By Dr Nahla Madan NCD Committee April 2010. The working group on the guideline The working Group Reviewing Group Dr. Ibtihal Al Reefy Dr. Badryia Yaser.

ByDr Nahla MadanNCD Committee

April 2010

The working group on the guidelineThe working Group Reviewing Group

Dr. Ibtihal Al Reefy

Dr. Badryia Yaser Dr. Fathyia

AbdullaDr. Mai BubshaitDr. Basma Al

Tajer 

Dr. A. Hussain AL Ajami

Dr. Mariam Al-Jalahma

Dr. Kadhim Jaffer Zaber

Dr. Ali Mirza SalmanDr. Abeer Al Ghawi

Colorectal cancerfactsMajority of colorectal cancer develop from

precancerous changes (polyps) About 90% of patients are over the age of 50Early Colorectal cancers are usually

asymptomaticThe average duration of symptoms (from onset

to diagnosis) is 14 weeks. There is no association between overall duration of symptoms and the stage of the tumor

Symptoms of Colorectal Cancer :May IncludesConstipation/DiarrheaNarrow StoolsAbdominal CrampsBloody StoolsUnexplained Weight Loss/Loss of AppetiteSense of FullnessNausea & VomitingGas & BloatingLethargy (Fatigue)

Colorectal cancer Risk factorsAge >50Personal or family history of colorectal cancer or

adenomatous polypFamilial syndromes as Familial Adenomatous Polyposis

(FAP) or Hereditary Non-polyposis Colorectal Cancer (HNPCC)

H/o inflammatory bowel diseasesHigh animal fat dietTobaccoPhysical inactivity

Colorectal screening guidelines in PHC For average risk population

Screening starts at the age of 50-90 or until there is a 30% chance of living to the next screening interval

Colorectal screening guidelines in PHC For average risk population

Fecal Occult Blood Test (FOBT) annually

andFlexible Sigmoidoscopy every 5

years

Colonoscopy every 10 years

or

Colorectal screening guidelines in PHC For High risk population

Screening start at the age of 40 or 10 years before the age of cancer in the first degree relative

First degree relative: Any relative who is one meiosis away from a particular individual in a family (i.e., parent, sibling, offspring)

Colorectal screening guidelines in PHC For special risk population

Patients with hereditary colorectal cancer syndrome should undergo annual colonoscopy

Patients with Ulcerative Colitis or Crohn’s Colitis of 7-10 years duration should start colonoscopy screening every 1-3 years

Colorectal Screening testsColonoscopy is the most sensitive and specific

test of the all available screening tests of colorectal cancer

FOBT has the most direct evidence of reducing colorectal cancer mortality

The sensitivity of sigmoidoscopy as a screening tests affected by type of the instrument

What is available in PHCA pilot screening campaign will be started using

HEXAGON OBTI to test stool for human blood in all adult 50-90 years of age attending LHC

The available test sample for the pilot campaign is 500, and will be distributed in the following HC:

Muharraq HCShaikh Sabah HCA’ali HCEast Raffa HC

Pilot screening campaign for colorectal cancerThe pilot period will end by using all the test samplesIt is necessary to collect data about the tested

candidates for the future analysis and updating of the guidelines

Collecting data will be by a form filled by the referring physician

After the pilot campaign, guidelines of colorectal cancer screening will be updating and a second awareness session will follow

HEXAGON OBTI Immunochromatographic rapid test

This rapid screening test detects human blood in the stool.

HEXAGON OBTI is a two-part test: - Collection tube for the

blood sample- Test bar

 DirectionsUnscrew the cap of the tube and collect the sample with the applicator stick by taking several postions at different sites (3-4) of the faeces . Remove excess stool with a tissue.

Reinsert the applicator stick into the tube. This sample collected is stable at room temperature and must be tested within one week after collection.

With the lid screwed back on, shake the sample gently inside the transport medium to assure proper mixing.

 DirectionsHold the tube with the red end upwards and break-off the tip.

Dispense exactly 2 full drops, drop by drop, into the test in the sample well (S) at the

lower end of the test .

 Results

A positive sample is typically detected within 2-3 minutes.

Negative results should be confirmed after 10 minutes.

Interpretation of ResultsA single blue line

means the testing liquid is working fine, but no human blood has been detected. It is called a “control line“

Two blue lines mean the test has detected human blood (even if blue color is weak)

No control line means that the test should be repeated

PositiveNegative Invalid

Other features

The test kit is stable up to the given expiration date when stored at 2 – 25 oC

Dietary restrictions are not necessary

Thank You and hope you a good day