Colorectal cancer screening by Stool occult blood test with

Colorectal cancer screening by Stool occult blood test with

«‘™“°“√
Colorectal cancer screening by Stool occult blood test with
Colonoscopy in Roiet province
Phaiboon Pensuwan, MD.
Department of Surgery RoiEt Hospital
Abstract
Given increasing rates of colorectal cancer (CRC) in Thailand , the decision to implement screening show that
can detect early cases and reduce mortality rate from colorectal cancer. The people who age more than 50 years and
have family history of colorectal cancer should be screen regulary. This study use screening method by exam stool
occult blood (FOBT) follow by colonoscopy in random populations.
A total of 10,081 subjects had 829 FOBT positive (8.2%). First screen colonoscope 522 cases were abnormal
166 cases (31.8%) mostly were Polyps. Colorectal cancer was 12 cases (11.5 per hundred thousand population) that
more than country incidence rate (male 7.6 per hundred thousand population, female 8.8 per hundred thousand
population) Second scope was done 222 cases in foremery 522 cases, detect abnormal 56 cases (28%). No new
colorectal cancer can detected.
So the effectively colorectal cancer screening method was done by Fecal Occult Blood test (FOBT) with
Colonoscopy in risk group can do early detection and reduce mortality rate.
Keywords : Colorectal cancer, Fecal occult blood test, Coloscopy.
28
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√“¬ (8.2%) ·≈–ºŸâ∑’Ë¡’º≈°“√µ√«®Õÿ®®“√–‡ªìπ∫«° ‰¥â‡¢â“√—∫°“√ àÕß°≈âÕß≈”‰ â„À≠à·≈–∑«“√Àπ—° §√—Èß·√° 522 √“¬
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§” ”§—≠ : °“√§—¥°√Õß, ¡–‡√Áß≈”‰ â„À≠à·≈–∑«“√Àπ—°, °“√µ√«®À“‡≈◊Õ¥„πÕÿ®®“√–, °“√ àÕß°≈âÕß≈”„ â„À≠à.
