Bowel Cancer UK

Abstract Shield‐driven tunnels play a key role in an efficient and clean future mobility. In order to ensure their reliable operation and to allow further innovations, it is necessary to know their level of safety from a structural point of view. Only if the internal forces within the tunnel linings are known precisely, a realistic estimation of the load‐bearing capacity is possible. However, this is easier said than done, as the prediction of internal forces is subjected to major uncertainties. In case of shield‐driven tunnels in particular, there is still a great need for research on the prediction of internal forces. Therefore, in a current research project the authors are performing an in‐situ structural monitoring on segmental tunnel linings in Frankfurt (Main) to observe the development of the internal forces. A sophisticated monitoring concept, as well as an extensive calibration and validation program, ensures reliable results. This article presents the current status of the project including the general concepts, theoretical aspects, calibration tests in the tunnel segment testing rig as well as first in situ measurement data.

IntroductionLynch syndrome (LS) is an autosomal dominant inherited disorder characterised by pathogenic variants within the mismatch repair (MMR) genes, MLH1, MSH2, MSH6, PMS2, and a variant in EPCAM, which regulates MSH2 expression and results in an increased risk of several cancers, particularly colorectal cancer with an annual incidence rate of 3-5%.The faecal immunochemical test (FIT) is currently used in non-LS symptomatic and screening populations to guide subsequent colonoscopy. We report preliminary results from an NHS England endorsed clinical service implemented during the COVID-19 pandemic (June-December 2020) which used FIT to prioritise colonoscopy in the highest risk LS patients in response to limited colonoscopy capacity throughout the pandemic.MethodsRegional genetic and endoscopy services across England were invited to participate, with the support of the British Society of Gastroenterology (BSG). Patient eligibility was determined by 1) Diagnosis of Lynch Syndrome 2) Planned colonoscopic surveillance between 1 March 2020 and 31 December 2020. Requests for FIT testing from participating NHS Trusts were sent to the NHS Bowel Cancer Screening South of England Hub in Guildford. The Hub sent patients a FIT kit (OC-Sensor™ (Eiken, Japan)), instructions for use, a questionnaire, and a pre-paid return envelope. Laboratory reports with faecal haemoglobin (f-Hb) results were returned electronically for clinical action. LS patients were risk-stratified for colonoscopy based upon the following f-Hb thresholds: (1) f-Hb ≥ 10µg Hb/g faeces: triaged for colonoscopy via the two-week wait (2WW) pathway, (2) f-Hb ≤10µg Hb/g faeces: schedule patients for colonoscopy within 6-12 weeks, where local endoscopy service availability permits.ResultsFourteen centres across England participated in the clinical service evaluation from 9th June 2020 to 1st December 2020. An uptake rate of 63% was observed from this cohort (269/428 invites). Of the 269 patients who returned their FIT devices, 20% (n=55) had f-Hb ≥ 10µg Hb/g faeces and met criteria for urgent colonoscopy triage via the 2WW pathway. 29% (n=77) of patients had a f-Hb that was greater than the limit of detection of the assay (6µg Hb/g faeces) yet below 10µg Hb/g faeces. 22 patients (8%) had f-Hb between 6 and 9.9µg Hb/g faeces. In a subgroup analysis of 67 patients from St Mark’s Hospital, the adenoma detection rate was 42.4%, and 9/67 proceeded to priority colonoscopy based on their FIT findings.ConclusionsImplementation of this clinical service during the COVID-19 pandemic has demonstrated clinical value for LS patients requiring routine surveillance. Further investigation on the efficacy of this novel intervention is warranted, namely as it pertains to additional data analysis to include endoscopy findings for participating LS patients to discern FIT sensitivity and specificity, which will be further explored under the auspices of a multi-centre prospective research study which is presently in development.

