COLORECTAL CANCER
	TESTING MATRIX
				Medicare
		Test Type	Target/Objective	Reimbursed	Detection Capabilities
		Fecal Occult	Detects presence of	Annual	25 - 30% effective in detecting
		Blood Test	blood in stool sample.	All patients	early colorectal cancer.
		Mutational DNA	Detects longer Human	TBD	75% effective in detecting
	Screening	Assay	DNA strands associated with		early colorectal cancer.
		PreGen Plus	abnormality.  Uses stool samples.
		Sigmoidoscopy	Direct visualization of	Every 4 years	Highly accurate for exams in lower
			lower half of bowel.	Moderate Risk	portion of colon, but misses
				Patients	upper colon.
Pre-
Surgery
		Colonoscopy with	Direct visualization of entire	Every 2 years	Highly accurate for examining
		tissue pathology	bowel system. Polyps sent	High Risk Patients	entire colon; offers capacity
			to pathology.		to remove polyps and growths.
	Diagnosis
		Histochemical	Polyps are dissected, stained	When Ordered	Can detect 1 cancer cell in 200
		Pathology	and examined under microscopes		normal cells under a microscope.
			for presence of cancer cells.
	Staging	Histochemical	Surgically removed lymph nodes
	for	Pathology for	from colon are examined under	When Ordered	Can detect 1 cancer cell in 200
	Treatment	Lymph Nodes	microscopes for presence of		normal cells under a microscope.
			cancer cells.  Presence indicates
			matastasis (spread) of the cancer.
Post
Surgery
		CEA	Peripheral blood is assayed		Specificity low, multiple tests
	Monitoring	(carcinoembryonic	to look for cancer return.	When Ordered	required over time.  High
		antigen)	Years 1 and 2 - 4 times/year;		false positive and false
			Years 3 and 4 - 2 times/year;		negative rates.
			Year 5 - once.
		GC-C Lymph Node	Lymph nodes tested for GC-C	TBD - currently	Can detect 1 cancer cell
New	Staging	test RNA (from DNA)	presence using RT-PCR	direct patient	per 10,000,000 normal cells
TDT		detection	indicating metastatic cells.	expense	with 100% specificity.
Tests
Post
Surgery		GC-C peripheral	Peripheral blood tested for GC-C	TBD - currently	Can detect 1 cancer cell
	Monitoring	blood test RNA	presence using RT-PCR	direct patient	per 10,000,000 normal cells
		(from DNA) detection	indicating metastatic cells.	expense	with 100% specificity.