MAHASARAKHAM HOSPITAL JOURNAL
Vol. 8 No. 4 January - March 2012
29
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30
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∑“ß欓∏‘«‘∑¬“µàÕ‰ª
º≈°“√»÷°…“
ª√–™“°√°≈ÿà ¡ ‡ ’Ë ¬ ß„π°“√µ√«®§— ¥ °√Õß¡–‡√Á ß
≈”‰ â„À≠à·≈–∑«“√Àπ—° ‰¥â√—∫°“√µ√«®§—¥°√ÕßÕÿ®®“√–
¥â«¬«‘∏’ FOBT ‡æ◊ËÕ∑¥ Õ∫°“√¡’‡ ≈◊Õ¥ªπ„πÕÿ®®“√–
®”π«π 10,081 §π ‡ªìπÀ≠‘ß√âÕ¬≈– 57 ·≈–‡æ»™“¬
√âÕ¬≈– 43
º≈°“√µ√«®§—¥°√Õß¡–‡√Áß≈”‰ â„À≠à·≈–∑«“√Àπ—°
æ∫«à“ °“√§—¥°√Õߥ⫬«‘∏’ FOBT æ∫¡’º≈∫«° §◊Õµ√«®
MAHASARAKHAM HOSPITAL JOURNAL
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æ∫¡’‡≈◊Õ¥ªπ„πÕÿ®®“√– ®”π«π 829 √“¬ §‘¥‡ªìπ√âÕ¬≈– Positive ¡“°∑’Ë ÿ¥ §◊Õ °≈ÿà¡Õ“¬ÿ¡“°°«à“·≈–‡∑à“°—∫ 75 ªï
8.2 ¢Õß°≈ÿà¡∑’ˉ¥â√—∫°“√µ√«®§—¥°√Õß ‚¥¬æ∫„π‡æ»™“¬ √âÕ¬≈– 14.5 √Õß≈ß¡“§◊Õ°≈ÿà¡Õ“¬ÿ 70-74 ªï √âÕ¬≈– 13
√âÕ¬≈– 8.5 ‡æ»À≠‘ß√âÕ¬≈– 8 °≈ÿ¡à Õ“¬ÿ∑æË’ ∫ —¥ à«π FOBT
µ“√“ß∑’Ë 2 º≈°“√µ√«®§—¥°√Õß¡–‡√Áß≈”‰ â„À≠à·≈–∑«“√Àπ—°¥â«¬«‘∏’ FOBT
√“¬≈–‡Õ’¬¥
FOBT Positive
®”π«π
√âÕ¬≈–
‡æ»
™“¬
˭ԧ
Õ“¬ÿ (ªï)
<50
50-54
55-59
60-64
65-69
70-74
>75
FOBT Negative
®”π«π
√âÕ¬≈–
368
461
8.5
8.0
4,319
5,761
91.5
92
10
101
144
172
142
131
129
3.0
4.9
6.7
8.2
9.2
13.0
14.5
333
2,067
2,150
2,085
1,537
1,011
889
97
95.1
93.3
91.8
90.8
87
85.5
º≈¢Õß°“√ àÕß°≈âÕß „π°“√ àÕß°≈âÕߧ√—Èß·√°
First screening ºŸâªÉ«¬∑’ˉ¥â√—∫°“√ª√–‡¡‘π ÿ¢¿“æ·≈–‰¡à¡’
¿“«–‡ ’¬Ë ߇¢â“√—∫°“√µ√«®¥â«¬°“√ àÕß°≈âÕß≈”‰ â„À≠à·≈–
∑«“√Àπ—° ®”π«π 522 √“¬ æ∫§«“¡º‘¥ª°µ‘§◊Õæ∫µ‘Ë߇π◊ÈÕ
∫√‘‡«≥≈”‰ â„À≠à·≈–∑«“√Àπ—°·≈–‰¥â√—∫°“√µ—¥™‘Èπ‡π◊ÈÕ
‡æ◊ËÕ àßµ√«®∑“ß欓∏‘«‘∑¬“ ®”π«π 166 √“¬ (32%) º≈
°“√µ√«®∑“ß欓∏‘«‘∑¬“ æ∫«à“‡ªìπ¡–‡√Áß ®”π«π 12 √“¬
§‘¥‡ªìπ 11.5 √“¬µàÕ· πª√–™“°√ ‚¥¬ºŸâªÉ«¬∑’ˇªìπ¡–‡√Áß
