Kolorektales Karzinom: Prävention und Früherkennung

Zusammenfassung

Das kolorektale Karzinom zählt zu den häufigsten krebsbedingten Erkrankungs- und Todesursachen. Wichtige Risikofaktoren sind fortgeschrittenes Alter, familiäre Belastung, männliches Geschlecht und Lebensstilfaktoren. Da die Entwicklung vom frühen Adenom bis zum invasiven Karzinom in der Regel mehr als 10 Jahre in Anspruch nimmt, ist eine Prävention mittels Koloskopie mit Polypektomie und Früherkennung asymptomatischer Stadien möglich. Die Koloskopie ist gleichzeitig diagnostisches und therapeutisches Instrument und das Verfahren mit der höchsten Sensitivität für Prä- und Frühneoplasien des Kolons. Neue fäkal immunologische Tests haben bei sehr guter Spezifität eine deutlich höhere Sensitivität für fortgeschrittene Adenome und Karzinome als der Guaiac-basierte Haemocculttest. Molekulare Stuhl- und Bluttests sind vielversprechende Entwicklungen. Sie haben aber ebenso wie die virtuelle Koloskopie und die Kolonkapselendoskopie heute noch keinen Stellenwert in der Prävention und Früherkennung des kolorektalen Karzinoms.

Abstract

Colorectal cancer is one of the leading causes of cancer associated morbidity and mortality. Main risk factors include advanced age, affected family members, male sex and lifestyle factors. The development of early adenoma to invasive cancer requires 10 and more years. Therefore, prevention via colonoscopy with polypectomy and early detection of asymptomatic stages is possible. Colonoscopy is a diagnostic and therapeutic tool with the highest sensitivity for precancerous lesions and early cancers of the colon. New fecal immunological tests reveal a higher sensitivity for advanced adenoma and cancer than guaiac based hemoccult tests while maintaining a high specificity. Molecular stool and blood tests are promising new developments. However, similar to virtual colonoscopy and colon capsule endoscopy, they have so far not been established as routine instruments for prevention and early detection of colorectal cancer.

