Materiały źródłowe

• #1 Colorectal cancer diagnosis: Pitfalls and opportunities

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4678389/

  Colorectal cancer (CRC) is a major health problem in the Western world. The diagnostic process is a challenge in all health systems for many reasons: There are often no specific symptoms; lower abdominal symptoms are very common and mostly related to non-neoplastic diseases, not CRC; diagnosis of CRC is mainly based on colonoscopy, an invasive procedure; and the resource for diagnosis is usually scarce. […] Understanding this process is the first step in identifying avoidable factors and reducing the effects of diagnostic delay on the prognosis of CRC. […] We summarize the available evidence concerning the diagnostic process, as well as the factors implicated in its delay and the methods proposed to reduce it. […] The early diagnosis of CRC in symptomatic patients remains a problem. It is a complex process that begins when the patient detects the first symptoms until a diagnostic procedure is performed, undergoing a consultation with a general practitioner, a referral to the specialist, and the waiting period for diagnostic procedures, such as colonoscopy.

• #1 Colorectal Cancer Screening – NCI

  https://www.cancer.gov/types/colorectal/patient/colorectal-screening-pdq

  Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread. […] If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests. […] Studies show that some screening tests for colorectal cancer help find cancer at an early stage and may decrease the number of deaths from the disease. […] The following types of tests are used to screen for colorectal cancer: Fecal occult blood test, Sigmoidoscopy, Colonoscopy, Virtual colonoscopy, DNA stool test. […] Studies have shown that screening for colorectal cancer using digital rectal exam does not decrease the number of deaths from the disease.

• #1 Colorectal Cancer: Screening and Symptoms | Doctor

  https://patient.info/doctor/colorectal-cancer

  Bowel cancer is the fourth most common cancer in the UK (after breast, prostate and lung cancer), accounting for 11% of all new cancer cases. […] Screening was introduced in the UK in 2006 and data suggests a 7% reduction in colorectal cancer diagnosis as a result of diagnosing more pre-cancerous lesions. […] Early diagnosis is essential for effective treatment to provide the greatest chance of survival. […] A FIT test should be offered. The National Institute for Health and Care Excellence (NICE) changed its guidance in 2023 and advises to use faecal immunochemical testing (FIT) to guide referral for suspected colorectal cancer in all adults with: An abdominal mass, or A change in bowel habit, or Iron-deficiency anaemia, or Aged 40 and over with unexplained weight loss and abdominal pain, or Aged under 50 with rectal bleeding and either unexplained abdominal pain or weight loss, or Aged 50 and over with unexplained rectal bleeding, abdominal pain or weight loss, or Aged 60 and over with anaemia even in the absence of iron deficiency.

• #1 Bowel cancer (including rectal cancer and colon cancer) | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/bowel-cancer

  If you have symptoms, you will usually begin by seeing your GP, who will examine you. If they think that your symptoms could be caused by cancer, they will refer you to a specialist doctor. […] The specialist doctor will examine you and you will usually have some tests. These include a rectal examination and a blood test. […] You usually also have test called a colonoscopy. A doctor or nurse uses a thin tube with a camera at the end to examine the inside of the whole bowel. […] Or you might have a sigmoidoscopy to examine the inside of the rectum and the part of the colon closest to the rectum. […] Some people are diagnosed with bowel cancer through the NHS Bowel Screening Programme. We have more information about bowel cancer screening. […] We have more information about the tests you may have and how bowel cancer is diagnosed.

• #1 Bowel cancer | Causes, Symptoms & Treatments | Cancer Council

  https://www.cancer.org.au/cancer-information/types-of-cancer/bowel-cancer

  A number of tests are used to diagnose bowel cancer. Initially, your doctor will give you a physical examination to feel if you have any abdominal swelling. Your doctor will also give you a digital rectal examination to check for any lumps or swelling in the rectum or anus. […] You may have a blood test to see if there are any signs that you are losing blood in your stools. It can also check your red blood cell count as low red blood cells are common in people with bowel cancer. […] You may have an iFOBT (often referred to as FOBT) depending on your symptoms. The test may be used if you have abdominal pain, changes to their bowel habits, unexplained weight loss, or anaemia. It is not recommended if you are bleeding from the rectum. […] With the iFOBT, you will take a sample of your stools at home. The sample is examined under a microscope for traces of blood which could be a sign of polyps, cancer, or another bowel condition. It does not diagnose cancer but if blood is detected, your doctor will usually recommend a colonoscopy.

• #1 Stool Tests for Colorectal Cancer: Types, Pros and Cons

  https://www.cancercenter.com/cancer-types/colorectal-cancer/diagnosis-and-detection/lab-tests/stool-tests

  Stool DNA testing is a newer type of non-invasive stool-based test to check for colorectal cancer. It looks for certain DNA or genetic changes that may suggest pre-cancerous growths or cancer cells. […] If a stool DNA test finds something abnormal, a colonoscopy may be needed to follow up on the findings.

• #1 Colorectal Cancer Diagnostic Methods: The Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10185295/

  Colon capsule endoscopy (CCE) is a safe and effective tool for detecting CRC and polyps in a screening setting. […] Flexible sigmoidoscopy (FS) is an endoscopic CRC screening modality that allows for direct visualization of the rectum, sigmoid, and descending colon. […] Colonoscopy has been utilized in various studies of hsFOBT, FIT, mt-sDNA, and other non-colonoscopic test modalities as the gold standard comparative test. […] The guanosine triphosphate protein (GTP)-binding protein Septin 9 (SEPT9) is a member of the GTP family, and SEPT9 methylation is connected to carcinogenesis and acts as a biomarker for CRC. […] Numerous significant and encouraging developments have taken place in CRC screening in the last ten years, such as the development of novel screening procedures and the improvement of current technology to detect colonic neoplasia better. […] Its capacity for handling vast amounts of data and its ability to extract information that experts cannot notice are further advantages. […] The search for blood biomarkers of CRC has been conducted during the past ten years using a range of proteomics-based techniques.

