Familial Risk And Familial Risk And Pathological Outcomes Of Pathological Outcomes Of Colorectal Cancer In An Colorectal Cancer In An Asymptomatic General Asymptomatic General

Population CohortPopulation Cohort

By: Michelle By: Michelle MedinaMedina

Simplified TitleSimplified Title

To find if heredity has anything to do To find if heredity has anything to do with the actual risk of contracting with the actual risk of contracting colorectal cancer in patients that colorectal cancer in patients that show no symptomsshow no symptoms

What is Colorectal Cancer?What is Colorectal Cancer?

• Colorectal cancer, also known as Colorectal cancer, also known as colon cancer or bowel cancer, colon cancer or bowel cancer, includes cancerous growths in the includes cancerous growths in the colon, rectum and appendix.colon, rectum and appendix.

• Most cases begin as small benign Most cases begin as small benign polyps. polyps.

• It is the third most common form of It is the third most common form of cancer and the second leading cause cancer and the second leading cause of death in the Western World.of death in the Western World.

The colonThe colon

Colorectal CancerColorectal Cancer

Who gets colorectal cancer?Who gets colorectal cancer?

• Everyone is affected by colorectal cancer.Everyone is affected by colorectal cancer.

• People older than fifty are more People older than fifty are more susceptible to it.susceptible to it.

• Death rates for colorectal cancer among Death rates for colorectal cancer among African Americans are about 30% higher African Americans are about 30% higher than among Whites and more than two than among Whites and more than two times higher than for Asian Americans, times higher than for Asian Americans, Pacific Islanders, American Indians, and Pacific Islanders, American Indians, and Hispanics. Hispanics.

Risk Factors of Colorectal Risk Factors of Colorectal CancerCancer

• age age

• polyp growth polyp growth

• history of cancerhistory of cancer

• heredityheredity

• virus exposure virus exposure

• diabetesdiabetes

• Crohn’s disease Crohn’s disease

• sclerosing sclerosing cholangitischolangitis

• dietdiet

• physical inactivityphysical inactivity

• alcohol alcohol consumptionconsumption

• smokingsmoking

Symptoms of Colorectal Symptoms of Colorectal CancerCancer

• change in bowel change in bowel habits habits

• blood in the stoolblood in the stool

• rectal bleedingrectal bleeding

• bowel obstructionbowel obstruction

• fatiguefatigue

• jaundicejaundice

• narrow stoolnarrow stool

• anemiaanemia

• unexplained weight unexplained weight lossloss

• hepatomegalyhepatomegaly

• gasgas

• crampingcramping

• abdominal painabdominal pain

• feeling of partially full feeling of partially full bowelbowel

Screening Methods for Screening Methods for Colorectal CancerColorectal Cancer

• FOBT – Fecal Occult Blood TestingFOBT – Fecal Occult Blood Testing

• IFOBT – Immunochemical FOBTIFOBT – Immunochemical FOBT

• Double-Contrast Barium EnemaDouble-Contrast Barium Enema

• Flexible SigmoidoscopyFlexible Sigmoidoscopy

• ColonoscopyColonoscopy

• Virtual ColonoscopyVirtual Colonoscopy

Purpose of StudyPurpose of Study

• To establish a correlation between To establish a correlation between family history of colorectal cancer family history of colorectal cancer and present cases.and present cases.

• To determine if race is a major risk To determine if race is a major risk factor for colorectal cancer factor for colorectal cancer susceptibility.susceptibility.