Schlüsselwörter

Darmkrebs - Vorsorge - Früherkennung - Screening

Keywords

colorectal cancer - prevention - early detection - screening

• Literatur

• 1 Leitlinienprogramm Onkologie. S3-Leitlinie Kolorektales Karzinom, Version 1.1. Im Internet: 2014. http://www.dgvs.de/fileadmin/user_upload/Leitlinien/kolorektalesKarzinom/LL_KRK_Langfassung_1.1.pdf letzter Zugriff: 24.8.2015
• 2 RKI. Krebs in Deutschland. Darm. Im Internet: http://www.rki.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/kid_2013/kid_2013_c18-21_darm.pdf letzter Zugriff: 24.8.2015
• 3 Platz EA, Willett WC, Colditz GA et al. Proportion of colon cancer risk that might be preventable in a cohort of middle-aged US men. Cancer Causes Control 2000; 11: 579-588
• 4 Lieberman DA, Prindiville S, Weiss DG et al. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA 2003; 290: 2959-2967
• 5 Botteri E, Iodice S, Raimondi S et al. Cigarette smoking and adenomatous polyps: a meta-analysis. Gastroenterology 2008; 134: 388-395
• 6 Kahi CJ, Rex DK, Imperiale TF. Screening, surveillance, and primary prevention for colorectal cancer: a review of the recent literature. Gastroenterology 2008; 135: 380-399
• 7 Brenner H, Altenhofen L, Stock C, Hoffmeister M. Incidence of colorectal adenomas: birth cohort analysis among 4. 3 million participants of screening colonoscopy. Cancer Epidemiol Biomarkers Prev 2014; 23: 1920-1927
• 8 Butterworth AS, Higgins JP, Pharoah P. Relative and absolute risk of colorectal cancer for individuals with a family history: a meta-analysis. Eur J Cancer 2006; 42: 216-227
• 9 Aretz S. The differential diagnosis and surveillance of hereditary gastrointestinal polyposis syndromes. Dtsch Arztebl Int 2010; 107: 163-173
• 10 Nguyen SP, Bent S, Chen YH, Terdiman JP. Gender as a risk factor for advanced neoplasia and colorectal cancer: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009; 7: 676-681
• 11 Kolligs FT, Crispin A, Munte A et al. Risk of advanced colorectal neoplasia according to age and gender. PLoS ONE 2011; 6: e20076
• 12 Brenner H, Hoffmeister M, Arndt V, Haug U. Gender differences in colorectal cancer: implications for age at initiation of screening. Br J Cancer 2007; 96: 828-831
• 13 Kaminski MF, Polkowski M, Kraszewska E et al. A score to estimate the likelihood of detecting advanced colorectal neoplasia at colonoscopy. Gut 2014; 63: 1112-1119
• 14 Dignass A, Preiss JC, Aust DE et al. Updated German guideline on diagnosis and treatment of ulcerative colitis, 2011. Z Gastroenterol 2011; 49: 1276-1341
• 15 Preiß JC, Bokemeyer B, Buhr HJ et al. Updated German clinical practice guideline on diagnosis and treatment of Crohn’s disease 2014. Z Gastroenterol 2014; 52: 1431-1484
• 16 Flossmann E, Rothwell PM. British doctors aspirin trial and the UK-TIA aspirin trial. Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet 2007; 369: 1603-1613
• 17 Rothwell PM, Fowkes FG, Belch JF et al. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 2011; 377: 31-41
• 18 Winawer SJ, Zauber AG, Ho MN et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981
• 19 Zauber AG, Winawer SJ, O’Brien MJ et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 20 Nishihara R, Wu K, Lochhead P et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105
• 21 Brenner H, Altenhofen L, Hoffmeister M. Eight years of colonoscopic bowel cancer screening in Germany: initial findings and projections. Dtsch Arztebl Int 2010; 107: 753-759
• 22 Pickhardt PJ, Choi JR, Hwang I et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003; 349: 2191-2200
• 23 Johnson CD, Chen MH, Toledano AY et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 2008; 359: 1207-1217
• 24 Graser A, Stieber P, Nagel D et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut 2009; 58: 241-248
• 25 Levin B, Lieberman DA, McFarland B et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008; 134: 1570-1595
• 26 Cash BD, Riddle MS, Bhattacharya I et al. CT colonography of a Medicare-aged population: outcomes observed in an analysis of more than 1400 patients. AJR Am J Roentgenol 2012; 199: W27-34
• 27 Macari M, Nevsky G, Bonavita J et al. CT colonography in senior versus nonsenior patients: extracolonic findings, recommendations for additional imaging, and polyp prevalence. Radiology 2011; 259: 767-774
• 28 Kuehle CA, Langhorst J, Ladd SC et al. Magnetic resonance colonography without bowel cleansing: a prospective cross sectional study in a screening population. Gut 2007; 56: 1079-1085
• 29 Graser A, Melzer A, Lindner E et al. Magnetic resonance colonography for the detection of colorectal neoplasia in asymptomatic adults. Gastroenterology 2013; 144: 743-750
• 30 Spada C, Hassan C, Munoz-Navas M et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc 2011; 74: 581-589
• 31 Kaminski MF, Regula J, Kraszewska E et al. Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 2010; 362: 1795-1803
• 32 Pohl H, Srivastava A, Bensen SP et al. Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 2013; 144: 74-80
• 33 Hewitson P, Glasziou P, Watson E et al. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol 2008; 103: 1541-1549
• 34 Hundt S, Haug U, Brenner H. Comparative evaluation of immunochemical fecal occult blood tests for colorectal adenoma detection. Ann Intern Med 2009; 150: 162-169
• 35 Brenner H, Tao S. Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. Eur J Cancer 2013; 49: 3049-3054
• 36 Segnan N, Patnick J, von Karsa L Hrsg. European guidelines for quality assurance in colorectal cancer screening and diagnosis. 1st. edition. Luxembourg: Publications Office of the European Union; 2010
• 37 Imperiale TF, Ransohoff DF, Itzkowitz SH et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014; 370: 1287-1297
• 38 Brenner H, Werner S, Chen H. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014; 371: 184-185
• 39 Church TR, Wandell M, Lofton-Day C et al. Prospective evaluation of methylated SEPT9 in plasma for detection of asymptomatic colorectal cancer. Gut 2014; 63: 317-325
• 40 Freedman AN, Slattery ML, Ballard-Barbash R et al. Colorectal cancer risk prediction tool for white men and women without known susceptibility. J Clin Oncol 2009; 27: 686-693
• 41 Park Y, Freedman AN, Gail MH et al. Validation of a colorectal cancer risk prediction model among white patients age 50 years and older. J Clin Oncol 2009; 27: 694-698
• 42 Tao S, Hoffmeister M, Brenner H. Development and validation of a scoring system to identify individuals at high risk for advanced colorectal neoplasms who should undergo colonoscopy screening. Clin Gastroenterol Hepatol 2014; 12: 478-485