• #1 Testing for Colorectal Cancer | How Is Colorectal Cancer Diagnosed? | American Cancer Society

  https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/how-diagnosed.html

  If you have symptoms that might be from colorectal cancer, or if a screening test shows something abnormal, your doctor will recommend one or more of the exams and tests below to find the cause. […] Your doctor might also order certain blood tests to help determine if you have colorectal cancer. These tests also can be used to help monitor your disease if you’ve been diagnosed with cancer. […] A diagnostic colonoscopy is just like a screening colonoscopy, but it’s done because a person is having symptoms, or because something abnormal was found on another type of screening test. […] If a suspected colorectal tumor is found during a screening or diagnostic test, it usually is biopsied. […] Biopsy samples (from colonoscopy or surgery) are sent to the lab where they are looked at closely. If cancer is found, other lab tests may also be done on the biopsy samples to help better classify the cancer and guide specific treatment options.

• #1 Screening and Diagnosis of Colon and Rectal Cancer | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/cancer-care/gastrointestinal-cancers/colorectal-cancer/screening-and-diagnosis

  Regular colonoscopy screenings are recommended for anyone aged 45 years and older. […] There are a variety of leading-edge tools available to diagnose colorectal cancer. Most commonly they include: […] Blood tests look for anemia, which can result from a bleeding tumor. […] Imaging tests: Procedures such as CT scan, PET scan, ultrasound or MRI of the abdomen may be done to look for tumors or other problems. These tests may also be done if you have been diagnosed with colon or rectal cancer to help determine the extent (stage) of the cancer.

• #1 Diagnosis of colorectal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/colorectal/diagnosis

  A biopsy is usually done during a colonoscopy or sigmoidoscopy (called an endoscopic biopsy) to remove polyps or small amounts of tissue from the colon or rectum. […] Tumour markers are substances found in blood, tissues or fluids removed from the body. An abnormal amount of a tumour marker may mean that a person has colorectal cancer. Tumour marker tests are also used to check your response to cancer treatment. […] Stool tests check for hidden (occult) blood in the stool. A guaiac-based fecal occult blood test (gFOBT) or a fecal immunochemical test (FIT) may be done during diagnosis if it was not used during screening. […] A CT scan is used to check if colorectal cancer has spread to lymph nodes or organs in the chest, abdomen and pelvis. A CT scan of the pelvis may be used to measure how far a rectal tumour is from the anus.

• #1 Tests and next steps for bowel cancer – NHS

  https://www.nhs.uk/conditions/bowel-cancer/tests-and-next-steps/

  If a GP refers you to a specialist because they think you could have bowel cancer, you’ll have tests to check for cancer. […] The main test for bowel cancer is a colonoscopy. This is where a thin, flexible, tube with a camera is used to look inside your bowel. […] During the colonoscopy, a small sample of the lining of your bowel may be taken for testing (called a biopsy). […] If you’ve been told you have bowel cancer, you may need more tests which can include: a CT scan, an MRI scan, a PET scan, blood tests, genetic testing. […] The results of these tests can show how far the cancer has spread, and if the cancer has been caused by certain changes in your genes. […] This will help your specialist team decide what treatment you need.

• #1 Colon cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/colon-cancer/diagnosis-treatment/drc-20353674

  Blood tests aren’t used to diagnose colon cancer. But blood tests can give clues about overall health, such as how well the kidneys and liver are working. A blood test might be used to look for a low level of red blood cells. This result might indicate that a colon cancer is causing bleeding. […] After a colon cancer diagnosis, other tests might be needed to find out the extent of the cancer. This is called the cancer’s stage. The health care team considers the cancer’s stage when creating a treatment plan. […] Staging tests might include imaging scans of the abdomen, pelvis and chest. Imaging tests take pictures of the body. They show the location and the size of the colon cancer. Often, doctors can’t be certain of the cancer’s stage until after colon cancer surgery. […] Colon cancer stages range from 0 to 4. The lowest numbers mean the cancer is all inside the lining of the colon. By stage 4, the cancer is considered advanced and has spread to other areas of the body. When cancer spreads, it’s called metastatic cancer.

• #1 Cancer Society NZ — Diagnosing bowel cancer

  https://www.cancer.org.nz/cancer/types-of-cancer/bowel-cancer/diagnosis-of-bowel-cancer/

  If you have any symptoms of bowel cancer, they need to be checked by your doctor. […] Your doctor will suggest several tests and scans to check for any abnormal changes. […] These tests may include: […] A test for blood in your bowel motions A sample of your poo (faeces) is tested for blood (faecal occult blood). This is most commonly used as part of the national screening programme for bowel cancer. […] Blood count test A sample of your blood is taken to count the number of red cells in your blood. A low red blood cell level (anaemia) can be a sign of bowel cancer. […] Carcinoembryonic antigen (CEA) CEA is a blood test that measures a protein in your blood which is sometimes raised in people with bowel cancer. […] Sigmoidoscopy A specialist examines your rectum and the lower part of your bowel using a short tube. They may take a small sample of tissue (biopsy) during the procedure.

• #1 Colon Cancer Workup: Approach Considerations, Blood Studies, Imaging Studies

  https://emedicine.medscape.com/article/277496-workup

  After tissue diagnosis is confirmed, laboratory studies are done with a goal of assessing patients organ function (liver, kidneys) in anticipation of diagnostic and therapeutic procedures and also to estimate tumor burden. Adequate imaging of the chest and abdomen should be obtained for staging purposes, ideally preoperatively. […] Laboratory studies are done with a goal of assessing patients organ function (liver, kidneys) in anticipation of diagnostic and therapeutic procedures and also to estimate tumor burden. Studies may include the following: Complete blood cell count, Serum chemistries, Liver function tests, Kidney function tests, Serum carcinoembryonic antigen (CEA) level. […] A baseline CEA level should be obtained preoperatively as it carries prognostic value and when highly elevated may indicate more advanced, disseminated disease. Increased levels of serum CEA have been associated with an adverse prognosis in patients with resectable colorectal cancer; however, this biochemical marker has not as of yet been included in colorectal cancer staging guidelines.