¡’√–¬–¢Õß‚√§µ“¡µ“√“ß∑’Ë 4 ·≈–‰¥â√—∫°“√√—°…“µ“¡
µ“√“ß∑’Ë 5
°“√ àÕß°≈âÕߧ√—Èß∑’Ë Õß Subsequent screening
®”π«π 222 √“¬ ®“° 522 √“¬‡¥‘¡ æ∫§«“¡º‘¥ª°µ‘‡ªìπ
‡π◊ÈÕßÕ°µ‘Ë߇π◊ÈÕ 56 √“¬ (28%) ‰¡àæ∫§«“¡º‘¥ª°µ‘‡ªìπ
¡–‡√Áß√“¬„À¡à
µ“√“ß∑’Ë 3 º≈°“√µ√«®§—¥°√Õß¡–‡√Áß°≈âÕß≈”‰ â„À≠à·≈–∑«“√Àπ—°
√“¬≈–‡Õ’¬¥
®”π«πºŸâ‡¢â“√—∫°“√µ√«® ¡’§«“¡º‘¥ª°µ‘‡ªìπ‡π◊ÈÕßÕ°
Colonoscope
polyps
°“√§—¥°√Õߧ√—Èß·√°
First screening
°“√§—¥°√Õߧ√—Èß∑’Ë Õß
Subsequent screening
32
«“√ “√‚√ß欓∫“≈¡À“ “√§“¡
ªï∑’Ë 8 ©∫—∫∑’Ë 4 ¡°√“§¡ - ¡’π“§¡ 2555
‡ªìπ¡–‡√Áß
≈”‰ â„À≠à
522
166
12
222
56
-
º≈°“√√—°…“
µ“√“ß∑’Ë 4 √–¬–¢Õß‚√§‡∑’¬∫µ“¡°≈ÿà¡Õ“¬ÿ
Õ“¬ÿ (ªï)
Stage I
Stage I
T1N0M0
T2N0M0
50-59
60-69
70-79
√«¡
1
3
1
1
4
2
Stage IIA
T3N0M0
2
2
1
5
Stage III*
T3N2M0
®”π«π
4
7
1
12
1*
1
*¡’°“√ºà“µ—¥§√—Èß∑’Ë Õß æ∫‡ªìπ carcinomatosis peritonei
µ“√“ß∑’Ë 5 À—µ∂°“√ºà“µ—¥‡∑’¬∫µ“¡°≈ÿà¡Õ“¬ÿ
Õ“¬ÿ (ªï) polypec sigmoidec low anterior
tomy
tomy
resection
50-59
60-69
70-79
√«¡
1
2
3
2
2
4
left half abdominoperineal ®”π«π
colectomy
resection
1
3
3
«‘®“√≥å
®“°°“√»÷°…“°“√§—¥°√Õߧ√—Èß·√° First screening
æ∫«à“ ¡’ºŸâªÉ«¬‡ªìπ¡–‡√Áß≈”‰ â„À≠à·≈–∑«“√Àπ—° ®”π«π
12 √“¬ §‘¥‡ªìπÕÿ∫µ— °‘ “√≥å ®”π«π 11.5 √“¬ µàÕ· πª√–™“°√
´÷Ë߇ªìπÕÿ∫—µ‘°“√≥å∑’Ë Ÿß°«à“√–¥—∫ª√–‡∑» ∑’Ëæ∫„π‡æ»™“¬
7.6 ·≈–‡æ»À≠‘ß 8.8 µàÕ· πª√–™“°√ ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫
°—∫ª√–‡∑»„π‡Õ‡™’¬ æ∫«à“Õÿ∫—µ‘°“√≥å„°≈⇧’¬ßª√–‡∑»
§Ÿ‡«µ (™“¬ 13.7, À≠‘ß 12.5) ‘ߧ‚ª√å (™“¬ 22.5, À≠‘ß
18.2) øî≈‘ªªîπ å (™“¬ 24.3, À≠‘ß 18.5) ·≈– Ÿß°«à“Õ‘π‡¥’¬
(™“¬ 5.9, À≠‘ß 5.3) ∑”„À≥â¢âÕ —߇°µ«à“ ª√–™“°√„π
™π∫∑À√◊ Õ °≈ÿà ¡ ª√–™“°√∑’Ë °‘ π Õ“À“√∑’Ë ¡’ ‡ â 𠄬 Ÿ ß π—È π
Õ“®¡’Õÿ∫—µ‘°“√≥åÀ√◊Õ§«“¡™ÿ°¢Õß‚√§¡–‡√Áß≈”‰ â„À≠à
·≈–∑«“√Àπ—°‰¡à·µ°µà“ß°—π°—∫ª√–™“°√„π‡¢µ‡¡◊Õß
