In the early stages of colorectal cancer there are typically no symptoms. Therefore, the American Cancer Society (ACS) recommends beginning screening average-risk asymptomatic people for colorectal cancer at the age of 50. According to the ACS guidelines, men and women should follow one of the examination schedules below:
·         A fecal occult blood test (FOBT) every year
·         A flexible sigmoidoscopy (FSIG) every five years
·         Annual fecal occult blood test and flexible sigmoidoscopy every five years
·         A double-contrast barium enema every five years
·         A colonoscopy every 10 years
Since these guidelines were last updated by the ACS, studies demonstrating the superiority of colonoscopy over FSIG were published (77, 78). These studies demonstrated that 66% of men with advanced neoplasia and only 35% of women with advanced lesions would have their disease identified by FSIG alone.   Therefore, a screening strategy that includes colonoscopy every 10 years is the most effective way to identify early-stage colorectal cancer (77, 78).
The chart in Table 4 lists the types of diagnostic studies and tests that are performed for detecting colon cancer.
Table 4

Diagnostic Studies- Laboratory Tests
·         Fecal occult blood test (FOBT)
·         Liver Function Tests (LFT)
·        Carcinoembryonic Antigen (CEA)
Diagnostic Studies – Imaging
·         Barium Enema
·         Small Bowel Series
·         Chest X-ray
·         Imaging, Abdomen/pelvis
·         Imaging, Liver/Spleen
·         Imaging, Brain
·         Imaging, Bone
Diagnostic Studies – Tumor Markers
·         CEA
·         Ca19
·         Ca195
Diagnostic Studies – Procedures
·         Flexible sigmoidoscopy
·         Colonoscopy
·         Digital Rectal Exam
·         (DRE)
·         Cystoscopy

After initial testing has been performed, such as the laboratory tests and tumor marker tests, those with abnormal findings, other imaging studies, and/or endoscopies, may be performed.

Comprehensive Cancer Control Plan

The Cherokee Nation Comprehensive Cancer Control (CNCCC) Project assists in the development of networks and collaboration that produce an infrastructure for a comprehensive approach to cancer within the Cherokee Nation. Since 2003, coalition members and partners have come together to discuss the burden of cancer in Cherokee Nation. Coalition members and partners include local, regional, state and national representatives committed to identifying areas of cancer concern, planning interventions, prioritizing greatest areas of identified need, and then implementing identified strategies and/or providing needed resources. This is the second edition of the Cherokee Nation Comprehensive Cancer Control Plan and will serve, like the first, as an information resource for health care professionals and community members, as well as a tool for the Cherokee Nation Comprehensive Cancer Control Coalition and its respective entities. The coalition is committed to the process of enhancing infrastructure for comprehensive cancer control in the Cherokee Nation with the ultimate goal of reducing morbidity and mortality among the Cherokee community.