• #1 Testing for Colorectal Cancer | How Is Colorectal Cancer Diagnosed? | American Cancer Society

  https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/how-diagnosed.html

  Colorectal cancer cells are also typically tested to see if they have high numbers of gene changes called microsatellite instability (MSI). Testing might also be done to check for changes in any of the mismatch repair (MMR) genes (MLH1, MSH2, MSH6, and PMS2) or the proteins they encode. […] Imaging tests may be done for a number of reasons, such as: To look at suspicious areas that might be cancer, To learn how far cancer might have spread, To help determine if treatment is working, To look for signs of cancer coming back after treatment.

• #1 Diagnosis of colorectal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/colorectal/diagnosis

  An ultrasound uses high-frequency sound waves to make images of parts of the body. It may be used to check if colorectal cancer has spread to the liver. […] An MRI of the pelvis may be used to find out the stage of rectal cancer and where it has spread within the pelvis. […] A PET-CT scan combines images from a PET scan and a CT scan, which are done at the same time using the same machine. It may be used to help with staging colorectal cancer or to plan surgery for metastatic tumours.

• #1

  https://www.beaumont.org/treatments/colorectal-cancer-diagnosis

  Barium enema with air contrast (also called a double contrast barium enema): fluid called barium (a metallic, chemical, chalky liquid used to coat the inside of organs so that they will show up on an x-ray) is given into the rectum to partially fill up the colon. An x-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages) and other problems.

• #1 Tests for bowel cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bowel-cancer/getting-diagnosed/tests-bowel-cancer

  You usually have a number of tests to check for bowel cancer. The tests you may have include: a test that looks for blood in your poo. This is a Faecal Immunochemical Test (FIT) […] Tests your GP might do include: a test that looks for tiny traces of blood in a sample of poo (FIT) […] FIT is a test that looks for tiny traces of blood in poo that are too small to see. Blood in poo can be caused by a number of medical conditions but it can also be a sign of bowel cancer. […] Your specialist does more tests. These might include: colonoscopy, flexible sigmoidoscopy, CT colonography, CT scan of your tummy (abdomen) and pelvis, colon capsule endoscopy. […] A colonoscopy looks at the whole of the inside of your large bowel using a flexible tube called a colonoscope. […] During the test, your doctor can take tissue samples (biopsies) of any abnormal areas. They send the biopsies to the laboratory to check for bowel cancer.

• #1 Colon Cancer Diagnosis and Stages – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/cancer/colon-cancer/colon-cancer-diagnosis-and-stages

  The AJCC (American Joint Committee on Cancer) TNM staging system (Stages 0IV) is commonly used for colon cancer. This staging is especially helpful upon immediate diagnosis since we might not know if the cancer has spread to nearby lymph nodes at that time. A higher number, such as stage IV, means a more advanced cancer.

• #1 Diagnosing Colon Cancer

  https://www.verywellhealth.com/colon-cancer-diagnosis-797562

  Stage 0 colon cancer is the earliest stage possible and is also called carcinoma in situ („carcinoma” refers to cancer and „in situ” means original position or place). Stage 0 cancer has not grown beyond the mucosa. […] Stage 1 colon cancer means that the tumor has grown through the mucosa into the submucosa or the muscularis propia. […] Stage 2 colon cancer means one of the following scenarios: Cancer has grown into the outermost layers of the colon, but not through them. […] Stage 3 colon cancer means one of several things: Cancer has grown into the submucosa layer and spread to four to six nearby lymph nodes. […] Stage 4 colon cancer is synonymous with metastatic colon cancer, in which the tumor has spread to one or more distant organs (for example, the liver or lungs), to a distant set of lymph nodes, or to distant parts of the lining of the abdominal cavity (called the peritoneum).

• #1 Colorectal Cancer Diagnostic Methods: The Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10185295/

  To meet the needs of the colorectal cancer (CRC) patient population, colorectal cancer screening is continuously updated. The most significant advice is to start CRC screening exams at age 45 for people at average risk for CRC. CRC testing is divided into two categories: stool-based tests and visual inspections. High-sensitivity guaiac-based fecal occult blood testing, fecal immunochemical testing, and multitarget stool DNA testing are stool-based assays. Colon capsule endoscopy and flexible sigmoidoscopy are visualization examinations. […] Recent advancements in artificial intelligence and genetics have prompted the creation of newer diagnostic tests, which require validation in diverse populations and cohorts. In this article, we have discussed the present and emerging diagnostic tests.

• #1 Colon Cancer Workup: Approach Considerations, Blood Studies, Imaging Studies

  https://emedicine.medscape.com/article/277496-workup

  In 2016, the FDA approved the first blood-based colorectal cancer screening test, Epi proColon. This is a qualitative in vitro assay for detecting methylated Septin9 DNA, which has been associated with the occurrence of colorectal cancer, in plasma obtained from whole-blood specimens. It is indicated for use in average-risk patients who have chosen not to undergo other screening methods, such as colonoscopy or stool-based tests.

• #1 Rectal Cancer Diagnosis | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/rectal/diagnosis

  Your care team may recommend CT and MRI scans to determine the stage of the cancer and to see if it has spread to other organs. […] For some advanced cancers, pathologists at Memorial Sloan Kettering will do molecular testing on the tumor to find somatic mutations. These mutations can predict how a tumor might react to treatments. Knowing as much as possible about a tumors genetic makeup can help your care team choose the treatments that are most likely to help you. […] If the cancer has spread outside the rectum, your doctor will test tumor samples for mutations in genes called EGFR, KRAS, and BRAF. These are common in rectal cancer. We will also test for mutations in less common genes.

