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Screening des kolorektalen Karzinoms

Screening of colorectal neoplasm

Zusammenfassung

In Deutschland starben im Jahr 2002 ca. 29.000 Menschen an einem kolorektalen Karzinom (CRC); das Lebenszeitrisiko, an einem CRC zu erkranken, beträgt mit dem Alter steigend ab dem 50. Lebensjahr in Deutschland 4–6%. Etwa 1/3 aller über 50-Jährigen hat relevante Polypen im Kolorektum, ein ausreichend hoher Prävalenzwert für ein sinnvolles Screening. Im Gegensatz zu den meisten anderen Krebserkrankungen kann man beim CRC außerdem die Krebserkrankung verhindern und nicht nur in einem frühen Stadium erkennen. Die Mortalität des CRC kann durch die Anwendung des Tests auf okkultes Blut (FOBT) bei Personen zwischen dem 45. und 80. Lebensjahr um 14% gesenkt werden. Bereits durch regelmäßige Sigmoidoskopien mit einer konsequenten Polypektomie kann einer Senkung der Karzinominzidenz zwischen 50 und 70% angenommen werden. Die Koloskopie ist zweifelsfrei das Verfahren der Wahl für die Sekundärprävention, da sie die komplette Diagnostik und Behandlung bei vertretbar geringem Risiko vereint. Wirtschaftliche Vorteile einer Vermeidungsstrategie gegenüber der überaus teuren Behandlung des CRC sind nachgewiesen. Aufgrund aller berichteten Daten sind Präventionsmaßnahmen beim CRC nachhaltig zu empfehlen.

Abstract

In Germany approximately 29,000 people died of colorectal carcinoma (CRC) in 2002; the risk of getting CRC is 4–6% in Germany, rising with age from the 50th year of life. About one third of all people over 50 years of age have polyps with the potential for malignant transformation in the colorectum, which is a sufficiently high prevalence rate to justify screening. In contrast to most other cancer diseases, in the case of CRC it is possible to prevent the cancer and not only to detect it at an early stage. Application of the test for occult blood in persons between their 45th and 80th years can reduce the mortality of CRC by 14%. We can assume that already regular sigmoidoscopies with consistent performance of polypectomy when needed could reduce the incidence of CRC by 50–70%. There is no doubt that coloscopy is the technique of choice for secondary prevention, as it unites the possibility of complete diagnosis and treatment with a justifiably low level of risk. The economic advantages of an avoidance strategy compared with the treatment of CRC, which is certainly expensive, have been documented. On the basis of all the data reported, in the case of CRC preventive strategies can be emphatically recommended.

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Literatur

  1. Ajaj W, Pelster G, Treichel U et al. (2003) Dark lumen magnetic resonance colonography: comparison with conventional colonoscopy for the detection of colorectal pathology. Gut 52: 1738–1743

    PubMed  Article  CAS  Google Scholar 

  2. Barish MA, Soto JA, Ferrucci J (2005) Consensus on current clinical practice of virtual colonoscopy. AJR 184: 786–792

    PubMed  Google Scholar 

  3. Cotton PB, Durkalski VL, Pineau BC et al. (2004) Computed tomographic colonography (virtual colonoscopy). JAMA 291: 1713–1719

    PubMed  Article  CAS  Google Scholar 

  4. Eickhoff A, Riemann JF (2002) Health economic aspects colorectal cancer: prevention, treatment and follow-up: what is the most cost-effective approach? Gesund Ökon Qual Manag 7: 232–240

    Article  Google Scholar 

  5. Frentz SM, Summers BS, Summers RM (2006) Current status of CT colonography. Acad Radiol 13: 1517–1531

    PubMed  Article  Google Scholar 

  6. Goyen M, Ajaj W (2006) MR imaging of the colon: technique, indications, results and limitations. Eur J Radiol 10: 1016

    Google Scholar 

  7. Graser A, Wintersperger BJ, Suess C et al. (2006) Dose reduction and image quality in MDCT colonography using tube current modulation. AJR 187: 695–701

    PubMed  Article  CAS  Google Scholar 

  8. Halligan S, Altman DG, Taylor SA et al. (2005) CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and proposed minimum data set for study level reporting. Radiology 237: 893-904

