Colon Cancer Screening in Average Risk Patients
Diagnosis/Definition
All patients > 50 yrs that have none of the following risk factors:
- Positive occult blood or frank bleeding
- History of colonic adenomas
- Family history of colon cancer
- Ulcerative colitis
- Crohn’s colitis, or
- History of colon cancer (see individual referral guidelines above for each of those).
Initial Diagnosis and Management
History and occult blood (x3).
Ongoing Management and Objectives
- Yearly hemoccult (x 3) and flexible sigmoidoscopy every five years (= routine screening). Hemoccults should be performed prior to sigmoidoscopy and should be negative. If positive see Hemoccult Positive Stool referral guideline.
- After a normal colonoscopy, NO screening is needed for ten years.
- After a colonoscopy, hemoccults are not indicated.
Indications for Specialty Care Referral
Any of risk factors defined above (after seeing individual referral guidelines).
Polyp by flex-sigmoidoscopy > 8 mm (i.e. greater than the width of the open biopsy forceps), or biopsy showing adenoma (biopsy all polyps, even those < one cm).
Other abnormalities by flex-sigmoidoscopy (e.g., mass, colitis, etc.).
Inability to perform flexible sigmoidoscopy in referring clinic (an examination to 35 cm or more may be considered adequate for screening; referrals to GI for sedated sigmoidoscopies for asymptomatic screening purposes are not indicated).
Patients over 65 who desire colonoscopy may be referred for screening.
Criteria for Return to Primary Care
Completion of colonoscopy or flexible sigmoidoscopy.