• #1 Colorectal Cancer Diagnosis: The Obstacles We Face in Determining a Non-Invasive Test and Current Advances in Biomarker Detection

  https://www.mdpi.com/2072-6694/14/8/1889

  Colorectal cancer (CRC) is one of the most common cancers in the western world. […] Endoscopic evaluation remains the gold-standard investigation for the disease. […] The removal of neoplastic adenomas via polypectomy remains an important measure to prevent dysplastic adenomas from evolving into invasive carcinoma. […] The screening process for abnormal adenomas and early diagnosis of CRC is currently conducted through colonoscopies, which have been recognized as the ‘gold standard’ due to both their potential in the diagnosis and removal of adenomas. […] Early detection of CRC is intimately linked to higher survival rates from the disease, ranging from as high as a 90% five-year survival rate in stage 1 disease, to as low as 10% five-year survival in stage 4 disease. […] Proposed guidelines to reduce the incidence of CRC recommend that the screening procedure should be carried out initially at the age of 50 and then every 10 years thereafter.

• #1 Colorectal Cancer: What You Should Know About Screening | FDA

  https://www.fda.gov/consumers/consumer-updates/colorectal-cancer-what-you-should-know-about-screening

  The evidence is clear – screening for colorectal cancer may save your life. […] The only way to find a polyp, precancerous growth, or colorectal cancer is to do a screening test or procedure. […] The benefits of screening are so great that doctors recommend most people start colorectal cancer screening by age 45. Some people who are at higher risk may need to start screening before age 45. […] The U.S. Food and Drug Administration reviews and clears or approves colorectal cancer tests, prescription medicines, and medical devices used during colorectal cancer screening. […] Today there are 2 types of screening recommended for colorectal cancer: Stool (poop) sample tests and Visual screening procedures such as colonoscopy. […] If the test shows blood or possible DNA from cancer or a precancerous polyp, your doctor will order a colonoscopy or other type of visual screening to get more information.

• #1 Detection & Diagnosis of Colorectal Cancer | Compass Oncology

  https://www.compassoncology.com/colon-rectal/diagnosis

  Over the past two decades, there have been several advancements in colon and rectal cancer treatments. […] In addition to understanding your family history, it is important to stay on top of regular colorectal cancer screening. […] There are several screening tests for colon and rectal cancers, including some that were recently made widely available. […] The best method of screening depends on factors such as your age and risk for developing colon and rectal cancer. […] Colonoscopies continue to be the best approach for detecting colon and rectal cancer. […] According to the National Cancer Institute, studies show that colonoscopy screenings can reduce colorectal cancer deaths by as much as 60-70%. […] A key benefit of a colonoscopy is the ability to view the entire colon. […] Patients at average risk for colon cancer and who are age 45 and older are ideal candidates for a virtual colonoscopy.

• #1 Diagnosis of bowel cancer. Booking Health

  https://bookinghealth.com/blog/diagnoses-and-treatment/diagnosis-and-treatment/354804-diagnosis-of-bowel-cancer.html

  The most successful bowel cancer diagnosis stories start from timely preventive examination and referral to oncologist. […] Telling your doctor about your complaints and symptoms is the first important step. […] According to the primary results, investigations for confirming or excluding diagnosis of bowel cancer may include such outpatient and inpatient procedures: Laboratory tests, Instrumental examination, Endoscopic examination, Different types of CT/MRI, Biopsy with histological and immunohistochemical study, Genetic testing. […] Biopsy with histological and immunohistochemical study remains golden standard in establishing the diagnosis of bowel cancer. […] Early diagnosis of bowel cancer and timely treatment significantly improves prognosis and full recovery rates. That is why screening tests become more popular and widespread.

• #1 Colorectal Cancer Diagnosis: The Obstacles We Face in Determining a Non-Invasive Test and Current Advances in Biomarker Detection

  https://www.mdpi.com/2072-6694/14/8/1889

  There still remains a large unmet need for non-invasive biomarkers to be used as accurate screening tools for the early detection of CRC. […] The existing molecular markers utilized in stool and serum tests, and to a lesser degree the immunoaffinity-based FIT test, are suitable for identifying low CRC risk, but do not provide the high level of specificity needed for an accurate screening tool.

• #2 Colorectal Cancer Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/colorectal-cancer/colorectal-cancer-diagnosis.html

  Colorectal cancer can be identified during a routine screening. Everyone with an average risk for colorectal cancer should start getting regular colorectal screenings starting at age 45. […] People who have symptoms of colorectal cancer should be tested regardless of their age. This is considered a diagnostic test. […] Endoscopic tests are the most effective tests for colorectal cancer. They can be used for routine screening that everyone should have starting at age 45. They are also used for patients who have colorectal cancer symptoms and need a diagnostic test. […] Colonoscopies are used for routine screening and to diagnose people with colorectal cancer symptoms. […] If doctors remove any polyps during a colonoscopy, they will be examined under a microscope for the presence of cancer cells. The process of removing and examining suspected disease tissue is called a biopsy.

• #2 Early detection of bowel cancer | Cancer Council

  https://www.cancer.org.au/cancer-information/causes-and-prevention/early-detection-and-screening/early-detection-of-bowel-cancer

  Early detection saves lives […] If detected early, the chance of successful treatment and long-term survival improves significantly. […] Bowel cancer can be detected using a variety of methods. […] A faecal occult blood test (FOBT) is a simple test that can be done at home and looks for hidden traces of blood in a bowel motion. It can help detect bowel cancer in its early stages in people without symptoms. […] You should have an FOBT every two years from age 50. If an FOBT finds blood, further investigation, usually a colonoscopy, is needed to establish the cause. […] Colonoscopy involves a long, thin, flexible tube with a video camera lens on the end, enabling a specialist to look inside your bowel. If a polyp or bowel cancer is found, it can be removed during the procedure. […] Colonoscopy is usually performed under sedation as day procedure. It is also used as a surveillance test for people at increased risk of developing bowel cancer.