    PubMed  Article  Google Scholar 

  9. Halligan S, Taylor SA (2007) CT colonography: results and limitations. Eur Radiol 61: 400–408

    Article  Google Scholar 

  10. Hardcastle JD, Chamberlain JO, Robinson MH et al. (1996) Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 348: 1472–1477

    PubMed  Article  CAS  Google Scholar 

  11. Hartmann D, Bassler B, Schilling D et al. (2006) Colorectal polyps: detection with dark-lumen MR colonography versus conventional colonoscopy. Radiology 238: 143

    PubMed  Article  Google Scholar 

  12. Hartmann D, Bassler B, Pfeifer B et al. (2006) Patientenakzeptanz der MR-Kolonographie: Eine prospektive Erhebung im Vergleich zur Koloskopie. Dtsch Med Wochenschr 131: 2519–2523

    PubMed  Article  CAS  Google Scholar 

  13. Hauser H, Mischinger HJ (1998) Gastrointestinale Karzinome – epidemiologische und ernährungsspezifische Aspekte. Arzt Praxis 52: 576–579

    Google Scholar 

  14. Heresbach D, Manfredi S, D’halluin PN et al. (2006) Review in depth and meta-analysis of controlled trials on colorectal cancer screening by faecal occult blood test. Eur J Gastroenterol Hepatol 18: 427–433

    PubMed  Article  Google Scholar 

  15. Imperiale TF, Wagner DR, Lin CY et al. (2000) Risk of admvanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343: 169–174

    PubMed  Article  CAS  Google Scholar 

  16. Jensch S, van Gelder RE, Venema HW et al. (2006) Effective radiation doses in CT colonography: results of an inventory among research institutions. Eur Radiol 16: 981–987

    PubMed  Article  Google Scholar 

  17. Jorgensen OD, Kronborg O, Fenger C (2002) A randomized study of screening for colorectal cancer using faecal occult blood testing: results after 13 years and seven biennial screening rounds. Gut 50: 29–32

    PubMed  Article  CAS  Google Scholar 

  18. Kronborg O, Fenger C, Olsen J et al. (1996) Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 348: 1467–1477

    PubMed  Article  CAS  Google Scholar 

  19. Kung JW, Levine MS, Glick SN et al. (2006) Colorectal cancer: screening double-contrast barium enema examination in average-risk adults older than 50 years. Radiology 240: 725–735

    PubMed  Article  Google Scholar 

  20. Lane N, Fenoglio CM (1976) The adenoma-carcinoma sequence in the stomach and colon. Gastrointest Radiol 1: 111–119

    PubMed  Article  CAS  Google Scholar 

  21. Levin B (1992) Nutrition and colorectal cancer. Cancer 70: 1723–1726

    PubMed  Article  CAS  Google Scholar 

  22. Levin TR (1999) Predicting advanced proximal colonic neoplasia with screeing sigmoidoscopy. J Am Med Assoc 281: 1611–1617

    Article  CAS  Google Scholar 

  23. Lieberman DA, Weiss DG, Bond JH et al. (2000) Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans Affairs Cooperative Study Group. N Engl J Med 343: 162–168

    PubMed  Article  CAS  Google Scholar 

  24. Liu K, Stamler J (1979) Dietary, cholesterol, fat and fiber and colon cancer mortalilty: an analysis of international data. Lancet 2: 782–795

    PubMed  Article  CAS  Google Scholar 

  25. Lynch HT, Smyrk T, Lynch JF (1998) Molecular genetics and clinical pathology features of hereditary nonpolyposis colorectal carcinoma (Lynch syndrome): historical journey from pedigree anecdote to molecular genetic confirmation. Oncology 55: 103–108

    PubMed  Article  CAS  Google Scholar 

  26. Mandel JS, Bond JH, Church TR et al. (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med 328: 1365–1371

    PubMed  Article  CAS  Google Scholar 

  27. Mandel JS (2000) The effect of fecal occult blood screening on the incidence of colorectal cancer. N Engl J Med 343: 1603–1607

