ACTIONABLE NUGGET:
Initiate colorectal cancer screening for patients with SCI using the same principles as those for the general population.
The Problem
The incidence of colorectal cancer in individuals with spinal cord injury (SCI) is similar to the general population; however, diagnosis of these tumours often occurs at an advanced stage in the SCI population. Sensory deficits and motor limitations can prevent individuals with SCI from recognizing symptoms that would be evident to individuals who are neurally intact. The high prevalence of rectal bleeding among individuals with SCI means that it is not a good indicator for screening; instead routine screening for colorectal cancer is essential.
Evidence-based Best Practice
As with the general population, individuals with SCI between the ages of 50 and 74 years and with a negative family history should be screened for colorectal cancer according to current Canadian guidelines:
- Fecal occult blood test (FOBT) every 2 years, or
- Flexible sigmoidoscopy every ten years.
Individuals over 75 years of age should not be screened.
Screening with FOBT can reduce mortality from colorectal cancer by 15-33%. Screening with sigmoidoscopy can reduce colorectal cancer mortality by up to 67% for lesions within reach of the sigmoidoscope.
Colonoscopy is not recommended to screen for colorectal cancer. Preparation for colonoscopy is a significant ordeal for someone with neurogenic bowel, to the extent that it is often incomplete and produces compromised results. It is recommended only in the case of a positive screening test (above), because it permits direct visualization of the large bowel in its entirety. For patients with SCI, consultation with the gastroenterologist may be required.
Key Reference
Hayman, A. V, Guihan, M., Fisher, M. J., Murphy, D., Anaya, B. C., Parachuri, R., … D.J., B. (2013). Colonoscopy is high yield in spinal cord injury. Journal of Spinal Cord Medicine, 36(5), 436–442. http://doi.org/10.1179/2045772313Y.0000000091
Actionable Nuggets (4th ed., 2019)
Additional References (since 2016)
Song, S. H., Svircev, J. N., Teng, B. J., Dominitz, J. A., & Burns, S. P. (2018). A safe and effective multi-day colonoscopy bowel preparation for individuals with spinal cord injuries. The Journal of Spinal Cord Medicine, 41(2), 149-156. doi:10.1080/10790268.2016.1258968
Teng, B. J., Song, S. H., Svircev, J. N., Dominitz, J. A., & Burns, S. P. (2018). Colorectal cancer screening in patients with spinal cord injury yields similar results to the general population with an effective bowel preparation: A retrospective chart audit.Spinal Cord, 56(3), 226-231. doi:10.1038/s41393-017-0025-3
Actionable Nuggets for Spinal Cord Injury 