Case examples illustrating the practical applicability of the nomenclature
| Case | Description | Nomenclature | Level of agreement* |
|---|---|---|---|
| 1 | 60-year-old female participates in a biennial FIT screening programme. The first FIT screening episode is negative. The second FIT screening episode is negative. The third FIT screening episode is positive. Subsequent colonoscopy detects a CRC. | FIT screen-detected cancer | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
| 2 | 57-year-old male participates in a biennial FIT screening programme. The first FIT screening episode is negative. One year later, he develops rectal blood loss for which colonoscopy is performed showing a CRC in the rectosigmoid. | FIT interval cancer (within a FIT screening programme) | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
| 3 | 64-year-old male, participates in a biennial FIT screening programme. The first FIT screening episode is positive. Colonoscopy shows no abnormalities. A recommendation is made to participate again in the FIT programme, after 10 years. A colonoscopy performed 4 years later, due to rectal blood loss, reveals a cancer in the rectosigmoid colon. | CS interval cancer (within a FIT screening programme) | 1=87.5%; 2=12.5%; 3=0%; 4=0%; 5=0% |
| 4 | 69-year-old male participates in a primary colonoscopy screening programme. Baseline colonoscopy shows no abnormalities, and repeat screening colonoscopy is recommended after 10 years. However, 6 years later he undergoes colonoscopy due to an iron deficiency anaemia, which reveals a cancer of the caecum. | CS interval cancer (within a CS screening programme) | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
| 5 | 55-year-old male participates in a once in 5-year FS-screening programme. Baseline FS shows no abnormalities. However, a colonoscopy performed 3 years later due to rectal blood loss shows a cancer in the rectosigmoid colon. | FS interval cancer (within a FS screening programme) | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
| 6 | 60-year-old male participates in a biennial FIT screening programme. The first FIT screening episode is positive. Subsequent colonoscopy shows two small adenomas, for which a repeat colonoscopy is recommended after 5 years. However, 3 years later a colonoscopy is performed due to rectal blood loss, which shows a cancer in the rectosigmoid colon. | CS interval cancer (within a FIT screening programme) | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
| 7 | 75-year-old male participates in a primary colonoscopy screening programme. Baseline colonoscopy detects eight adenomas, which are removed, with two of them containing high-grade dysplasia. Surveillance colonoscopy is recommended after 3 years. The patient experiences a coronary event and postpones the examination. Two years later (5 years from the initial colonoscopy), a repeat colonoscopy is performed due to symptoms, which shows a CRC. | This is not an interval CRC, because the detection occurred beyond the recommended interval for repeat testing | 1=87.5%; 2=12.5%; 3=0%; 4=0%; 5=0% |
| 8 | 75-year-old male participates in a primary colonoscopy screening programme. Baseline colonoscopy detects six adenomas, which are removed, with two of them containing high-grade dysplasia; surveillance colonoscopy is recommended after 3 years. Two years later a colonoscopy is performed due to rectal blood loss, which shows a cancer in the rectosigmoid colon. | CS interval cancer (within a CS screening programme) | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
| 9 | 60-year-old female participates in a 5-yearly FS-screening programme. Baseline FS examination shows one small rectal adenoma, which is removed. Subsequent colonoscopy shows no additional neoplasms; surveillance colonoscopy is recommended after 5–10 years. Four years later a colonoscopy is performed for obstructive symptoms, showing a cancer in the rectosigmoid colon. | CS interval cancer (within a FS screening programme) | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
| 10 | 55-year-old male participates in a once in 5-year FS screening programme. FS shows no abnormalities. Three years later a colonoscopy is performed due to iron deficiency anaemia, which shows a cancer in the ascending colon. | FS interval cancer (within a FS screening programme) | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
| 11 | 58-year-old male underwent a screening colonoscopy, recommended by his general practitioner (opportunistic screening), which showed no abnormalities. A repeat colonoscopy is advised after 10 years. Four years later a colonoscopy is performed because of rectal bleeding, showing a cancer in the sigmoid colon. | CS interval cancer (following opportunistic CS screening) | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
| 12 | 55-year-old male underwent a screening colonoscopy (opportunistic screening) showing two tubular adenomas in the sigmoid colon, for which a surveillance colonoscopy is recommended after 5 years. Three years later he is noted to be iron-deficient and colonoscopy demonstrates a cancer in the ascending colon. | CS interval cancer (following opportunistic CS screening) | 1=100%; 2=0%; 3=0%; 4=0%; 5=0% |
*Level of agreement: 1, accept completely; 2, accept with minor reservation; 3, accept with major reservation; 4, reject with reservation; and 5, reject completely.
CRC, colorectal cancer; CS, colonoscopy; FIT, faecal immunochemical test; FS, flexible sigmoidoscopy.