À√◊Õ°≈ÿࡪ√–™“°√∑’Ë°‘πÕ“À“√∑’Ë¡’‡ âπ„¬Õ“À“√µË”À√◊Õ°‘π
Õ“À“√∑’Ë¡’‰¢¡—π ·≈–®“°°“√»÷°…“¬—ßæ∫ºŸâªÉ«¬¡–‡√Áß
√–¬–·√° Stage I ®”π«π 6 √“¬ ®“°∑—ÈßÀ¡¥ 12 √“¬ ´÷Ëß
· ¥ß„Àâ‡ÀÁπ«à“°“√§—¥°√Õßµ√«®æ∫‚√§µ—ßÈ ·µà√–¬–‡√‘¡Ë µâπ
1
1
1
4
7
1
12
∑”„Àâ “¡“√∂„Àâ°“√√—°…“ºŸâªÉ«¬‰¥âßà“¬·≈–‰¥âº≈¬‘Ëߢ÷Èπ
™à«¬‡æ‘Ë¡√–¬–‡«≈“°“√√Õ¥™’æ¢ÕߺŸâªÉ«¬ ‡¡◊ËÕ∑”°“√ àÕß
°≈âÕß ´È”„π§√—Èß∑’Ë Õß Subsequent screening °Á‰¡àæ∫
¡–‡√Áß√“¬„À¡à
º≈®“°°“√æ∫¡–‡√Áß√–¬–·√° °Á®–™à«¬≈¥§à“
„™â®à“¬∑’Ë®–‡°‘¥¢÷Èπ„π°“√¥Ÿ·≈ºŸâªÉ«¬¡–‡√Áß ‡æ√“–®“°°“√
àÕß°≈âÕßæ∫§«“¡º‘¥ª°µ‘∂÷ß 1 „π 3 ‡ªìπ‡π◊ÈÕßÕ°µ‘Ë߇π◊ÈÕ
Polyps ´÷Ëß∂⓪≈àÕ¬∑‘È߉«â‰¡à∑”Õ–‰√ „π 2 À√◊Õ 3 ªï °Á¡’
‚Õ°“ ∑’Ë®–‡ª≈’Ë¬π‰ª‡ªìπ¡–‡√Á߉¥â ‡¡◊ËÕ∑”°“√§—¥°√Õß´È”
„π§√—Èß∑’Ë Õß Subsequent screening °Á¬—ßæ∫§«“¡º‘¥ª°µ‘
∑’ˇªìπ‡π◊ÈÕßÕ°µ‘Ë߇π◊ÈÕ Polyps ·∫∫π’È„π°≈ÿࡇ¥‘¡
°“√µ√«®À“‡≈◊Õ¥„πÕÿ®®“√– fecal occult blood
test - FOBT ®“°°“√»÷°…“æ∫«à“¡’º≈∫«°∂÷ß 8.2% ¥â«¬
°“√µ√«®∑’ˉ¡à¬ÿà߬“° ¡’§«“¡®”‡æ“–°—∫‡≈◊Õ¥§π ®÷ß
‡À¡“–∑’Ë®–π”¡“„™â„π°“√§—¥°√Õß¡–‡√Áß≈”‰ â„À≠à·≈–
∑«“√Àπ—°
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¥—ßπ—Èπ°“√µ√«®§—¥°√ÕßÕ¬à“ß ¡Ë”‡ ¡Õ·≈–°“√µ√«®
À“§«“¡º‘¥ª°µ‘∑’Ë≈”‰ â·µà‡π‘ËπÊ „π°≈ÿà¡∫ÿ§§≈∑’Ë¡’Õ“¬ÿ
¡“°°«à“ 50 ªï ·≈–∫ÿ§§≈∑’Ë¡’ æàÕ ·¡à æ’Ë πâÕß≈Ÿ°ªÉ«¬¥â«¬
‚√§¡–‡√Áß≈”‰ â„À≠à ‚¥¬°“√µ√«®‡≈◊Õ¥„πÕÿ®®“√–√à«¡°—∫
°“√ àÕß°≈âÕßµ√«®≈”‰ â„À≠à·≈–∑«“√Àπ—° ®– “¡“√∂
§âπæ∫¡–‡√Áß„π√–¬–·√° ∑”„Àâ “¡“√∂ªÑÕß°—π·≈–√—°…“
¡–‡√Á߉¥â∑π— ≈¥Õ—µ√“°“√‡ ’¬™’«µ‘ ®“°‚√§¡–‡√Áß≈”‰ â„À≠à
·≈–∑«“√Àπ—°„π∑’Ë ÿ¥
‡Õ° “√Õâ“ßÕ‘ß
1. «√¡‘π∑√å ‡À√’¬≠ ÿ«√√≥. ¿—¬‡ß’¬∫¡–‡√Áß≈”‰ â. [online] 2550 [ ◊∫§âπ‡¡◊ËÕ 26 ¡°√“§¡ 2552] ·À≈àߢâÕ¡Ÿ≈ : URL:
http://www.si.mahidol.ac.th/sidoctor/e-pl/articledetail.asp?id=692
2. ∫—π≈◊Õ ‡©≈¬°‘µµ‘. §Ÿà¡◊Õ°“√√—°…“‚√§ ”À√—∫ª√–™“™π ¡–‡√Áß≈”‰ â„À≠à·≈–∑«“√Àπ—°. °√ÿ߇∑æ¡À“π§√ :
§—≈‡≈Õ√匓√å‚¡π’Ë; 2549.
