Published online Mar 10, 2016. doi: 10.4253/wjge.v8.i5.252
Peer-review started: May 7, 2015
First decision: July 17, 2015
Revised: October 24, 2015
Accepted: December 29, 2015
Article in press: January 1, 2016
Published online: March 10, 2016
Colorectal cancer (CRC) is the 2nd most common cancer in women and 3rd most common cancer in men worldwide. Most CRCs develop from adenomatous polyps arising from glandular epithelium. Tumor growth is initiated by mutation of the tumor suppressor gene APC and involves other genetic mutations in a stepwise process over years. Both hereditary and environmental factors contribute to the development of CRC. Screening has been proven to reduce the incidence of CRC. Screening has also contributed to the decrease in CRC mortality in the United States. However, CRC incidence and/or mortality remain on the rise in some parts of the world (Eastern Europe, Asia, and South America), likely due to factors including westernized diet, lifestyle, and lack of healthcare infrastructure. Multiple screening options are available, ranging from direct radiologic or endoscopic visualization tests that primarily detect premalignant or malignant lesions such as flexible sigmoidoscopy, optical colonoscopy, colon capsule endoscopy, computed tomographic colonography, and double contrast barium enema - to stool based tests which primarily detect cancers, including fecal DNA, fecal immunochemical test, and fecal occult blood test. The availability of some of these tests is limited to areas with high economic resources. This article will discuss CRC epidemiology, pathogenesis, risk factors, and screening modalities with a particular focus on new technologies.
Core tip: Multiple societies have issued screening guidelines for colorectal cancer (CRC). However, global CRC screening implementation can be challenging due to wide variability in healthcare infrastructure and resources in different countries. The practical implementation of CRC screening in a given area depends mainly upon availability of endoscopic resources. In areas with the greatest healthcare resources, colonoscopy remains the gold standard, although technological advances have provided alternative screening methods including computed tomographic colonography, fecal DNA testing, and colon capsule endoscopy. In areas with fewer healthcare resources, guaiac-based fecal occult blood testing is the predominant screening modality.