Colonoscopy Cancer screening guidelines and follow up Flashcards
pt after colonoscopy and polypectomy gets a follow up in ?
small rectal hyperplastic polyp
10 years
pt after colonoscopy and polypectomy gets a follow up in ?
1 or 2 small <1 cm tubular adenomas
5 years
pt after colonoscopy and polypectomy gets a follow up in ?
3-10 adenomas
3 years
pt after colonoscopy and polypectomy gets a follow up in ?
any adenoma >1 cm
3 years
pt after colonoscopy and polypectomy gets a follow up in ?
adenoma with high grade dysplasia or villous features
3 years
pt after colonoscopy and polypectomy gets a follow up in ?
more than 10 adenomas
<3 years and consider evaluating for underlying familial syndrome
pt after colonoscopy and polypectomy gets a follow up in ?
large >2 cm sessile polyp removed by piecemeal excision
2-6 months or 2-3 months
pt after colonoscopy and polypectomy gets a follow up in
polyp with adenocarcinoma (must have minimal invasion and >2 mm margin)
follow up in 2-3 months
who gets follow up in 3 years based on these results on colonoscopy?
3-10 adenomas
any adenoma >1 cm
adenoma with high grade dysplasia or villous features
who gets 10 year follow up based on these results on colonoscopy?
small rectal hyperplastic polyp
who gets 5 year follow up based on their colonoscopy?
1 or 2 small <1 cm tubular adenoma
colonic polyps that are neoplastic
serrated
adenomatous (villous greater than tubular)
colonic polyps that are non -neoplastic (no risk for cancer)
hyperplastic, inflammatory, juvenile, submucosal
what are acceptable alternatives for colonoscopy for average risk individuals if performed every 5 years?
flexible sigmoidoscopy, double contrast barium enema, and CT colonography
Not be used for moderate to high risk pts
who are people who are greater risk for colon cancer based on family history?
family history of adenomatous polyps or
colorectal cancer who have 1st degree relative <60 yrs
>2 1st degree relatives at ANY age
What conditions make someone at greater risk for colorectal cancer and therefore need modified regimen of colonoscopy surveillance?
inflammatory bowel disease - ulcerative colitis, Crohn’s dx with colonic involvement
Classical familial adenomatous polyposis
HNPCC Lynch syndrome
Colonoscopy recommendations for family history of adenomatous polyps or colorectal cancer (1st degree relative <60 or >2 1st degree relatives of ANY AGE)
get colonoscopy at age 40 or 10 years before age of diagnosis of affected relative
repeat every 5 years
inflammatory bowel disease (UC and Crohn’s) colonoscopy recommendations and surveillance
8-10 years post diagnosis (12-15 years if dx is only left colon)
repeat every 1-3 years
colonoscopy recommendations for classic familial adenomatous polyposis
start at age 10-12 yrs
repeat colonoscopy annually
Need a EGD with duodenoscopy with standard upper scope and side viewing port - age 25 to 30 or onset of colonic polyps. Repeat every 1-5 years as needed.
to screen for periampullary and duodenal adenomas and adenocarcinoma
FAP - small 100’s polyps - start screening when small.
HNPCC lynch syndrome colonoscopy surveillance
start at age 20-25 yrs
repeat every colonoscopy 1-2 years.
After 40 yrs need a yearly EGD.
also need an EGD to screen for upper GI cancers
if pt had poor quality bowel preparation for one small adenoma the next step is to
repeat colonoscopy within a year.
can miss a small but significant lesion. Aiming to see >5mm polyps and can miss those lesions even if there were no large masses or lesions.
CT colonography is done on what time interval?
who is it meant for?
every 5 years and can be done for someone with average risk for colon cancer.
Not recommended for surveillance in pts who have history of polyps as it’s less sensitive than a colonoscopy for detecting small polyps.
Annual fecal immunochemical testing can be considered
for colorectal cancer screening in average risk pts when colon imaging or endoscopy is not possible.
Has no role for surveillance post polypectomy.
screening colon cancer guidelines for acromegaly
acromegaly pts are at greater risk for colon cancer
screen with colonoscopy at time of diagnosis and every 3-4 yrs after age of 50 yrs
what is hyperplastic polyposis syndrome?
rare syndrome associated with increased risk for colorectal cancer
Need to have 1 or more of the criteria:
5 or more proximal (to sigmoid colon) hyperplastic polyps (at least 2 of which are >1 cm)
OR
any number of proximal hyperplastic polyps and family history of 1st degree relative with HPS
OR
> 30 hyperplastic polyps throughout the colon
average risk pt colonoscopy screening test is:
colonoscopy at age 50.
acceptable alternatives are:
- CT colonoscopy every 5 years
- flexible sigmoidoscopy every 5-10 years.
- FIT-DNA testing every 3 years
Lynch syndrome should be suspected
- three family members affected by a Lynch syndrome cancer
- at least two successive generations, one is affected member is 1st degree and two other are affected family members
- one had a cancer diagnosed <50 yrs
3-2-1-1-0
Lynch is associated with this genetic defect:
microsatellite instability testing or immunohistochemistry with mismatch repair
Lynch screening schedule for colonoscopy?
start at age 20-25 yrs
repeat colonoscopy every 1-2 years
also need an EGD to screen for upper GI cancers
increased risk for small intestinal cancer.
-Three family members are affected with a Lynch syndrome–associated cancer
At least two successive generations are affected
-One affected family member is a first-degree relative of the other two affected family members
-One of the cancers was diagnosed before age 50 years
-Familial adenomatous polyposis has been excluded
-Tumors have been verified histologically
Amsterdam II criteria to screen for Lynch syndrome screening
women with lynch syndrome are greater risk for
endometrial cancer
see gastric cancer, small intestinal cancer, urothelial, ovarian and pancreaticobiliary cancers.
lynch syndrome women need to have screening for this cancer regardless if symptoms
endometrial cancer
Treatment of FAP is
prophylactic colectomy
when to end colonoscopy screenings?
75 years or when the pt’s estimated life expectancy is <10 years