• #2 Bowel cancer

  https://www.cancervic.org.au/cancer-information/types-of-cancer/bowel_cancer/diagnosing_bowel_cancer.html

  Some people have tests for bowel cancer because they have symptoms; others have no symptoms but have tests because of a strong family history of bowel cancer or after receiving a positive result through the National Bowel Cancer Screening Program. […] If your doctor suspects you have bowel cancer, you may have some of the tests described in this chapter, but you are unlikely to need them all. Some tests may be repeated during or after treatment to check how well treatment is working. […] A test called the immunochemical faecal occult blood test (iFOBT) looks for tiny amounts of blood in your faeces. It is commonly used as a screening test for bowel cancer. […] Screening is the process of looking for cancer or abnormalities that could lead to cancer in people who do not have any symptoms.

• #2 Colorectal Cancer Diagnostic Methods: The Present and Future

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10185295/

  The American Cancer Society (ACS), US Preventative Services Task Force (USPSTF), and US Multi-Society Task Force are three prominent American organizations that oversee CRC screening recommendations. […] The stool-based tests highlighted in their guidelines were the fecal immunochemical test (FIT) test, the guaiac-based fecal occult blood test (gFOBT), and the multitarget stool DNA test. The structural examinations highlighted were the colonoscopy, computerized tomography colonography examination, and flexible sigmoidoscopy. […] The immunochemical fecal occult blood test, which uses human hemoglobin, particularly for detection, has a higher sensitivity than gFOBT and a similar specificity to gFOBT for detecting advanced neoplasia. […] The multitarget stool DNA test includes immunochemical assays for human hemoglobin and molecular assays for abnormally methylated bone morphogenetic protein 3 (BMP3) and N-Myc downstream-regulated gene 4 (NDRG4) promoter regions, mutant Kirsten rat sarcoma (KRAS) virus, and -actin.

• #2 Colorectal Cancer Screening Tests: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/colorectal-cancer-screening-tests/

  Types of stool tests include: Fecal occult blood tests (FOBT). These tests look for hidden (known as occult) blood in your stool. […] Stool DNA test (FIT-DNA test). This test checks for genetic changes in your stool that may be signs of colorectal polyps or cancer. […] If your fecal occult blood test or stool DNA test had abnormal results, it doesn’t necessarily mean you have cancer. But your provider will probably order more tests, such as a colonoscopy, to help make a diagnosis. […] Most polyps aren’t cancerous but can turn into cancer if not removed. Depending on the size and number of polyps, your provider may recommend more frequent colonoscopies. […] Each type of screening test has advantages and disadvantages. You and your provider should discuss the benefits and risks of each option.

• #2 Tests for bowel cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bowel-cancer/getting-diagnosed/tests-bowel-cancer

  A flexible sigmoidoscopy looks inside the lower part of your large bowel using a flexible tube. […] CT colonography is a test that uses a CT scan to check the large bowel and rectum. […] You might have a CT scan to help diagnose bowel cancer if you’re not able to have bowel preparation. […] A colon capsule endoscopy looks at the inside of your large bowel (colon) using a capsule that you swallow. […] If you have a biopsy that shows that you have bowel cancer, you may have more tests to work out where and how big the cancer is. This is called staging the cancer. […] After a doctor removes tissue or cancer from your bowel, they send the samples to a laboratory. A doctor called a pathologist does various tests on the cells. These tests can help to diagnose bowel cancer and look for certain gene changes.

• #2 Bowel cancer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/bowel-cancer/

  Diagnosing bowel cancer involves a series of steps. When you first see your GP, they will ask about your symptoms and whether you have a family history of bowel cancer. […] They will then usually carry out a simple examination of your abdomen (tummy) and your bottom. This is known as a digital rectal examination (DRE). […] If your symptoms suggest you may have bowel cancer or the diagnosis is uncertain, you’ll be referred to your local hospital initially for a simple examination called a flexible sigmoidoscopy. […] A flexible sigmoidoscopy is an examination of your rectum and some of your large bowel using a device called a sigmoidoscope. […] Most people with bowel cancer can be diagnosed by flexible sigmoidoscopy. However, some cancers can only be diagnosed by a more extensive examination of the colon.

• #2 Colon cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/colon-cancer/diagnosis-treatment/drc-20353674

  Colonoscopy During a colonoscopy, a healthcare professional puts a colonoscope into the rectum to check the entire colon. […] Tests and procedures used for colon cancer diagnosis include: […] Using a scope to examine the inside of the colon. Colonoscopy uses a long, flexible and slender tube attached to a video camera and monitor to view the whole colon and rectum. A doctor may pass surgical tools through the tube to take tissue samples and remove polyps. […] Removing a sample of tissue for testing. A biopsy is a procedure to remove a sample of tissue for testing in a lab. For colon cancer, the tissue sample is often collected during a colonoscopy. Sometimes surgery is needed to get the tissue sample. In the lab, tests can show whether the cells are cancerous and how quickly they’re growing. Other tests can give more information about the cancer cells. Your health care team uses the results to understand your prognosis and create a treatment plan.

• #2 Diagnosis of colorectal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/colorectal/diagnosis

  Diagnosis is the process of finding out the cause of a health problem. Diagnosing colorectal cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for colorectal cancer or other health problems. […] The following tests are usually used to rule out or diagnose colorectal cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment. […] A colonoscopy is the most common test used to diagnose colorectal cancer. During a colonoscopy, the doctor looks inside the colon and rectum using a flexible tube with a light and lens on the end (called an endoscope).