    PubMed  Article  CAS  Google Scholar 

  28. Mang T, Graser A, Schima W, Maier A (2007) CT colonography: techniques, indications, findings. Eur Radiol 61: 388–399

    Article  Google Scholar 

  29. Martinez ME, McPherson RS, Levin B, Glober GA (1997) A case-control study of dietary intake and other lifestyle risk factors for hyperplastic polyps. Gastroenterology 113: 423–429

    PubMed  Article  CAS  Google Scholar 

  30. Mulhall BP, Veerappan GR, Jackson JL (2005) Meta-analysis: computed tomographic colonography. Ann Intern Med 142: 635–650

    PubMed  Google Scholar 

  31. Newcomb PA (1992) Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 84: 1572–1575

    PubMed  Article  CAS  Google Scholar 

  32. Offit K (2000) Genetic prognostic markers for colorectal cancer: N Engl J Med 342: 124–125

    Google Scholar 

  33. Pickhardt PJ, Choi JR, Hwang I et al. (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349: 2191–2200

    PubMed  Article  CAS  Google Scholar 

  34. Pickhardt PJ, Taylor AJ, Kim DH et al. (2006) Screening for colorectal neoplasia with CT colonography: Initial experience from the 1st year of coverage by third-party payers. Radiology 241: 417

    PubMed  Article  Google Scholar 

  35. Ransohoff DF (1994) Colon cancer and ulcerative colitis. Gastroenterology 94: 1089–1091

    Google Scholar 

  36. Riemann JF, Rosenbaum A (2006) Früherkennung des kolorektalen Karzinoms – welchen Beitrag leisten Stifungen? Endo Heute 19: 257–262

    Article  Google Scholar 

  37. Rockey DC, Paulson E, Niedzwicki D et al. (2005) Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet 365: 305–311

    PubMed  CAS  Google Scholar 

  38. Rollandi GA, Biscaldi E, DeCicco E (2007) Double contrast barium enema: technique, indications, results and limitations of a conventional imaging methodology in the MDCT virtual endoscopy era. Eur Radiol 61: 382–387

    Article  Google Scholar 

  39. Sonnenberg A, Delco F, Inadomi JM (2000) Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Int Med 133: 573–584

    PubMed  CAS  Google Scholar 

  40. Thomas DB, Karagas MR (1987) Cancer in first and second generations Americans. Cancer Res 47: 5771–5776

    PubMed  CAS  Google Scholar 

  41. Vogelstein B, Fearon ER, Hamilton SR et al. (1988) Genetic alterations during colorectal-tumor development. N Engl J Med 319: 525–532

    PubMed  CAS  Article  Google Scholar 

  42. Winawer SJ, Zauber AG, O’Brien MJ et al. (1992) The National Polyp Study. Design, methods, and characteristics of patients with newly diagnosed polyps. The National Polyp Study Workgroup. Cancer 70: 1236–1245

    PubMed  Article  CAS  Google Scholar 

  43. Winawer SJ, Zauber AG, Gerdes H et al. (1996) Risk of colorectal cancer in the families of patients with adenomatous polyps. National Polyp Study Workgroup. N Engl J Med 334: 82–87

    PubMed  Article  CAS  Google Scholar 

  44. Winawer S, Fletcher R, Rex D et al. (2003) Colorectal cancer screening and surveillance: clinical guidelines and rationale update based on new evidence. Gastroenterology 142: 544–560

    Article  Google Scholar 

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Layer, G., Riemann, J. Screening des kolorektalen Karzinoms. Radiologe 48, 26–32 (2008). https://doi.org/10.1007/s00117-007-1584-7

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  • DOI: https://doi.org/10.1007/s00117-007-1584-7

Schlüsselwörter

  • Kolorektales Karzinom
  • Screening
  • Prävention
  • Koloskopie
  • CT-Kolographie
  • MR-Kolographie
  • Okkult-Bluttest
  • Polyp
  • Adenom

Keywords

  • Colorectal neoplasm
  • Screening
  • Prevention
  • Coloscopy
  • Computed tomography colonography
  • Magnetic resonance colonography
  • Occult blood test
  • Polyp
  • Adenoma