11. Screening for Colorectal Cancer in SCI Patients

Actionable Nuggets for SCI (2nd ed., 2013)

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 problems that might be detected by individuals who are neurally intact. The high prevalence of constipation, sensory deficits, and low dietary fiber intake of individuals with SCI emphasize the need for routine screening for colorectal cancer as outlined for the general population.

Evidence-based Best Practice:

As with the general population, individuals with SCI over the age of 50 years and with a negative family history should be screened for colorectal cancer using one of the following strategies: 1) Annual fecal occult blood test (FOBT); 2) Flexible sigmoidoscopy every five years; 3) Colonoscopy every 10 years.

Screening with FOBT can reduce mortality from colorectal cancer by 15-33%. Screening sigmoidoscopy can reduce colorectal cancer mortality by up to two thirds for lesions within reach of the sigmoidoscope. Colonoscopy remains the gold standard for detection of colonic neoplasms as it permits direct visualization of the large bowel in its entirety. Routine colonoscopy preparation may not be possible for those with SCI, in which case, consultation with the gastroenterologist may be required.

Key reference:

    Stratton, M.D., et al. (1996). Colorectal cancer in patients with previous spinal cord injury. Diseases of the Colon & Rectum39(9): 965-8.http://dx.doi.org/10.1007/BF02054682

Additional references:

    Consortium for Spinal Cord Medicine (1998). Clinical practice guidelines: Neurogenic bowel management in adults with spinal cord injury. Journal of Spinal Cord Medicine21(3): 248-93.
    Hardcastle, J.D., et al. (1996). Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet348(9040): 1472-7. http://dx.doi.org/10.1016/S0140-6736(96)03386-7
    Kronborg, O., et al. (1996). Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet348(9040): 1467-71. http://dx.doi.org/10.1016/S0140-6736(96)03430-7
    Leddin, D., et al. (2004). Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation: Guidelines on colon cancer screening. Canadian Journal of Gastroenterology18(2): 93-9. http://www.pulsus.com/journals/abstract.jsp
    Mandel, J.S., et al. (1999). Colorectal cancer mortality: effectiveness of biennial screening for fecal occult blood. Journal of the National Cancer Institute91(5): 434-7.
    Selby, J.V., et al. (1992). A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. New England Journal of Medicine326(10): 653-7.
    Weaver, F.M., & LaVela, S.L. (2007). Preventative care in spinal cord injuries and disorders: Examples of research and implementation. Physical Medicine and Rehabilitation Clinics of North America18(2007): 297-316.
    Winawer, S.J., et al. (2000). A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. National Polyp Study Work Group. New England Journal of Medicine342(24): 1766-72. http://content.nejm.org/cgi/content/full/342/24/1766
    Winawer, S., et al. (2003). Colorectal cancer screening and surveillance: clinical guidelines and rationale-update based on new evidence. Gastroenterology124(2): 544-60.