EligibilityEligibility

• Age 50-69 (40-69) Age 50-69 (40-69) – Men and women in ~ equal numbersMen and women in ~ equal numbers

• No prior colonoscopy or recent No prior colonoscopy or recent sigmoidoscopysigmoidoscopy

• No IBD, FAP, colorectal cancerNo IBD, FAP, colorectal cancer

• No prior use of an implanted defibrillatorNo prior use of an implanted defibrillator

• No serious comorbidityNo serious comorbidity– Exclusions: MI (past year) and other heart Exclusions: MI (past year) and other heart

problems, anticoagulants, cancer therapyproblems, anticoagulants, cancer therapy

Genetics Review CriteriaGenetics Review Criteria

• Amsterdam IIAmsterdam II– At least 3 At least 3 relatives with HNPCC associated cancers relatives with HNPCC associated cancers (one a (one a

FDR of the other two)FDR of the other two)• CRC, Endometrial, Kidney, Ovarian, Stomach, Small Bowel, Renal CRC, Endometrial, Kidney, Ovarian, Stomach, Small Bowel, Renal

Pelvis/UreterPelvis/Ureter

– At least At least 22 successive generations affected successive generations affected– At least 1At least 1 diagnosed with cancer before the age of 50 diagnosed with cancer before the age of 50– No FAP No FAP

• First DegreeFirst Degree– At least one immediate family member diagnosed with At least one immediate family member diagnosed with

colorectal cancer prior to the age of 60.colorectal cancer prior to the age of 60.

• Standard RiskStandard Risk– No outstanding family history of colorectal cancerNo outstanding family history of colorectal cancer

MethodsMethods

• Patients who have already been reviewed by Patients who have already been reviewed by the genetics review committee were the genetics review committee were analyzed.analyzed.

• Each participants’ colonoscopy results were Each participants’ colonoscopy results were queried.queried.

• Those with First Degree risk and those Those with First Degree risk and those meeting the Amsterdam II criteria were sent meeting the Amsterdam II criteria were sent high risk letters advising them to go see a high risk letters advising them to go see a genetics counselor.genetics counselor.

• Those who were at standard risk were sent Those who were at standard risk were sent standard risk letters advising them they had standard risk letters advising them they had no outstanding risk for colorectal cancer.no outstanding risk for colorectal cancer.

MaterialsMaterials

• FOBT Cards: The fecal occult blood FOBT Cards: The fecal occult blood test chemically checks your stool for test chemically checks your stool for hidden blood. hidden blood.

Materials Cont.Materials Cont.

• Flexible Sigmoidoscope: A short, Flexible Sigmoidoscope: A short, flexible, lighted tube which transmits flexible, lighted tube which transmits an image of the inside of the distal an image of the inside of the distal bowel about 60 cm into the colon.bowel about 60 cm into the colon.

Materials Cont.Materials Cont.

• Colonoscope: A thin, lighted tube Colonoscope: A thin, lighted tube used to look all around the inside of used to look all around the inside of the colon. the colon.

Materials Cont.Materials Cont.

• Baseline Questionnaires: Collects Baseline Questionnaires: Collects participants’ information.participants’ information.

Materials Cont.Materials Cont.

• Family History Questionnaires: Family History Questionnaires: Collects patients’ family history of Collects patients’ family history of cancer.cancer.

Materials Cont.Materials Cont.

• Pathology Review Form: Used by our Pathology Review Form: Used by our pathologist to review colonoscopy pathologist to review colonoscopy specimens.specimens.

Genetics Review ResultsGenetics Review Results

435435401401992525TotalTotal

193(44)193(44)182(45)182(45)3(33)3(33)8(32)8(32)Unknown Unknown Race n(%)Race n(%)

55(13)55(13)50(12)50(12)1(11)1(11)4(16)4(16)MinoritiesMinorities

n(%)n(%)

187(43)187(43)169(42)169(42)5(56)5(56)13(52)13(52)CaucasianCaucasian

n(%)n(%)

TotalTotalStandarStandard Riskd Risk

AmsterdaAmsterdam IIm II

First First DegreDegre

ee

Familial Familial RiskRisk

Genetics Review ResultsGenetics Review Results

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

First Degree Amsterdam II Standard Risk

Caucasian

Minorities

Unknown Race

Perc

enta

ge

Perc

enta

ge

of of

Part

icip

an

Part

icip

an

tsts

Familial Risk Familial Risk

Pathology Review ResultsPathology Review Results

20820820(10)20(10)188(90)188(90)Non-Adenomas Non-Adenomas n(%)n(%)

