Colorectal Cancer Prevention and Emergency Management

Abstract

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the United States and the third most common cause of death for both men and women after lung and prostate for men and lung and breast for women. The American Cancer Society estimates that 136,830 people will be diagnosed with CRC and 50,310 people will die from the disease in 2014 alone (American Cancer Society. Cancer facts and figures 2012. Atlanta: American Cancer Society; 2012). Fortunately, the incidence of CRC has declined steadily in recent years and is largely attributed to the detection and removal of precancerous polyps with CRC screening (Edwards et al. Cancer 116:544–573, 2010).

Although the overall incidence is declining, incidence in patients under the age of 50 is still on the rise (Surveillance, Epidemiology, and End Results (SEER) Program Stat Database: NAACR incidence–CiNA analytic file, 1995–2010, for expanded races, custom file with county, ACS Facts and Figures projection Project, North American Association of Central Cancer Registries, 2013; Siegel et al. Cancer Epidemiol Biomarkers Prev 18:1695–1698, 2009). Surgery is considered the first-line therapy for CRC and is generally elective. Chemotherapy and radiation are also treatment options in more advanced stages. Unfortunately, patients with CRC may present to the emergency department with complications such as perforation, hemorrhage, and obstruction and general complications secondary to chemotherapy and radiation (Cuffy et al. Surg Oncol 13(2–3):149–157, 2004). This chapter focuses on (1) the diagnosis of CRC in the emergency department and (2) the recognition and management of patients with complications associated with CRC that present to the emergency department.