Colorectal cancer in young adults: improving identification and management of familial gastrointestinal cancer syndromes

This thesis evaluates colorectal cancer (CRC) outcomes in young adults and explores various approaches of improving identification and management of individuals with genetic familial gastrointestinal (GI) cancer syndromes such as Lynch syndrome (LS) and familial adenomatous polyposis (FAP). Several research methodologies were utilised to address various hypothesis. Firstly, we evaluated differences in clinicopathological features between early onset CRC (adults less than 40 years of age) and late onset CRC and the prevalence of familial gastrointestinal (GI) cancer syndromes in the young adults with CRC. This thesis demonstrated that 28% of EOCRC had hereditary GI cancer syndromes. The rectum was the most common site of CRC and EOCRC tend to present with poor histological features and advanced disease. Although young age was not an independent prognostic factor, EOCRC had worse diseasefree survival. To improve management of individuals at risk of EOCRC, this thesis explored phenotypic and genotypic factors that can be optimised to improve diagnosis, surveillance and surgical Colorectal Cancer in Young Adults: Improving Identification and Management of Familial Gastrointestinal Cancer Syndromes 4 outcomes in LS and FAP. In FAP, we demonstrated that attenuated FAP is an obsolete term due to observed phenotypic and genotypic variability. We also found that the rate of adenoma of progression in the preoperative colorectum and postoperative rectal remnant was slow (12.5 and 5.5 polyps/year respectively). Therefore, tailored endoscopic surveillance and polypectomy (rectum) are appropriate surveillance strategies. Furthermore, surgical outcomes in individuals undergoing prophylactic surgery for can be improved by ileodistal anastomosis (IDSA), a modification of the conventional ileorectal anastomosis. Finally, this thesis demonstrates that pre-operative screening for LS using mismatch repair immunohistochemistry (MMR IHC) testing on preoperative endoscopic biopsy and metastatic tissue is feasible. In the event of LS CRC, a systematic review and meta-analysis demonstrated that extended colectomy should be considered in young individuals with higher risk MMR pathogenic variant to reduce the risk of metachronous CRC.Open Acces

MEDIA AWARENESS CAMPAIGNS ON BREAST SELF EXAMINATION (BSE): A KAP ANALYSIS

The campaigns on breast self examination is aimed at preventing cases of cancer of the breast. Media campaigns like “know your melon” help to teach women how to detect early lump in the breast. This study was built on theory of planned behaviour. This study employed the survey design which made use of questionnaires to obtain primary data from respondents. The Australian sample size calculator was used to arrive at a sample size of 383 respondents to be studied. The area studied was female residents of Imo state. Findings from the study revealed that greater numbers of the respondents (96.6%) in Owerri municipal were aware of the Breast Self Examination campaigns. It was also revealed that the knowledge level of 92.2% of the respondents on breast self examination was moderate. Further findings indicated that 91.8% of the respondents think it is appropriate to engage in breast self examination. Findings also revealed that 71% of the respondents practiced breast self examination as a result of the awareness campaigns. The study recommended that the campaigns should be maintained so as to achieve a holistic result. It was also recommended that women should engage in constant breast self examination, so as not to be taken unaware by a cancerous lump