?
Which of the following described the prep procedure for sigmoidoscopy?
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Which medication is noted for its potential to reduce CRC risk, yet currently not recommended for routine cancer prevention?
Which medication is noted for its potential to reduce CRC risk, yet currently not recommended for routine cancer prevention?
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What is the main reason for conducting regular examinations of the entire colon?
What is the main reason for conducting regular examinations of the entire colon?
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Which factor is associated with a significant increase in colorectal cancer risk?
Which factor is associated with a significant increase in colorectal cancer risk?
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What is a significant effect of processed meat consumption related to colorectal cancer?
What is a significant effect of processed meat consumption related to colorectal cancer?
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What can be said about the association of red meat with colorectal cancer?
What can be said about the association of red meat with colorectal cancer?
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How does the Human Development Index (HDI) relate to colorectal cancer incidence rates?
How does the Human Development Index (HDI) relate to colorectal cancer incidence rates?
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Which statement correctly describes the process of colorectal tumorigenesis?
Which statement correctly describes the process of colorectal tumorigenesis?
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What hereditary factor plays a role in colorectal cancer risk?
What hereditary factor plays a role in colorectal cancer risk?
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What is a primary strategy for preventing colorectal cancer in at-risk populations?
What is a primary strategy for preventing colorectal cancer in at-risk populations?
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How do NSAIDs contribute to colorectal cancer management?
How do NSAIDs contribute to colorectal cancer management?
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Study Notes
IC 17 Pharmacist-led Management of Lower GIT Conditions
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Learning Outcomes: Recognize colon and rectal cancer global and local incidence.
- Global Incidence: 9.6% of 20 million new cases
- Global Mortality: 9.3% of 9.7 million deaths
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Singapore (SG) Incidence:
- Male: 16.3% - second most common after prostate cancer
- Female: 12.9% - second most common after breast cancer
Risk Factors for Colon & Rectal Cancer Development
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Personal Medical History:
- Age: >50 (US: 45)
- Adenomatous Polyps: Generally asymptomatic; colonoscopy for detection
- Symptoms: Bleeding (how? abrasion with polyps as feces move through colon), more dry.
- Colorectal Cancer:
IBD, CD, UC
- Chronic Underlying Inflammation: Oxidative stress, release of various cytokines → promote tumorigenesis
- Type II DM: Hyperinsulinemia and elevated free insulin-like growth factor-1 (IGF-1) levels → promote tumor cell proliferation
Familial History & Genetic Risk
- Colorectal Cancer / Adenomatous Polyps: Inherited genes, shared environmental factors, combined effect increases risk.
- Hereditary Syndromes: Somatic (2/3) and germline (1/3) genetic mutations. Familial adenomatous polyposis (FAP) - mutation suppressor gene (APC). Lynch syndrome - genes involved in DNA repair pathways(MLH1, MSH2).
- Ethnicity: Chinese have higher risk in Singapore (SG).
Lifestyle Factors
- Sedentary Lifestyle: Inverse relationship between physical activity and colon cancer risk.
- Overweight & Obesity: Dose-response relationship with elevated BMI, waist circumference, and waist-to-hip ratio.
- Alcohol Intake: ≥30g/day (~2 drinks) → significant positive association.
- Smoking: ≥40 cigarettes/day or 2 packs/day → increased colorectal cancer risk by 40%, doubling colorectal cancer death risk.
- Processed Meat: 50g/day → significant increase in colorectal cancer risk.
- Red Meat: Positive association, but not significant for colorectal cancer.
Colorectal Cancer Pathophysiology
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Colorectal Tumorigenesis: Multistep process involving genetic/phenotypic alterations → dysregulated cell growth/proliferation → tumor development.
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Contributors: Genomic instability, oncogene pathway activation, silencing of tumor suppressor genes, and DNA mismatch repair activation of growth factor pathways.
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Mutation accumulation: within colonic epithelium confers selective growth advantage to cells.
- Mutation (1): Inherited; genetic risk factors
- Low-Grade Dysplasia: Determined by histology.
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Mutation accumulation: within colonic epithelium confers selective growth advantage to cells.
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Contributors: Genomic instability, oncogene pathway activation, silencing of tumor suppressor genes, and DNA mismatch repair activation of growth factor pathways.
NSAIDs and Chemoprevention
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Strategies for Prevention: Prevent colorectal cancer in population at risk through lifestyle modifications (e.g., dietary factors) and therapeutics (e.g., vaccination)
- Examples: Eat more fruits/vegetables, reduce red meat intake, reduce processed meat intake, avoid cooking meat at high temp (e.g., charring, grilling, deep frying), avoid barbequing, limit alcohol intake (males: 2 drinks, female 1), exercise regularly, maintain healthy weight, quit smoking.
- Aspirin: Efficacy in reducing colonic adenomas and colorectal cancer risk (20-40% reduction in average-risk individuals). High dose (600mg/day) benefit for hereditary nonpolyposis colorectal cancer (HNPCC) patients.
- Selective COX-2 Inhibitors (e.g., NSAIDs): Efficacy in colorectal neoplasia prevention is unlikely. Chronic use increases cardiovascular risk.
Screening Strategies
- Most Appropriate Strategies: Discuss options and weigh risks/costs (e.g., Colonoscopy, FOBT, Flexible Sigmoidoscopy, FIT, Stool DNA tests). Factors to consider include age, risk factors, family history, etc.
Colorectal Cancer Signs and Symptoms
- Distribution: Ascending: 20-30%, Transverse: 10%, Descending: 60%.
- Treatment Modalities: Various treatment options for colorectal cancer
Summary of CRC Risk
- Factors: Advancing age, inherited/acquired genetic susceptibility, lifestyle choices, and Inflammatory bowel disease (IBD).
- Methods to Reduce Risk: Regular use of aspirin, NSAIDs, calcium intake (but not currently recommended for routine cancer prevention).
- Effective Screening: Regular entire colon examination, when to start? 50 (average risk). Colorectal adenomas can progress to cancer.
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Description
This quiz focuses on the incidence and risk factors associated with colon and rectal cancer, as well as the management of lower gastrointestinal tract conditions. It covers important statistics, personal medical history influences, and the relationship between chronic inflammation and tumorigenesis. Test your knowledge on this critical area of patient care.