• #2 Diagnosing Colorectal Cancer | NYU Langone Health

  https://nyulangone.org/conditions/colorectal-cancer/diagnosis

  Diagnosing Colorectal Cancer […] Colorectal cancer may be diagnosed during a screening test, which is done before symptoms occur, or as a result of diagnostic testing, which is performed to determine the cause of symptoms. […] Screening guidelines recommend testing starting at age 45 for men and women at average risk. Routine screening can help detect colorectal cancer early or help prevent it altogether. […] Depending on your symptoms, medical history, and physical examination, our specialists may use a number of tests to help diagnose colorectal cancer or another gastrointestinal condition. […] They may include blood tests to check for conditions such as anemia or vitamin deficiency; colonoscopy or sigmoidoscopy to examine the colon or rectum; or imaging tests to view the colon, rectum, and abdomen.

• #2 Bowel cancer | Causes, Symptoms & Treatments | Cancer Council

  https://www.cancer.org.au/cancer-information/types-of-cancer/bowel-cancer

  The best test for bowel cancer is a colonoscopy, which examines the length of the large bowel. Air is pumped into the colon through a flexible tube that is inserted into the anus. A camera on the end of the tube allows your doctor to look for abnormal tissue that is removed for further examination. […] Flexible sigmoidoscopy is used to examine the rectum and left side of the lower colon. Any unusual tissue can be removed for further examination. […] An MRI scan produces detailed cross-sectional pictures of the body and can show the extent of any tumours. […] CT scans produce three-dimensional pictures of several organs at the same time and can be used to examine the bowel. […] In a positron emission tomography (PET) scan, a small amount of radioactive glucose is injected into the body. When scanned, cancer cells will appear brighter.

• #2 Diagnosis of colorectal cancer | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/colorectal/diagnosis

  A biopsy is usually done during a colonoscopy or sigmoidoscopy (called an endoscopic biopsy) to remove polyps or small amounts of tissue from the colon or rectum. […] Tumour markers are substances found in blood, tissues or fluids removed from the body. An abnormal amount of a tumour marker may mean that a person has colorectal cancer. Tumour marker tests are also used to check your response to cancer treatment. […] Stool tests check for hidden (occult) blood in the stool. A guaiac-based fecal occult blood test (gFOBT) or a fecal immunochemical test (FIT) may be done during diagnosis if it was not used during screening. […] A CT scan is used to check if colorectal cancer has spread to lymph nodes or organs in the chest, abdomen and pelvis. A CT scan of the pelvis may be used to measure how far a rectal tumour is from the anus.

• #2 Small bowel cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-bowel-cancer/diagnosis-treatment/drc-20442293

  Small bowel cancers are difficult to diagnose. For this reason, people suspected of having small bowel cancer often need multiple tests and procedures to locate the cancer or rule out a cancer. These may include: […] Blood tests can’t detect small bowel cancer, but they can give clues about your health. A blood test called a complete blood count can detect a low red blood cell count. The red blood cells could be low if small bowel cancer is causing bleeding. Blood tests also can show how well the organs are working. For example, results on kidney or liver function tests could be a clue that the cancer has spread to those organs. […] Imaging tests create pictures of the body. They can show the location and size of small bowel cancer. Tests might include MRI, CT and positron emission tomography, also called a PET scan.

• #2 Screening and Diagnosis of Colon and Rectal Cancer | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/cancer-care/gastrointestinal-cancers/colorectal-cancer/screening-and-diagnosis

  Regular colonoscopy screenings are recommended for anyone aged 45 years and older. […] There are a variety of leading-edge tools available to diagnose colorectal cancer. Most commonly they include: […] Blood tests look for anemia, which can result from a bleeding tumor. […] Imaging tests: Procedures such as CT scan, PET scan, ultrasound or MRI of the abdomen may be done to look for tumors or other problems. These tests may also be done if you have been diagnosed with colon or rectal cancer to help determine the extent (stage) of the cancer.

• #2 Colorectal Cancer – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/tumors-of-the-gastrointestinal-tract/colorectal-cancer

  Colorectal cancer is extremely common. Diagnosis is by colonoscopy. […] Patients who have symptoms that suggest colon cancer or who have a positive screening test need a diagnostic test to confirm whether they do or do not have cancer. Current guidelines recommend screening for all people, regardless of risk factors. […] Colonoscopic biopsy […] CT to evaluate extent of tumor growth and spread […] Genetic testing. […] Once cancer is diagnosed, patients should undergo complete imaging staging with CT of the chest, abdomen, and pelvis and routine laboratory tests to seek metastatic disease and anemia and to evaluate overall condition. […] Elevated serum carcinoembryonic antigen (CEA) levels are present in 70% of patients with CRC. CEA level is routinely obtained as part of the initial evaluation for CRC, but this test is neither sensitive nor specific and therefore is not recommended for screening purposes. However, if the CEA level is high preoperatively and low after removal of a colon tumor, monitoring the level may help detect recurrence earlier. […] Colon cancers that were removed during surgery are now routinely tested for the gene mutations that cause Lynch syndrome.

• #2 How We Diagnose Colon Cancer | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/colon-cancer/diagnosis

  A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of colon cancer and can be used to determine how a patient’s treatment is progressing. […] If you have been diagnosed with colon cancer, it is important to be seen quickly to start timely treatment. We are committed to seeing patients for an initial diagnosis or second opinion within days. We will assemble the team of specialists that is right for your stage and type of colon cancer. […] The process used to find out the extent of the cancer within the colon, or if it has spread to other parts of the body, is called staging. This determines your prognosis and your treatment plan. […] Some staging can be done before having surgery, and other parts of the staging process are done after the cancer is removed from the colon. During your first meeting with your team at Dana-Farber Brigham Cancer Center, we will discuss with you the best strategy to stage your cancer.

