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
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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 CraneSlide5Slide6
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