Actionable Nuggets for SCI (2nd ed., 2013)
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.
Initiate colorectal cancer screening for patients with SCI using the same principles as those 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.
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