<h3>Introduction</h3> There remains an urgent need for non-invasive, low cost methods for diagnosis of colorectal cancer (CRC). We undertook a diagnostic accuracy study using faecal haemoglobin (F-Hb), faecal calprotectin (FCP) and urinary volatile organic compounds (VOCs) in patients presenting with lower gastrointestinal symptoms referred via Two Week Wait colorectal pathway. <h3>Methods</h3> Of 1850 patients approached, 1016 were recruited prospectively. Of these, 562 with complete colonic investigations returned matched urine and stool samples and were included in the final statistical analysis. <h3>Results</h3> The sensitivity and specificity for CRC using F-Hb were 0.80 (95% confidence interval (CI): 0.66–0.93) and 0.93 (CI: 0.91–0.95) respectively. The negative predictive value (NPV) was 0.99 (CI: 0.98–1.0). Using urinary VOCs the sensitivity and specificity were 0.63 (CI: 0.46–0.79) and 0.63 (CI: 0.59–0.67) respectively and the NPV was 0.96 (CI: 0.94–0.98). For those with F-Hb negative CRC (false negatives), adding urinary VOCs revealed the sensitivity of 0.97 (CI: 0.90–1.0) and specificity of 0.72 (CI: 0.68–0.76) with the NPV of 1.0 (CI: 0.99–1.0). <h3>Conclusions</h3> Urinary VOCs applied to a F-Hb negative group excludes CRC with the NPV of 1.0. Thus, the addition of urinary VOCs shows promise as a second stage test in investigating symptomatic population.

IntroductionThe diagnosis of colorectal cancer (CRC) in primary care can be challenging as symptoms are variable with poor specificity. We investigated the diagnostic accuracies of faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (FCP) in symptomatic patients referred from primary care for urgent lower gastrointestinal investigations via the two-week wait colorectal pathway.Method1016 patients were prospectively recruited between January 2015 and September 2016. In total 612 patients returned stool samples, completed colonic investigations and were included in the final statistical analysis (51% women, median age 68 years, IQR: 57–76). FIT was performed on HM-JACKarc analyser (Kyowa Medex), and FCP by EliA Calprotectin immunoassay (Thermo Fisher Scientific). Any detectable FIT (detection limit 7 µg Hb/g faeces) and a cut-off of 50 µg/g for FCP were considered positive.Results37 (6%) patients were diagnosed with CRC. The negative predictive value (NPV) of FIT vs. FIT plus FCP was the same at 99% (95% CI 98% to 100%). The sensitivity and specificity of FIT was 84% and 89%, respectively. Whereas, it was 89% and 86% for FIT combined with FCP. The ROCs for FIT, FCP and both faecal biomarkers combined showed AUC 0.90, 0.73 and 0.91, respectively. Faecal ćhaemoglobin measurements were significantly higher in left-sided colonic lesions compared ćwith the right side; 490 µg Hb/g faeces vs. 90 µg Hb/g faeces; p=0.007). OC-057 Figure 1ConclusionUndetectable FIT is sufficiently sensitive to exclude colorectal cancer, with higher values in left-sided lesions. FCP in combination does not appear to provide additional diagnostic information. Further studies to determine the health economic benefits of implementing FIT in primary care are required.Disclosure of InterestM. Widlak: None Declared, C. Thomas: None Declared, M. Thomas: None Declared, C. Tomkins Conflict with: Educational lectures on behalf of Thermo Fisher Scientific Ltd., S. Smith: None Declared, C. Darby: None Declared, N. O’Connell: None Declared, S. Wurie: None Declared, L. Burns: None Declared, C. Harmston: None Declared, C. Evans: None Declared, C. Nwokolo: None Declared, B. Singh: None Declared, R. Arasaradnam Conflict with: Educational lectures on behalf of Thermo Fisher Scientific Ltd.

