Colorectal Cancer Screening and Surveillance. This post will cover the points you need to know for your board exams as well as for teaching residents on the daily rounds. Please don't use the information here to treat your patients.
The information in this post is true for the date of writing this post which is October 2023. The information here is just a summary of guidelines and recommendations combined of USPSTF, ACG and ACS. For exam purposes, we made all these recommendations into one form, although some discrepancies in real guidelines between these 3 boards might be present.
Colorectal Cancer Screening should start at age of 45 for people with average risk. Screening after age of 75 should be individualized.
Options for screening include:
- High-sensitivity fecal occult blood testing annually.
- Stool DNA-FIT every 1 to 3 years.
- Computed tomography colonography every 5 years.
- Flexible sigmoidoscopy every five years with high-sensitivity fecal occult blood testing every three years.
- Colonoscopy every 10 years, if initial one is normal.
Guidelines for people with high risk for colorectal cancer and those with polyps on initial colonoscopy include:
1- History of colorectal cancer surgery: start with colonoscopy at 1-, 3- and 5-years intervals then every 5 years.
2- First degree relative with colon cancer: start at age of 40 or 10 years earlier of the relative's age at diagnosis then every 5 years.
3- Family members with hereditary colorectal cancer syndrome will need to start at young age and probably yearly depending on the disease and findings.
4- People with history of radiation therapy of the abdomen or pelvis: start with colonoscopy at age of 30 or after 5 years of radiation with an interval of 5 years after that.
5- Patients with inflammatory bowel disease should have colonoscopy 8 years after diagnosis then every 1-3 years after that.
6- Patients with distal hyperplastic polyps less than 10 mm, repeat colonoscopy in 5-10 years.
7- Patients with 1-2 tubular adenomas less than 10 mm in size completely removed, repeat colonoscopy in 5-10 years.
8- If 3-10 tubular adenomas present, serrated adenoma, villous adenoma, high-grade dysplastic adenoma or adenoma larger than 10 mm removed completely, then repeat colonoscopy in 3 years.
9- If more than 10 adenomas present, repeat in less than 3 years.
8- Patients with serrated polyp without dysplasia less than 10 mm completely removed, repeat colonoscopy in 5 years. Serrated polyp with dysplasia repeat in 3 years.
A colon polyp and cancer book from Dr Engine is available here.
The information in this post is not for patients and shouldn't be used in treating patients. Please refer to your doctor for medical advice.