1. SPECC – Significant Polyp and Early Colorectal Cancer
Sarah Crane
Pelican Cancer Foundation
On behalf of the SPECC Team

2. Pelican Cancer Foundation
Bill Heald and Basingstoke
1993
Funding from donations, industry,
fees and charitable grants
Conferences and workshops
Research

3. What is SPECC?
“SPECC is a national development programme, focussed on the treatment of significant polyps and small (T1) tumours”
Multidisciplinary – surgeons, gastroenterologists, radiologists, pathologists, nurse specialists
6 free places for every MDT

4. Steering group Brendan Moran - Lead Brian Saunders Rob Glynn-Jones
Phil Quirke
Gina Brown
Chris Cunningham
John Stebbing
Wendy Atkin
Matt Rutter
Rupert Pullan
Bob Steele
Graham Williams
Sunil Dolwani
Michael Machesney
Gerald Langman
Neil Borley
Nicky Richards
Sarah Crane

6. SPECC workshops SPECC workshops London Cancer Yorkshire & Humberside
Started November 2015
SPECC workshops
London Cancer
Yorkshire & Humberside
London Alliance
West Midland
East Midland
Wessex
Greater Manchester
South East Coast
Wales
Northern England
East of England
Cheshire & Mersey
South West Coast
Eire
Ulster
Scotland

7. So far….. 6 SPECC workshops completed
424 clinicians attended from 73 trusts
Feedback on changes to clinical practice:
Take more time at endoscopy
Develop patient information
Offer alternatives e.g. brachytherapy

8. Aims Definition – are you confident what it is?
Recognition – who and when
Documentation – who needs what
Treatment - alternatives
Strategic planning – locally, regionally, nationally

9. Guidelines

10. This is what a SPECC looks like

11. Introduction Incidence of colorectal polyps increasing
Wider public awareness
Bowel Cancer Screening Programme
Basil Morson
Morson B. The Polyp-cancer sequence in the Large Bowel. Proceedings of the Royal Society of Medicine. 1974;67:451-7

12. Risk of LN involvement 2% 8% 23%
Kikuchi classification – sm1 is fisrt 1/3 of submucosa, sm2 is second 1/3 of submucosa, and sm3 is last 1/3
Risk of LN involvement 2% 8%
23%

13. SPECC not suitable for routine colonoscopic excision
may occur anywhere in the colon or rectum
a large (>20mm) sessile lesion
morphologically aberrant & difficult to access endoscopically
Malignancy spectrum- shades of grey
non-involvement of lymph nodes
not common – up to 5% polyps only 10% malignant. Increasing with BCSP

14. Factors contributing to significance
Size
Morphology
Site
Access
Patient factors – comorbidity

15. Questions to ask yourself:
Have you fully assessed the lesion?
Are there high malignancy risk features?
How should this lesion be managed?
Is MDT discussion required?
How does patient fitness impact on options?
Has the patient been fully consented?
If endoscopic resection –How complex will it be? –En bloc or piecemeal?
When should it be removed?
SPECC not prescriptive about treatment
Meticulous assessment of the lesion
Good decision making

16. Recognition - MRI
Setup and planning are critical to achieve optimal images
Structured reporting to allow best MRI input to decision making

17. CT Colonography well-tolerated test that find early CRC & significant polyps
CTC has been around a long time
Diagnostic performance seems good
95%+ sensitivity for cancer
90% sensitivity for 10mm+ polyps
80% sensitvitiy for 6mm+ polyps
For symptomatic patients, CTC is an excellent alternative to colonoscopy in UK real-world practice
Early cancers and polyps may present a particular challenge
Radiologist QA is developing
With thanks to Andrew Plumb at UCLH

18. Triple assessment Flexible Endoscopy Rigid Endoscopy TRUS
With thanks to Neil Borley

19. Documentation: MRI reporting

20. Documentation What have you recorded?
Picture
Video
Tattoo
Report
Not just a polyp!

21. Treatment: EMR
Hardly features in the workshops or early patient information leaflet
Assumptions
Risk / benefit
Piecemeal
Time / available equipment & expertise
Have a go……!

22. ESD Endoscopic Submucosal Dissection
Drive for single piece resection – especially in uncertain lesions

23. Potential advantages of ESD
En bloc resection
Better interpretation of pathology
Potentially better decision making
BUT
Time & Effort intensive
Training
If more than sm1 – Is local resection alone…?

24. TEMS T1 disease Balancing risk
Potential to extend with adjuvant therapy
Thanks to Chris Cunningham

25. Contact Brachytherapy ‘Papillon’
NICE guidelines
Patient selection
Older patients
Patients with high surgical risk

26. Key messages Think twice and cut once
Maximise local expertise in diagnostic assessment
Developing local service / up skilling
Work with virtual polyp / SPECC MDTs
Regional and supra-regional referral networks
Thanks to James East

27. Next Pelican project is SMART
SPECC
Coming to South West in December 2017
Next Pelican project is SMART
Synchronous Metastases, Advanced and Recurrent colorectal Tumours

28. 4th International Workshop on Complete Response to Neoadjuvant
Therapy for Rectal Cancer
Discussing the challenges in recognition and treatment of a clinical Complete Response to neoadjuvant therapy for rectal cancer.
This meeting will seek consensus on the terminology of a complete response.
With an international faculty from across Europe, the USA and Brazil
22nd March 2016 | Basingstoke, UK
Convenors: Professor Bill Heald & Mr Brendan Moran
To find out more or book a place: |