51514(8)4(8)47(92)47(92)Adenomas Adenomas n(%)n(%)

3543543131323323TotalTotal

551(20)1(20)4(80)4(80)Advanced Advanced Adenomas Adenomas

n(%)n(%)

90906(7)6(7)84(93)84(93)Hyperplastic Hyperplastic Only n(%)Only n(%)

TotalTotalMinoritiesMinoritiesWhite Non-White Non-HispanicsHispanics

Polyp Polyp ClassificationClassification

Pathology Review ResultsPathology Review ResultsPerc

enta

ge

Perc

enta

ge

of of

Part

icip

an

Part

icip

an

ts

ts

Types of Polyps Types of Polyps Found Found

0%

10%

20%

30%

40%

50%

60%

70%

HyperplasticOnly

AdvancedAdenoma

Non-Adenoma

Adenoma

White Non-Hispanic

Minorities

ConclusionConclusion

• More data is still needed for results More data is still needed for results to be conclusive.to be conclusive.

• The National Colonoscopy Study still The National Colonoscopy Study still has three more years before it ends has three more years before it ends therefore there is still more to be therefore there is still more to be learned and much more data to be learned and much more data to be acquired.acquired.

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• Iammarino, Nicholas K. Iammarino, Nicholas K. African Americans & CancerAfrican Americans & Cancer. Intercultural Cancer Council. 2001. 17 July 2006 . Intercultural Cancer Council. 2001. 17 July 2006 <http://iccnetwork.org/cancerfacts/cfs1.htm>. <http://iccnetwork.org/cancerfacts/cfs1.htm>.

• Kelley, Robert B., Frank J. Domino, and Carolyn Lopez. "Colorectal Cancer Screening." Kelley, Robert B., Frank J. Domino, and Carolyn Lopez. "Colorectal Cancer Screening." Family DoctorFamily Doctor. 2006. 17 July . 2006. 17 July 2006 <http://familydoctor.org/556.xml>. 2006 <http://familydoctor.org/556.xml>.

• Minorities and Colorectal CancerMinorities and Colorectal Cancer. Cancer Research and Prevention Foundation. Alexandria, VA, 2006. 17 July 2006 . Cancer Research and Prevention Foundation. Alexandria, VA, 2006. 17 July 2006 <http://www.preventcancer.org/colorectal/facts/minorities.cfm>. <http://www.preventcancer.org/colorectal/facts/minorities.cfm>.

• Weaver, Charles H. Weaver, Charles H. Genetiv Testing for Colorectal CancerGenetiv Testing for Colorectal Cancer. Ed. C. D. Buckner. Cancer Consultants. 2004. Sept. 2004 . Ed. C. D. Buckner. Cancer Consultants. 2004. Sept. 2004 <http://patient.cancerconsultants.com/print_tnpv.aspx?id=739>. <http://patient.cancerconsultants.com/print_tnpv.aspx?id=739>.

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• "Hyperplastic Polyp." Def. 1. "Hyperplastic Polyp." Def. 1. DictionaryDictionary. 18 Aug. 2006 <http://dictionary.reference.com/browse/hyperplastic. 18 Aug. 2006 <http://dictionary.reference.com/browse/hyperplastic%20polyp>.%20polyp>.

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Acknowledgments Acknowledgments

• Victoria Serrano (our mentor)Victoria Serrano (our mentor)

• Epidemiology and Biostatistics Epidemiology and Biostatistics DepartmentDepartment

• Dr. Sat BhattacharyaDr. Sat Bhattacharya

• Harlem Children SocietyHarlem Children Society

• Memorial Sloan Kettering Cancer Memorial Sloan Kettering Cancer CenterCenter