<h3>Introduction</h3> The NHS Bowel Cancer Screening Programme (BCSP) commenced in England in August 2006. Patients are offered colonoscopy if they have a positive FOB test. If a patient is found to have 3 to 4 small (&lt;10 mm) adenomas or 1 to 2 adenomas of which at least one is 10 mm or greater in size, they are defined as being at ‘intermediate risk’ of having advanced adenomas or cancer in the future.1 Such patients are offered a surveillance colonoscopy three years after their screening colonoscopy.2 <h3>Methods</h3> The aim of the study was to assess the findings at, and hence appropriateness of 3-year surveillance colonoscopy for intermediate risk patients. Data regarding each patient entering the screening programme is contemporaneously recorded on the National BCSP database. The database was interrogated for individuals who underwent screening colonoscopy between August 2006 and September 2007 and who were classified as intermediate risk. Details of the endoscopic and histological findings at 3-year surveillance colonoscopy were ascertained. Findings at surveillance colonoscopy were classified according to the BSG Adenoma surveillance guidelines. Patients with incomplete datasets were excluded. <h3>Results</h3> 352 patients underwent 3-year surveillance colonoscopy. This accounts for 10.3% of all patients undergoing screening colonoscopy in that time period. The mean age of patients was 67.1 years. 243/352 (69.0%) were male. At 3-year surveillance, 13 patients (3.7%) were categorized as high risk, 42 (11.9%) intermediate risk, 86 (24.4%) low risk and 202 (57.3%) had normal colonoscopies (i.e., no adenomas detected). No cancers were detected. 9 (2.6%) had incomplete data. <h3>Conclusion</h3> Approximately 40% of intermediate risk patients had one or more adenomas detected. A small proportion of individuals undergoing 3-year surveillance colonoscopy have multiple or large adenomas. In this group, no surveillance cancers were detected. Although the number of individuals in this study is relatively small, these data suggest that the 3-year interval for surveillance may be unnecessary for many intermediate risk individuals. Further work on larger datasets may help identify individuals at high risk of having advanced adenoma at surveillance. This may allow the criteria for determining surveillance interval to be refined.

O'Morain, Colm A.; Van Cutsem, Eric; Spicak, Julius; Classen, Meinhard; Faulds Wood, Lynn; Stockbrugger, Reinhold Author Information

For international communication in cancer, staging systems such as TNM are essential; however, the principles and processes used to decide about changes in every new edition of TNM need to be subject to debate. Changes with major impact for patient treatment are introduced without evidence. We think that TNM should be a continual reactive process, rather than a proactive process. Changes should only occur after extensive discussion within the community, and before the introduction of any changes these should be tested for reproducibility and compared to the currently used gold standard. TNM should not be used to test hypotheses. It should introduce established facts that are beneficial to predicting patient prognosis. TNM should thus be restructured on a basis equivalent to evidence-based guidelines. The strength of the evidence should be explicitly stated and the evidence base given. It is time for the principles of staging to be widely debated and new principles and processes to be introduced to ensure that we are not in the same situation in the future. The disparity between therapeutic decision making and TNM staging is marked and we would appeal for the radical overhaul of TNM staging to make it fit for the twenty-first century. TNM is central to the management of cancer patients and we must protect and enhance its reputation.

The National Health Service has recently begun the introduction of a Bowel Cancer Screening Programme (BCSP), offering biennial screening to men and women aged 60-69 years. This study aimed to explore public perceptions regarding the communication of information designed to facilitate informed choice in relation to this new screening programme. Fourteen single sex focus groups were conducted in England with 86 individuals aged 60-69 years. Focus groups were conducted either with individuals who had participated in the pilot phase of the BCSP, or with members of the public living outside the pilot areas. The majority of participants expressed positive attitudes towards bowel cancer screening, identifying items highlighting the benefits of the programme as important for others to know. Whilst some believed it was appropriate for information regarding the potentially negative aspects of the programme to be communicated at the outset, others expressed concerns about the generation of anxiety and potential for decreased participation. A number of participants questioned the concept of informed choice, arguing that once in place, a screening programme should be vigorously promoted. There is some variation in the type of information favoured by those eligible for bowel cancer screening. This may present challenges for the provision of information aiming to facilitate informed choice in the BCSP. Flexible approaches to information provision that recognize the perceptions of patients may be required.

Colorectal cancer is a largely preventable disease but remains the second commonest cause of death from cancer in the UK. Carol Fordy argues that practice nurses can play an important role in raising public awareness of this costly form of cancer