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SPECC – Significant Polyp and Early Colorectal Cancer SPECC – Significant Polyp and Early Colorectal Cancer

SPECC – Significant Polyp and Early Colorectal Cancer - PowerPoint Presentation

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SPECC – Significant Polyp and Early Colorectal Cancer - PPT Presentation

Sarah Crane Pelican Cancer Foundation On behalf of the SPECC Team Pelican Cancer Foundation Bill Heald and Basingstoke 1993 Funding from donations industry fees and charitable grants Conferences and workshops ID: 599339

amp specc patient cancer specc amp cancer patient polyps resection polyp treatment workshops therapy lesion local endoscopy complete response

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Slide1

SPECC – Significant Polyp and Early Colorectal Cancer

Sarah CranePelican Cancer FoundationOn behalf of the SPECC TeamSlide2

Pelican Cancer Foundation

Bill Heald and Basingstoke1993Funding from donations, industry, fees and charitable grants

Conferences and workshops

ResearchSlide3

What is SPECC?

“SPECC is a national development programme, focussed on the treatment of significant polyps and small (T1) tumours”

Multidisciplinary – surgeons, gastroenterologists, radiologists, pathologists, nurse specialists

6 free places for every MDTSlide4

Steering group

Brendan Moran - LeadBrian SaundersRob Glynn-JonesPhil QuirkeGina Brown

Chris Cunningham

John Stebbing

Wendy Atkin

Matt Rutter

Rupert Pullan

Bob Steele

Graham WilliamsSunil DolwaniMichael Machesney

Gerald Langman

Neil Borley

Nicky Richards

Sarah CraneSlide5
Slide6

SPECC workshops

London Cancer

Yorkshire & Humberside

London Alliance

West Midland

East Midland

Wessex

Greater Manchester

South East Coast

Wales

Northern England

East of England

Cheshire & Mersey

South West Coast

17.12.17

EireUlsterScotland

SPECC workshopsStarted November 2015Slide7

So far…..

6 SPECC workshops completed424 clinicians attended from 73 trustsFeedback on changes to clinical practice:Take more time at endoscopyDevelop patient information

Offer alternatives e.g. brachytherapySlide8

Aims

Definition – are you confident what it is?Recognition – who and whenDocumentation – who needs whatTreatment - alternativesStrategic planning – locally, regionally, nationallySlide9

Guidelines

Slide10

This is what a SPECC looks likeSlide11

Incidence of colorectal polyps increasingWider public awareness

Bowel Cancer Screening Programme

Introduction

Morson

B. The Polyp-cancer sequence in the Large Bowel. Proceedings of the Royal Society of Medicine. 1974;67:451-7

Basil

MorsonSlide12

2%

23%

8

%

Risk of LN involvement Slide13

SPECC

not suitable for routine colonoscopic excisionmay occur anywhere in the colon or rectum

a

large (>20mm) sessile

lesion

morphologically aberrant & difficult to access endoscopically Malignancy spectrum- shades of grey

non-involvement of lymph

nodes

not common – up to 5% polyps only 10% malignant. Increasing with BCSPSlide14

Factors contributing to significance

Size Morphology Site Access

Patient

factors –

comorbiditySlide15

Questions to ask yourself:

Have you fully assessed the lesion?Are there high malignancy risk features?

How

should this lesion be managed?

Is

MDT discussion required?How does patient fitness impact on options?Has the patient been fully consented?

If

endoscopic

resection –How complex will it be? –

En bloc or piecemeal?

When

should it be removed

?Slide16

Recognition - MRI

Setup and planning are critical to achieve optimal

images

Structured reporting to allow best MRI input to decision makingSlide17

CT Colonography well-tolerated test that find early CRC & significant polyps

CTC has been around a long time

Diagnostic performance seems good

95%+ sensitivity for cancer

90% sensitivity for 10mm+ polyps

80%

sensitvitiy

for 6mm+ polyps

For symptomatic patients, CTC is an excellent alternative to colonoscopy in UK real-world practice

Early cancers and polyps may present a particular challenge

Radiologist QA is developing

With thanks to Andrew Plumb at UCLHSlide18

Flexible Endoscopy Rigid

Endoscopy TRUS

Triple assessment

With thanks to Neil BorleySlide19

Documentation: MRI reportingSlide20

DocumentationWhat have you recorded?

Picture Video

Tattoo

Report

Not just a polyp!Slide21

Treatment: EMR

Hardly features in the workshops or early patient information leaflet AssumptionsRisk / benefitPiecemealTime / available equipment & expertise

Have a go……!Slide22

ESDEndoscopic Submucosal Dissection

Drive for single piece resection – especially in uncertain lesionsSlide23

Potential advantages of ESD

En bloc resection Better interpretation of pathology Potentially better decision making

BUT

Time

& Effort intensive

Training If more than sm1 – Is local resection alone…? Slide24

TEMS

T1 diseaseBalancing riskPotential to extend with adjuvant therapy

Thanks to Chris CunninghamSlide25

Contact Brachytherapy ‘Papillon’

NICE guidelinesPatient selectionOlder patientsPatients with high surgical riskSlide26

Key messages

Think twice and cut onceMaximise local expertise in diagnostic assessment

Developing

local service / up

skilling

Work with virtual polyp / SPECC MDTsRegional and supra-regional referral networks

Thanks to James EastSlide27

SPECC

Coming to South West in December 2017Next Pelican project is SMARTSynchronous

M

etastases,

A

dvanced and Recurrent colorectal TumoursSlide28

4th International Workshop

on

Complete Response to Neoadjuvant

Therapy for Rectal Cancer

D

iscussing the challenges in recognition and treatment of a clinical Complete

R

esponse to neoadjuvant therapy for rectal cancer.

This meeting will seek consensus on the terminology of a complete response.

With an international faculty from across Europe, the USA and Brazil

22nd March 2016

|

Basingstoke, UK

Convenors: Professor Bill

Heald

& Mr Brendan Moran

To find out more or book a place:

www.pelicancancer.org/our-courses

|

courses@pelicancancer.org