Patrick M Lynch

Chapter Overview 85

Introduction 86

Principles of Screening 87

Current Screening Recommendations and Limitations 88

Fecal Occult Blood Testing 88

Flexible Sigmoidoscopy 91

Barium Enema 91

Colonoscopy 92

Investigational Measures for Colorectal Cancer Screening 94

Colon Cancer Chemoprevention 95

Groups at High Risk for Colorectal Cancer as Targets for

Chemoprevention Trials 95

COX-2 Inhibition in Patients with Sporadic Colorectal

Adenoma 100

The Future 101

Key Practice Points 101

Suggested Readings 102

Chapter Overview

Colorectal cancer is one of the most common and serious cancers. The predictable adenoma-to-carcinoma sequence and the relative accessibility of the colon to available screening measures allow many opportunities for early detection and prevention. Accepted screening measures include testing for fecal occult blood, barium enema, flexible sigmoidoscopy, and more recently, colonoscopy. Newer screening techniques include computed tomography colonography and stool-based DNA testing. All of the above have to do with early detection and, in the case of colonoscopy, treatment of early colorectal neoplasia. Because these are still secondary prevention measures, primary prevention through "chemoprevention" is a focal point at M. D. Anderson Cancer Center and elsewhere. Epidemio-

logic and experimental background have provided a basis for recent clinical trials demonstrating a role for nonselective and selective cyclo-oxygenase-2 inhibition of adenoma progression in an important human condition, familial adenomatous polyposis. One ongoing trial involves use of a combination of agents (celecoxib and difluoromethylornithine) with different proposed mechanisms of action: COX-2 inhibition and ornithine decarboxylase inhibition. Another trial is investigating the role of COX-2 inhibition in potentially delaying onset of first adenomas in young carriers of APC gene mutations responsible for familial adenoma-tous polyposis.

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