IC 17 Pharmacist-led Management of Lower GIT Conditions

9.6% of 20 million new cases globally; 9.3% of 9.7 million deaths globally.

In Singapore, colon cancer incidence is 16.3% in men (second most common after prostate), and 12.9% in women (second most common after breast cancer).

Age (>50 in the US, 45 is a possible earlier age), adenomatous polyps (often asymptomatic), colorectal cancer, inflammatory bowel disease (IBD), type 2 diabetes.

Inherited genetic risk (e.g., familial adenomatous polyposis (FAP), Lynch syndrome, or inherited mutation in genes involved in DNA repair) and shared family history of colorectal cancer/adenomatous polyps.

Sedentary lifestyle (inverse relationship with physical activity), overweight/obesity.

Generally asymptomatic, polyps can cause bleeding as stool passes through the colon. When more dry stool moves through an affected area there is increased abrasion or contact with the polyp.

Chronic inflammatory conditions like Crohn's disease (CD) and ulcerative colitis (UC) increase colon cancer risk due to chronic inflammation, oxidative stress, and cytokine release.

Type 2 diabetes can increase the risk of colon cancer due to hyperinsulinemia and elevated free insulin-like growth factor-1 (IGF-1) levels, which promote tumor cell growth.

Higher body mass index (BMI), waist circumference, and waist-to-hip ratio correlate with increased risk of certain diseases.

Daily alcohol intake of 30g or more (approx. 2 drinks) significantly raises the risk of colorectal cancer (CRC).

Smoking (40 cigarettes, or 2 packs a day) increases the risk of colorectal cancer by 40% and doubles the risk of death from it.

Consumption of 50g or more of processed meat daily significantly raises the risk of colorectal cancer.

A composite statistic showing average life expectancy, education, and per capita income.

As the Human Development Index increases, cancer rates tend to rise.

The multistep process of colorectal cancer development involving genetic and phenotypic changes.

Non-steroidal anti-inflammatory drugs (NSAIDs) may play a role in preventing colorectal cancer.

Modifications in lifestyle can influence the risk of developing cancer. These factors include diet, exercise, weight management, and smoking cessation.

Strategies to potentially prevent cancer development by using drugs (like aspirin) to interfere with the cancer process.

Aspirin may lower the risk of colon cancer by 20-40%. However, this benefit isn't widespread enough for general use.

Low-dose aspirin (75-100mg) is used for cancer prevention. Higher doses (600mg/day) might benefit people with a genetic predisposition.

Long-term aspirin use can irritate the gut, potentially causing stomach issues like ulcers.

Drugs that selectively inhibit COX-2 enzymes are unlikely to be widely used in cancer prevention, despite initial promise.

Strategies to stop or reverse early stage cancer development or progression through early detection and treatment.

Secondary approaches to cancer prevention emphasize finding cancer early, effectively treating it, and removing precancerous or early cancerous cells.

The probability that a test correctly identifies a person who has the condition.

The probability that a test correctly identifies a person who does not have the condition.

Evaluating whether the benefits of screening outweigh the costs, considering factors like life expectancy gains, compliance rates, and potential risks.

A non-invasive stool test that detects microscopic blood in the stool, which can be a sign of colorectal cancer.

Similar to FOBT, but uses antibodies to detect human hemoglobin in the stool, offering higher sensitivity.

A procedure that allows visual examination of the entire colon using a flexible scope, considered the gold standard for colorectal cancer screening.

Direct visualisation for polyp removal at the same time, high sensitivity for detecting both polyps and cancer.

The best screening method varies depending on individual risk factors, compliance rates, and cost-effectiveness, requiring informed discussion with healthcare professionals.

Fecal Occult Blood Test; a simple stool-based test used to detect microscopic blood in stool, which can indicate colorectal cancer.

It has a simpler prep than colonoscopy, requiring only an enema beforehand. It also poses a lower risk of complications like perforation or bleeding.

It cannot detect polyps in the upper half of the colon, leading to potential missed diagnoses. If polyps are detected during the procedure, further colonoscopy is needed.

A non-invasive imaging technique that uses X-rays to create detailed images of the colon, allowing for the detection of polyps and possibly cancer.

Financial concerns despite subsidies, fear of bowel prep procedures like enemas and colonoscopies, and lack of awareness about the benefits and importance of screening.

The descending colon is where the largest percentage (60%) of colon cancers originate, followed by the ascending colon (20-30%) and then the transverse colon (10%).

Factors include advancing age, inherited and acquired genetic susceptibilities, lifestyle choices, inflammatory bowel disease (IBD), and the environment.

Regular whole colon examinations are important for effective CRC screening, especially starting at age 50 for average-risk individuals. This is because colorectal adenomas can progress to cancer, and removal of such polyps is crucial.

Early detection of colorectal cancer (CRC) is crucial. Most CRC cases originate from adenomatous polyps, which undergo multiple gene mutations and progress through premalignant stages, eventually transforming into malignant cancer. This process can be asymptomatic, but early detection allows for timely interventions like polyp removal during colonoscopy, preventing the need for surgery and improving chances of cure.

Colonoscopy is the gold standard for CRC screening. It allows for the removal of polyps during the procedure, effectively preventing cancer development. It also facilitates the detection of early-stage cancers, potentially leading to a cure.

Alternatives to colonoscopy include high-sensitivity guaiac fecal occult blood test (HSgFOBT), fecal immunochemical test (FIT) which detect hidden blood in stool, stool DNA tests, computed tomography colonoscopy, flexible sigmoidoscopy, and annual FIT.

CRC screening frequency varies based on the chosen method. Colonoscopy is recommended every 5-10 years, annual FIT every year, sigmoidoscopy every 5 years, and stool DNA test every 1-3 years.

Individuals aged 45-75 are recommended for CRC screening. For those over 75, individualized decisions are made based on factors like overall health, life expectancy, existing conditions, prior screening history, and personal preferences.

Individuals with average risk, meaning no family history of CRC beyond non-first degree relatives, should start CRC screening at age 50. Colonoscopy is the recommended tool with a frequency of every 5-10 years.

Individuals with high risk factors, including a family history of CRC in first-degree relatives or personal history of polyps, should have a more aggressive screening plan. The specific plan will depend on their individual risk profile and should involve a healthcare professional.

CRC screening plays a vital role in early detection and prevention. By identifying and removing precancerous polyps or detecting cancer at an early stage, the chances of successful treatment and cure are significantly increased.