Evaluation Of Positive Screening Findings

Normal risk:

■ Asymptomatic

• Negative family history

FOBT annually (category 1) and flexible sigmoidoscopy every 5 y

* 60 cm scope or longer

Double-contrast barium enema every 5 y

CcEonoscopy every 10 y^ c

Biopsy

Hyperplastic

- Routine screening

No biopsy

Colonoscopy a,b-

See Follow-Up of Clinical Findings: Adenoma fCSCR-3)

ctq m 3

a alf FOBT positive and colonoscopy negative, proceed with additional workup.

blf colonoscopy incomplete, perform double-contrast barium enema at discretion of physician.

cData regarding virtual colonoscopy Is too premature to warrant its use in screening.

Fecal Occult Blood Test fFOBTl

• Any positive test requires evaluation

• 3 successive stool specimens

• Prescribed diet

• Not via digital rectal examination

• Guaiac-based nonrehydrated

• Immunochemical techniques under investigation

• Coordinated by health care provider

• Annual FOBT need not be performed if screening colonoscopy or double-contrast enema are used as a screening measure in an average-risk patient

Halo: All racommdnclaflioril fir calcgnjy 2A u''k>n otherwise Indicated.

Clinical Trials: NCCN hrliuvn^ that the bvil management of any caneer patient In a elinieel trial. P.i rtic ipelig n in clinical (Halt It especially encouraged.

1 XOJ. tit'.T3 C 2QK NdHr^d C'-i"-----rM GtrtM V*-«« trK All nqfti .weiYri Tn««* eiKtallrwr and ttv* llluitraltQn ™r net m ttptedMd m •'< rrittlwri it r:.wrt t "t'.'i n—vi > * * NCCN. CSC R"1

Figure 7-1. National Comprehensive Cancer Network practice guidelines for colorectal screening. These guidelines are a work in progress that will be refined as often as new significant data become available. Reprinted with permission from NCCN 2003 Colorectal Screening Guideline (version 1.2003), 'The Complete Library of NCCN Oncology Practice Guidelines" [CD-ROM], (May 2003), Jenkintown, Pennsylvania. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Continued

Practice Guidelines in Oncology - v.1.2003

Colorectal Screening

Guidelines Index MS References

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