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Screening auf kolorektale Neoplasien

Aktuelle Evidenz und neue Entwicklungen

Screening for colorectal cancer

Current evidence and novel developments

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Zusammenfassung

Klinisches Problem

Das kolorektale Karzinom zählt zu den häufigsten krebsbedingten Erkrankungs- und Todesursachen. Durch Screening kann die Inzidenz und Mortalität des kolorektalen Karzinoms gesenkt werden. Neben der Normalrisikogruppe, die den größten Teil der Bevölkerung ausmacht, wird noch zwischen Personen mit erhöhtem Risiko bei familiärer Belastung und Personen aus Familien mit erblichem Darmkrebs unterschieden.

Standardverfahren zum Screening

Die höchste Evidenz aller Screeningverfahren existiert für den Guaiac-basierten Test auf okkultes Blut im Stuhl. Die Koloskopie ist zugleich diagnostisches als auch therapeutisches Instrument. Da sie die Referenzmethode für alle anderen Tests in Studien ist, wird sie als Goldstandard für das Screening auf Kolonneoplasien angesehen.

Leistungsfähigkeit und Bewertung neuer Verfahren

Neue, auf dem immunologischen Nachweis von humanem Hämoglobin beruhende Stuhltests, haben eine deutlich höhere Sensitivität als der Guaiac-Test bei vergleichbarer Spezifität. Zahlreiche neue Verfahren befinden sich in Entwicklung und könnten in Zukunft Einzug in Screeningprogramme halten. Die höchste Sensitivität nach der Koloskopie haben dabei die CT-Kolonographie und die Kapselkoloskopie. Molekulare Tests, die auf dem Nachweis genetischer und epigenetischer DNA-Veränderungen im Stuhl oder Blut beruhen, haben ein hohes Potenzial und könnten in Zukunft den Okkultbluttest ablösen.

Empfehlung für die Praxis

Primäres Screeningverfahren auf Kolonneoplasien ist die Koloskopie. Der Hämokkulttest sollte nur bei Ablehnung der Koloskopie eingesetzt werden. Die CT-Kolonographie ist zum Screening in Deutschland nicht zugelassen.

Abstract

Clinical issue

Colorectal cancer is one of the leading causes of cancer-related morbidity and mortality. Screening has been demonstrated to reduce both the incidence and mortality of colorectal cancer. In addition to the large group with a normal risk level, two further risk groups need to be distinguished: increased family risk and hereditary colorectal cancer syndromes.

Standard methods for screening

The highest evidence for all screening tests has been demonstrated for guaiac-based fecal occult blood testing. Colonoscopy is a diagnostic and therapeutic tool and it serves as the reference standard for other tests in clinical studies.

Innovations

Fecal immunochemical tests have a higher sensitivity than guaiac-based tests. Several novel techniques are under development and could be adopted by screening programs in the future. Next to colonoscopy, computed tomography (CT) colonography and colon capsule endoscopy have the highest sensitivity for colorectal neoplasia. Molecular tests which are based on the detection of genetic and epigenetic changes of DNA released by the tumor into feces or blood have a high potential and could potentially replace occult blood tests in the future.

Practical recommendations

Colonoscopy is the primary instrument for screening for colorectal neoplasia. Fecal occult blood testing should only be performed if colonoscopy is denied and CT colonography has not yet been approved for screening in Germany.

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Abbreviations

CRC:

kolorektales Karzinom

CT:

Computertomographie

FIT:

fäkal immunochemischer Test

FOBT:

fäkal okkulter Stuhlbluttest

HNPCC:

Hereditary Non-Polyposis Colorectal Cancer

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  1. Medizinische Klinik und Poliklinik II, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland

    F.T. Kolligs

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Kolligs, F. Screening auf kolorektale Neoplasien. Radiologe 52, 504–510 (2012). https://doi.org/10.1007/s00117-011-2281-0

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