• #2 Colon cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/colon-cancer/diagnosis-treatment/drc-20353674

  Blood tests aren’t used to diagnose colon cancer. But blood tests can give clues about overall health, such as how well the kidneys and liver are working. A blood test might be used to look for a low level of red blood cells. This result might indicate that a colon cancer is causing bleeding. […] After a colon cancer diagnosis, other tests might be needed to find out the extent of the cancer. This is called the cancer’s stage. The health care team considers the cancer’s stage when creating a treatment plan. […] Staging tests might include imaging scans of the abdomen, pelvis and chest. Imaging tests take pictures of the body. They show the location and the size of the colon cancer. Often, doctors can’t be certain of the cancer’s stage until after colon cancer surgery. […] Colon cancer stages range from 0 to 4. The lowest numbers mean the cancer is all inside the lining of the colon. By stage 4, the cancer is considered advanced and has spread to other areas of the body. When cancer spreads, it’s called metastatic cancer.

• #2 Colon Cancer Workup: Approach Considerations, Blood Studies, Imaging Studies

  https://emedicine.medscape.com/article/277496-workup

  Adequate imaging of the chest and abdomen should be obtained for staging purposes, ideally preoperatively. Abdominal/pelvic computed tomography (CT), contrast ultrasound of the abdomen/liver, and abdominal/pelvic magnetic resonance imaging (MRI) scans are appropriate for imaging the abdomen and liver, for the purpose of staging. […] The goal of colorectal cancer screening is to decrease mortality through diagnosis and treatment of precancerous lesions (adenomatous and serrated colon polyps) and early curable cancerous lesions. The evidence for the importance of early detection and removal of colorectal polyps in preventing development of invasive cancer is mostly indirect but has been corroborated by data from many trials. […] Screening options consist of tests that detect adenomatous polyps and cancer, and tests that primarily detect cancer. Any one of these tests can be used for screening.

• #2 How is bowel cancer diagnosed? | Cancer Australia

  https://www.canceraustralia.gov.au/cancer-types/bowel-cancer/how-bowel-cancer-diagnosed

  If you are diagnosed with bowel cancer, you might have more tests to determine the stage of the disease and whether the cancer has spread to other parts of the body. Knowing the stage of the disease helps your medical team plan the best treatment for you. […] Tests to determine the stage of bowel cancer can include: CT, MRI or PET (positron emission tomography) scans, chest X-ray (to see if the cancer has spread to the lungs), surgery to remove the tumour and see how far it has spread within the bowel, lymph node biopsy, blood tests, ultrasound.

• #2 How to Test & Diagnose Colorectal (Rectal or Colon) Cancer

  https://www.cancercenter.com/cancer-types/colorectal-cancer/diagnosis-and-detection

  Several types of imaging tests are used to diagnose colorectal cancer. […] A positron emission tomography-computed tomography (PET/CT) scan may be used to determine whether the colorectal cancer has spread to lymph nodes or other areas of the body, such as the liver or lungs. […] A barium enema is used to take X-rays of the large intestine, which includes the colon and rectum. It helps doctors diagnose and stage colorectal cancer, and in some cases, it is used when a colonoscopy is not an option.

• #2 Bowel cancer | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/bowel-cancer/

  The 2 tests used for this are colonoscopy and computerised tomography (CT) colonography. […] A colonoscopy is an examination of your entire large bowel using a device called a colonoscope. […] If a diagnosis of bowel cancer is confirmed, further testing is usually carried out to check if the cancer has spread from the bowel to other parts of the body. […] These tests can include a CT scan of your abdomen and chest this will check if the rest of your bowel is healthy and whether the cancer has spread to the liver or lungs. […] Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. […] Staging refers to how far your cancer has advanced. Grading relates to how aggressive your cancer is and how likely it is to spread. […] If you’re not sure what stage or grade of cancer you have, ask your doctor.

• #2 Tests and next steps for bowel cancer – NHS

  https://www.nhs.uk/conditions/bowel-cancer/tests-and-next-steps/

  If a GP refers you to a specialist because they think you could have bowel cancer, you’ll have tests to check for cancer. […] The main test for bowel cancer is a colonoscopy. This is where a thin, flexible, tube with a camera is used to look inside your bowel. […] During the colonoscopy, a small sample of the lining of your bowel may be taken for testing (called a biopsy). […] If you’ve been told you have bowel cancer, you may need more tests which can include: a CT scan, an MRI scan, a PET scan, blood tests, genetic testing. […] The results of these tests can show how far the cancer has spread, and if the cancer has been caused by certain changes in your genes. […] This will help your specialist team decide what treatment you need.

• #2 Colorectal Cancer: Screening and Symptoms | Doctor

  https://patient.info/doctor/colorectal-cancer

  Colonoscopy should be offered to patients without major comorbidity to confirm the diagnosis of colorectal cancer. If a lesion suspicious of cancer is detected, a biopsy sample should be sent for histology. […] Colonoscopy is the gold standard for diagnosis of colorectal cancer. […] Elevated pre-treatment serum levels of carcinoembryonic antigen (CEA) have a negative prognostic significance (CEA is of no use in screening but can be helpful in predicting relapse in patients after surgery suitable for further resection). […] Contrast-enhanced CT of the chest, abdomen and pelvis should be used to estimate the stage of disease for patients with colon cancer. […] The Dukes’ staging classification was as follows: Dukes’ A – the cancer is only in the innermost lining of the bowel or slightly growing into the muscle layer. Dukes’ B – the cancer has grown through the muscle layer of the bowel. Dukes’ C – the cancer has spread to at least one lymph node close to the bowel. Dukes’ D – the cancer has metastasised to other areas – eg, the liver, lungs or bones.