3. ∑— π’ πÿ™ª√–¬Ÿ√. À≈—°°“√·≈–°“√æ‘®“√≥“„™â°“√µ√«®‡æ◊ËÕ«‘π‘®©—¬‚√§·≈–°“√µ√«®§—¥°√Õß‚√§. „π: ∑— π’πÿ™
ª√–¬Ÿ√, ‡µ‘¡»√’ ™”π‘®“√°‘® ∫√√≥“∏‘°“√. ∂‘µ‘„π«‘®—¬∑“ß°“√·æ∑¬å, æ‘¡æå§√—Èß∑’Ë 2. °√ÿ߇∑æœ : ¥à“π ÿ∑∏“
°“√æ‘¡æå, 2541 : 297-313.
4. Kuo-Ching Yang, Chao-Sheng Liao, Yueh-Hsia Chiu, Amy Ming-Fang Yen, Tony Hsiu-His Chen. Colorectal cancer
screening with faecal occult blood test within a multiple disease screening programme : J Med Screen
2006; 13 : S8-S13.
5. Li-Sheng Chen, Amy Ming-Fang Yen, Sherry Yueh-Hsia Chiu, Chao-Sheng Liao, Prof Hsiu-Hsi Chen, Baseline
faecal occult blood concentration as a predictor of incident colorectal neoplasia : longitudinal follow-up of
a Taiwanese population-based colorectal cancer screening cohort; The Lancet Oncology, Volume 12, Issue 6,
Pages 551 - 558, June 2011.
6. Grace HM Wu, Yi-Ming Wang, Amy MF Yen, Jau-Min Wong, Hsin-Chih Lai, Jane Warwick and Tony HH Chen;
Cost-effectiveness analysis of colorectal cancer screening with stool DNA testing in intermediate-incidence
countries; BMC Cancer 2006, 6:136 doi : 10.1186/1471-2407-6-136.
7. Khuhaprema T, Srivatanakul P, Sriplung H, Wiangnon S, Sumitsawan Y, Attasara P, Cancer in Thailand Vol. IV,
1998-2000. Bangkok, National Cancer Institute. 2007.
8. Lejeune C, Arveux P, Dancourt V, Bejean S, Bonithon Kopp, Faivre J. Cost - effectiveness analysis of fecal occult
blood screening for colorectal cancer. International Journal of Technology Assessment in Health Care 2004;
20(4) : 434-9.
9. Lambert M. ACG guidelines for colorectal cancer screening. [cited 2010 Jan 26]; Available from : URL:www.aafp.
org/afp.
10. Li S, Wang J, Lu Y, Fan D. Screening and early detection of colorectal cancer in China: a 12 year retrospect (19942006). J Cancer Res Clin Oncol 2007; 133 : 679-86.
11. Khuhaprema T, Srivatanakul P. Colon and rectum cancer in Thailand: an overview. Jpn J Clin Oncol 2008; 38(4) :
237-43.
12. Tumor Registry. Cancer Institute Siriraj Hospital : Statistical report. Bangkok : Faculty of Medicine. Siriraj Hospital.
Mahidol University; 2003.
13. Melissa MC, Ahmedin J, Elizabeth W. International trends in colorectal cancer incidence rates. Cancer epidemiology
Biomarkers and prevention 2009; 18 : 1688-94.
34
«“√ “√‚√ß欓∫“≈¡À“ “√§“¡
ªï∑’Ë 8 ©∫—∫∑’Ë 4 ¡°√“§¡ - ¡’π“§¡ 2555
14. Chong VH, Abdullah MS, Telisinghe PU, Jalihal A.Colorectal cancer incidence and trend in Brunei Darussalam.
Singapore Med J 2009; 50(11) : 1085.
15. Wilkins T, Reynolds PL. Colorectal cancer : a summary of the evidence for screening and prevention. Am Fam
Physician 2008; 78(12) : 1385-92.
16. Jennifer J, Adrian R, Jennifer C, Denise Z. The costeffectiveness of screening for colorectal cancer. CMAJ. 2010;
182(12) : 1307-13.
17. Berhane C, Denning D. Incidental finding of colorectal cancer in screening colonoscopy and its cost effectiveness.
The American Surgeon 2009; 75 : 699-704.
18. World Health Organization. National Cancer Control Programmers : Policies and Managerial Guidelines 2nd ed.
Geneva : World Health Organization; 2002.
19. World Health Organization. World cancer report. Lyon : IARC Press; 2008.
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