For IBD Nurses
March-Colorectal Cancer Awareness
March is Colorectal Cancer Awareness Month. We can do our patients with inflammatory bowel disease (IBD) a service by providing information about the risk and prevention of colorectal cancer (CRC) and by providing them with reliable resources. It is also a great time to remind your patients to keep up with general health maintenance such as eye exams, dental checkups, pap smears, and prostate exams.
TIP #1: Help your patients understand that surveillance colonoscopies are particularly important for individuals with IBD because IBD increases the risk of developing CRC.
Increased risk associated with the IBD diagnosis starts at 8 to 10 years after diagnosis (Crohn’s and Colitis Foundation of America, 2013). Several studies report that IBD patients have a 2 to 5 times higher risk than the general population in comparable age groups (Guagnozzi & Lucendo, 2012).
TIP #2: Let your patients know that the symptoms of IBD can mask the symptoms of CRC.
Symptoms of CRC such as fatigue, diarrhea, cramps, bloating, blood in stool, weight loss, and abdominal pain may be mistakenly attributed to IBD because these symptoms are similar to those periodically experienced in the course of living with Crohn’s disease and ulcerative colitis. For these reasons, it is especially important for patients with IBD to understand the crucial need to follow through on surveillance CRC screening schedules, as determined by the health care provider, in accordance with the patient’s individual circumstances.
TIP #3: Reassure your patients that most individuals with IBD will never develop CRC, and yet, maintaining the appropriate screening schedule is the best protection against advancing CRC, if it has developed.
Nurses who encourage their patients to maintain the appropriate screening schedule can help increase the chances that, if CRC develops, it will be caught early and will be in a highly treatable stage. All of this information, and more, can be obtained in a downloadable brochure available from the CCFA website (Crohn's and Colitis Foundation of America, 2013).
TIP #4: Familiarize yourself with the range of CRC screening recommendations for individuals with IBD.
Each society of gastroenterologists (American Gastroenterological Association, American College of Gastroenterology, European Crohn’s and Colitis Organization, and British Society of Gastroenterology) has its own screening guidelines. Guidelines are determined by patient characteristics such as the length of time since diagnosis and the location of diseased tissue. Some gastroenterology societies also offer recommendations regarding the use of new endoscopic techniques such as chromoendoscopy. See Table 1 at the end of these tips.
TIP #5 Provide your patients with strategies for reducing risk of CRC through the adoption of simple healthy lifestyle habits that represent controllable variables related to level of risk for CRC.
Patients cannot choose CRC risk factors such as their genetic make-up, or their age, or whether or not they have IBD. However, every day, patients with IBD choose the foods and drinks that they consume and the activities in which they engage. Therefore, dietary intake and activity level are important controllable variables related to CRC risk. Nurses can disseminate the good news that an estimated 45% of U.S. CRC cases might be prevented through the adoption of simple lifestyle changes (American Institute for Cancer Research, 2013). By visiting the American Institute for Cancer Research (AICR) website, nurses can equip themselves with quickly and easily shared recommendations with patients in the natural course of delivering standard nursing care. See Table 2 at the end of these tips.
TIP #6 Make sure your patients know that taking their IBD medications on a regular basis, as prescribed, reduces their risk of CRC.
This month is a good time for nurses to emphasize that individuals with IBD further decrease their risk of CRC when they reduce intestinal inflammation by practicing consistent medication adherence (Crohn’s and Colitis Foundation of America, 2013).
Table 1: Summary of the differences in recommendations for colorectal cancer surveillance for patients with IBD (adapted from Guagnozzi & Lucendo, 2012)
Beginning of Surveillance (Years after diagnosis)
|Surveillance Schedule||New Endoscopic Technique Recommended|
8Years(pancolitis) 15 years (left sided colitis )
|Every 1-2 years||Not mentioned|
|ACG 2004||8-10 years||Every 1-2 years||Not mentioned|
|ECCO 2008||8Years(pancolitis) 15 years (left sided colitis )||Every 2 years (1-2nd decade) Every year (3rd decade)||Chromoendoscopy (For more information on chromoendoscopy. see Subramanian,Mannath, Ragunath, & Hawkey, 2011)|
|BSG 2010||10 years||
Every 3 years lower risk Every 2 years intermediate risk Every 1 year for higher risk
AGA, American Gastroenterological Association; ACG, American College of Gastroenterology; ECCO, European Crohn’s and Colitis Organization; BSG, British Society of Gastroenterology
Table 2: Examples of lifestyle recommendations for CRC prevention (adapted from American Institute of Cancer Research and American Cancer Society websites, 2013)
AICR, American Institute of Cancer Research; ACS, American Cancer Society
American Cancer Society. (2013). What are the risk factors for colorectal cancer? Retrieved February 18, 2013, from http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-risk-factors
American Institute for Cancer Research. (2013). Preventing colon cancer: Six steps to reduce your risk. Retrieved February 18, 2013, from http://www.aicr.org/press/press-releases/preventing-colon-cancer-6-steps.html
Crohn's and Colitis Foundation of America. (2013). Bringing to light the risk of colorectal cancer among Crohn's and ulcerative colitis patients. Retrieved February 19, 2013, from http://www.ccfa.org/resources/risk-of-colorectal-cancer.html
Guagnozzi, D., Lucendo, A. (2012). Colorectal cancer surveillance in patients with inflammatory bowel disease: What is new? WJGE, 4(4):108-116
Subramanian, V., Mannath, J., Ragunath, K., & Hawkey, C. J. (2011). Meta‐analysis: The diagnostic yield of chromoendoscopy for detecting dysplasia in patients with colonic inflammatory bowel disease. Alimentary
Pharmacology & Therapeutics, 33(3), 304-312.
World Cancer Research Fund/American Instutute for Cancer Research. (2013). Colorectal cancer: Latest evidence. Retrieved February 19, 2013, from http://www.dietandcancerreport.org/cup/current_progress/colorectal_cancer.php
CCFA Colorectal Cancer Resources:
Know your ABCC's Colorectal Cancer Brochure
View Archive Tips
CCFA Overview of Nursing initiatives Committee
These monthly nursing tips are provided by the CCFA Nursing initiatives committee. The 2012-2015 Nursing Initiative Committee is comprised of 23 nurses from across the US. If you have suggestions for content or want more information about the Nursing Initiatives Committee please contact Orna Ehrlich, Director, Professional Education, at firstname.lastname@example.org.