• #2 Diagnosing Colon Cancer

  https://www.verywellhealth.com/colon-cancer-diagnosis-797562

  Colon cancer survival rates hinge greatly on the stage of the disease. In essence, survival rates are used by healthcare providers as a way to discuss a person’s prognosis, which is the expected course of the disease. […] For early-stage cancers that are treated with the expectation of a complete cure, the five-year survival rate is sometimes considered the point at which a person is „out of the woods.” […] According to the National Cancer Institute and American Cancer Society, the five-year survival rates for people living with colon cancer (based on stage) are as follows: Stage 1: 92%, Stage 2: 63 to 87%, Stage 3: 53 to 69%, Stage 4: 11%. […] Colonoscopy is the „gold standard” test, and flexible sigmoidoscopy (which only looks at part of the colon) is another option. A tissue biopsy can be obtained during one of these invasive diagnostic procedures. Imaging, such as CT colography, may detect growths. Lab tests can be used to detect molecular markers for cancer or analyze stool samples for blood, and at-home colon cancer tests are a good preliminary step.

• #2 Colorectal Cancer Diagnosis: The Obstacles We Face in Determining a Non-Invasive Test and Current Advances in Biomarker Detection

  https://www.mdpi.com/2072-6694/14/8/1889

  The current screening program within the UK for CRC involves patients being invited to provide a stool sample, which is then tested for the presence of blood in the stool in the form of fecal immunohistochemistry testing (FIT). […] The current use of molecular biomarkers in the detection of CRC is extremely limited. […] CEA thus has poor sensitivity but excellent specificity. […] No other suitable diagnostic molecular biomarker is currently used to screen for CRC. […] The only serum biomarker for CRC tested for in the UK is carcinoembryonic antigen (CEA). […] The current advances in biomarker use for early detection of CRC have shown great potential in past years, and even though use of the Epi proColon blood test has been approved for use by the FDA, it is still only reserved for patients who refuse to participate in traditional screening for CRC.

• #2

  https://www.nbcnews.com/health/health-news/colon-cancer-blood-test-shield-screening-fda-approved-rcna163630

  The Food and Drug Administration on Monday approved Guardant Healths blood test, called Shield, to screen for colon cancer. […] Shield has previously been available to doctors as a screening tool, at an out-of-pocket cost of $895. […] Research published in March showed Shield was 83% effective in finding colorectal cancers. […] The test would need to be given at least every three years, starting at age 45 the same age it’s recommended to begin colorectal screening. […] A positive test isnt necessarily a diagnosis. If the results indicate cancer is present, patients would still need a colonoscopy so doctors can see where tumors are and how far theyve progressed. […] A test like this is not complete if its positive and you have not had a colonoscopy. […] Indeed, colorectal cancer is one of the only cancers that can be prevented with screening, and colonoscopy is, by far, the most accurate way to detect it.

• #2 Colon Cancer Diagnosis | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/colon/diagnosis

  Your care team may recommend CT and MRI scans to determine the stage of the cancer and to see if it has spread to other organs. […] For some advanced cancers, pathologists at Memorial Sloan Kettering will do molecular testing on a tumor to find somatic mutations. These mutations can predict how a tumor might react to treatments. Knowing as much as possible about a tumors genetic makeup can help your care team choose the treatments that are most likely to help you. […] If the cancer has spread outside the colon, your doctor will test biopsy samples for mutations in genes called EGFR, KRAS, and BRAF. These are common in colon cancer. We will also test for mutations in less common genes.

• #2 Colorectal cancer diagnosis: Pitfalls and opportunities

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4678389/

  In the general population, lower abdominal symptoms are very common and are a frequent cause of visits to the general practitioner. The issue is that symptoms are usually very vague and non-specific, with a poor sensitivity for CRC. […] For these reasons, as colonoscopy is the gold standard for CRC investigation, several risk classification scores based on symptoms have been developed to determine which patients are most at risk of having CRC and thus to reduce the delay between the initial consultation and the colonoscopy. […] The objective of this article was to review the pitfalls and missed opportunities in the process of CRC diagnosis in symptomatic patients. […] We showed the effect of delayed diagnosis on CRC prognosis as well as the factors related to this delay. […] The period of time from the first symptoms until a final diagnosis is achieved can vary.

• #2 Colorectal Cancer Screening – NCI

  https://www.cancer.gov/types/colorectal/patient/colorectal-screening-pdq

  Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread. […] If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests. […] Studies show that some screening tests for colorectal cancer help find cancer at an early stage and may decrease the number of deaths from the disease. […] The following types of tests are used to screen for colorectal cancer: Fecal occult blood test, Sigmoidoscopy, Colonoscopy, Virtual colonoscopy, DNA stool test. […] Studies have shown that screening for colorectal cancer using digital rectal exam does not decrease the number of deaths from the disease.

• #2 How to Detect Colon Cancer Early | Mass General Brigham

  https://www.massgeneralbrigham.org/en/about/newsroom/articles/how-to-detect-colon-cancer-early

  Screening can identify precancerous polyps that may be removed before they become colon cancer. Early detection of cancer leads to a better prognosis. […] We have invasive and noninvasive techniques for early detection of precancerous polyps and colon cancer. […] Colonoscopy is unsurpassed for screening of colorectal cancer, Dr. Parikh says. It is a very sensitive tool for the detection of small polyps and colon cancers and is the gold standard for screening. […] New technologies are being developed that can detect tumor byproducts that may be present in stool or circulating in your blood. Tests to detect tumor DNA in stool are approved as alternatives to colonoscopy for colorectal cancer screening.

• #2 Diagnosis of bowel cancer. Booking Health

  https://bookinghealth.com/blog/diagnoses-and-treatment/diagnosis-and-treatment/354804-diagnosis-of-bowel-cancer.html

  Optimal screening tests should correspond to general requirements: Be reliable, Be easy in performing, Be quick, Cause no harm or have significant benefits, that outweigh possible risks. […] Timely and precise diagnosis of bowel cancer depends on the availability of laboratory tests, instrumental investigations and qualified healthcare professionals.

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