Familial component of early-onset colorectal cancer: opportunity for prevention

Abstract

Background Individuals with a non-syndromic family history of colorectal cancer are known to have an increased risk. There is an opportunity to prevent early-onset colorectal cancer (age less than 50 years) (EOCRC) in this population. The aim was to explore the proportion of EOCRC that is preventable due to family history of colorectal cancer. Methods This was a retrospective multicentre European study of patients with non-hereditary EOCRC. The impact of the European Society of Gastrointestinal Endoscopy (ESGE), U.S. Multi-Society Task Force (USMSTF), and National Comprehensive Cancer Network (NCCN) guidelines on prevention and early diagnosis was compared. Colorectal cancer was defined as potentially preventable if surveillance colonoscopy would have been performed at least 5 years before the age of diagnosis of colorectal cancer, and diagnosed early if colonoscopy was undertaken between 1 and 4 years before the diagnosis. Results Some 903 patients with EOCRC were included. Criteria for familial colorectal cancer risk in ESGE, USMSTF, and NCCN guidelines were met in 6.3, 9.4, and 30.4 per cent of patients respectively. Based on ESGE, USMSTF, and NCCN guidelines, colorectal cancer could potentially have been prevented in 41, 55, and 30.3 per cent of patients, and diagnosed earlier in 11, 14, and 21.1 per cent respectively. In ESGE guidelines, if surveillance had started 10 years before the youngest relative, there would be a significant increase in prevention (41 versus 55 per cent; P = 0.010). Conclusion ESGE, USMSTF, and NCCN criteria for familial colorectal cancer were met in 6.3, 9.4, and 30.4 per cent of patients with EOCRC respectively. In these patients, early detection and/or prevention could be achieved in 52, 70, and 51.4 per cent respectively. Early and accurate identification of familial colorectal cancer risk and increase in the uptake of early colonoscopy are key to decreasing familial EOCRC.

Clinical study: the impact of goal-directed fluid therapy on volume management during enhanced recovery after surgery in gastrointestinal procedures

“…(1) ( Daca-Alvarez et al, 2022 ) Compensatory dilatation (5 mL/kg) was supplemented 30 min before anesthesia induction. Crystalloid solution (Ringer Lactate) was used as the background infusion.…”

“…These effects manifest in the form of a robust surgical stress response, leading to the production of significant amounts of stress hormones in patients' bodies. Consequently, symptoms such as elevated blood pressure, inadequate oxygen supply, and accelerated heart rate may arise, ultimately impacting the surgical outcomes ( Pu et al, 2020 ; Daca-Alvarez et al, 2022 ; Ding et al, 2022 ; Erdem et al, 2022 ). Therefore, it is particularly important to implement effective perioperative management for patients undergoing gastrointestinal surgery ( Ayala et al, 2022 ).…”

The diagnostic yield of colonoscopic surveillance following resection of early age onset colorectal cancer

“…8 Approximately, 1 in 4 patients with early onset CRC have a family history of CRC in at least one affected first-degree relative, 9 and in over half of these patients early diagnosis and/or prevention could be achieved. 10 The majority of EOCRC cases are not due to known Mendelian syndromes. 11 However, patients with EOCRC have a prevalence of 16%-35% of hereditary cancer predisposing syndromes, including Lynch syndrome and polyposis syndromes, which is almost double the prevalence compared to later-onset CRC.…”

“…Approximately, 1 in 4 patients with early onset CRC have a family history of CRC in at least one affected first‐degree relative, 9 and in over half of these patients early diagnosis and/or prevention could be achieved 10 . The majority of EOCRC cases are not due to known Mendelian syndromes 11 .…”

A Novel DNA Variant in SMARCA4 Gene Found in a Patient Affected by Early Onset Colon Cancer

“…Furthermore, we are seeing an increase in case numbers in subjects under the age of 50 years, considered as “early onset CRC’’ (EOCRC) which accounts for 10–12% of all CRCs [ 4 , 5 ]. In addition, the incidence and mortality rates in individuals younger than 50 years of age are also increasing compared with those in individuals older than 50 years of age [ 6 ]. This case-mix analysis, which was chosen from a larger group of CRC patients because of their early onset, highlights the growing need to study the younger population to understand better the mechanisms possibly involved, but not yet completely known, such as the analysis at the genomic level, at an earlier age, particularly in familial cases, and also by studying genomic predisposition.…”