Colorectal Cancer Screening
With 35,000 diagnoses every year, colorectal cancer is the third most common cancer in the UK. Because the disease can remain asymptomatic for many years, screening is the key to improving survival rates. This article looks at the different types of screening test, and how effective they can be in detecting colorectal cancer.
Types of Screening Test
It is important to catch colorectal cancer in the early stages. This is because the disease usually develops from non-cancerous growths or tumours (known medically as adenomatous intestinal polyps) in the colon, which over time become malignant. If diagnosed at this pre-malignant stage, or when cancer is still confined to the bowel, patients have a much higher survival rate, and can often be treated with surgery alone.
However, colorectal cancer can remain asymptomatic until the late stages of the disease. Detection of the disease therefore relies upon a number of diagnostic tests, including faecal blood tests, colonoscopy, and flexible sigmoidoscopy, all of which are explored in more detail below.
Faecal Blood Test (FOBT)
This test requires a patient to provide stool samples (usually two samples from each of three consecutive bowel movements made at home) which will then be analysed in a lab for the presence of blood. If a test is positive, it could be due to gastrointestinal tumours, and therefore the presence of colorectal cancer.
However, the effectiveness of this test can be queried as the presence of faecal blood can have a number of other causes. It is for this reason that patients with a positive test are advised to undergo further tests in the form of a colonoscopy.
Colonoscopy
During a colonoscopy procedure, a patient will be given a light sedative and possibly some pain medication, before being asked to lie on their left hand side on an examination table. A doctor will then gently insert a long, flexible tube called a colonoscope into the anus, and up through the rectum into the colon. A camera on the colonoscope relays an image of the intestinal lining onto a computer screen for the doctor to examine.
A colonoscopy is a skill-dependant procedure, and thus the effectiveness of the test can be determined by the technical proficiency of the doctor. With an experienced colonoscopist, a successfully completed colonoscopy with visualisation of the entire colon is 85-90%, but with a less experienced colonoscopist visualisation levels can fall to as low at 50%.
Flexible Sigmoidoscopy
A flexible sigmoidoscopy is very similar to a colonoscopy, in that a tube with a camera on it is inserted into the patient via the anus. Where a flexible sigmoidoscopy differs, however, is that it focuses upon the sigmoid colon alone, rather than the entire colon. The advantage of this is that it is an easier and quicker procedure to perform than a colonoscopy, and so can be performed by a specially trained nurse endoscopist.
NHS Bowel Screening Programme
The NHS Bowel Cancer Screening Programme (NHSBCSP) was introduced in 2006 with the aim of detecting early tumours and pre-malignant polyps in the colon, from which 70-90% of tumours in the colon arise.
The screening offers a Faecal Blood Test every two years to men and women aged between 60-69 years old. Those over 70 years can ask for a test to be sent to them. Carried out at home, the test requires a patient to smear stool on six tiles, before sending them back in a prepaid package. It is important, however, for a patient to avoid eating red meat and foods high in vitamin C for at least two days before beginning the process, as this can confuse the result.
If the presence of blood is found, it could be a sign of colorectal cancer. However, blood in the stool can be caused by a number of things, and so patients with a positive test (where blood shows in five out six tests) are offered a colonoscopy, whereby a more definitive diagnosis can be achieved. If one to four samples are positive, a patient is asked to complete another test immediately, and should this fail to provide a clear result, the patient will then be reviewed at a designated screening centre.
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